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      Community pharmacists’ knowledge, perceptions, and practices about topical corticosteroid counseling: A real-world cross-sectional survey and focus group discussions in Korea

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          Abstract

          Topical corticosteroids (TCs) are widely used to treat dermatological conditions such as eczema and psoriasis. It can be a safe and effective treatment when used appropriately. However, misguided information and corticosteroid phobia appear to contribute to inadequate adherence to therapy, leading to unsatisfactory treatment outcomes. Therefore, community pharmacists (CPs) are in a prime position to inform patients about the appropriate use of medicine. The aim of this study was to examine how the knowledge and perceptions of CPs, as well as other factors, associate CPs’ patient counseling practice around the use of TCs. A structured, validated questionnaire was distributed to CPs in the Republic of Korea, and additional focus group discussions were implemented to obtain a deeper understanding of the survey findings. We analyzed the survey results by applying a modified knowledge-perception-practice model. In addition, we used path analysis to validate the model and assessed how knowledge level and perceptions of barriers affect CPs’ counseling behavior. We ran a multiple regression to identify factors that associate CPs’ practice levels. A total of 1018 surveys were analyzed. In general, respondents had sufficient knowledge to provide appropriate patient counseling on TC use. An increase in knowledge level positively associated the quality of practice, and more knowledge increased the perception of barriers that negatively associated patient counseling. Location in rural areas and pharmacists’ perception of counseling barriers negatively associated the quality of practice. A higher level of knowledge, training in ADEs, higher proportion of OTC TC sales, and increased time for counseling positively associated the quality of practice. Therefore, minimizing barriers such as negative perceptions is very important in facilitating CPs’ counseling practice around TC use.

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          Most cited references31

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          Adverse effects of topical glucocorticosteroids.

          Topical corticosteroids were introduced into medicine about 50 years ago. They represent a significant milestone in dermatologic therapy. Despite encouragement to report observed adverse drug reactions, the clinical practice of reporting is poor and incomplete. Likewise, adverse effects and safety of topical corticosteroids are neglected in the medical literature. The authors provide an updated review of their adverse-effect profile. Children are more prone to the development of systemic reactions to topically applied medication because of their higher ratio of total body surface area to body weight. Cutaneous adverse effects occur regularly with prolonged treatment and are dependent on the chemical nature of the drug, the vehicle, and the location of its application. The most frequent adverse effects include atrophy, striae, rosacea, perioral dermatitis, acne, and purpura. Those that occur with lower frequency include hypertrichosis, pigmentation alterations, delayed wound healing, and exacerbation of skin infections. Of particular interest is the rate of contact sensitization against corticosteroids, which is considerably higher than generally believed. Systemic reactions such as hyperglycemia, glaucoma, and adrenal insufficiency have also been reported to follow topical application. The authors provide an updated review of local and systemic adverse effects upon administration of topical corticosteroids, including the latest FDA report on the safety of such steroids in children. At the completion of this learning activity, participants should be familiar with topical corticosteroids and their proper use.
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            Topical corticosteroid phobia in atopic dermatitis: a study of its nature, origins and frequency.

            Topical corticosteroids remain the mainstay of atopic dermatitis therapy. Many atopic dermatitis therapeutic failures appear to be attributable to poor adherence to treatment due to topical corticosteroid phobia.
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              Choosing topical corticosteroids.

              Topical corticosteroids are one of the oldest and most useful treatments for dermatologic conditions. There are many topical steroids available, and they differ in potency and formulation. Successful treatment depends on an accurate diagnosis and consideration of the steroid's delivery vehicle, potency, frequency of application, duration of treatment, and side effects. Although use of topical steroids is common, evidence of effectiveness exists only for select conditions, such as psoriasis, vitiligo, eczema, atopic dermatitis, phimosis, acute radiation dermatitis, and lichen sclerosus. Evidence is limited for use in melasma, chronic idiopathic urticaria, and alopecia areata.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draft
                Role: Data curationRole: Formal analysisRole: SoftwareRole: VisualizationRole: Writing – original draft
                Role: Data curationRole: Formal analysisRole: Writing – original draft
                Role: Data curationRole: Formal analysisRole: InvestigationRole: Methodology
                Role: ConceptualizationRole: Data curationRole: Supervision
                Role: ConceptualizationRole: Data curationRole: Supervision
                Role: ConceptualizationRole: Data curationRole: Supervision
                Role: ConceptualizationRole: Data curationRole: Supervision
                Role: ConceptualizationRole: Funding acquisitionRole: Project administrationRole: Supervision
                Role: ConceptualizationRole: Data curationRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                29 July 2020
                2020
                : 15
                : 7
                : e0236797
                Affiliations
                [1 ] Department of Pharmacy and Biomedical Research Institute Clinical Trials Center, Seoul National University Hospital, Seoul, South Korea
                [2 ] College of Pharmacy, Korea University, Sejong, South Korea
                [3 ] College of Pharmacy and Research Institute of Pharmaceutical Sciences, Korea University, Sejong, South Korea
                [4 ] Clinical Development Team, Wellmarker Bio Co, Seoul, South Korea
                [5 ] College of Pharmacy, Chung-Ang University, Seoul, South Korea
                [6 ] Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Seoul, South Korea
                [7 ] Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
                [8 ] College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea
                [9 ] Department of Internal Medicine, Korea University Guro Hospital, Korea University, Seoul, South Korea
                University of South Carolina College of Pharmacy, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist. The author Nam Gyu Kim's current affiliation is Wellmarker Bio Co, but they were not affiliated with that company during their involvement in this study, and Wellmarker Bio Co had no part in the research presented here. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                http://orcid.org/0000-0002-8066-8267
                http://orcid.org/0000-0002-6705-2193
                http://orcid.org/0000-0001-9053-6930
                http://orcid.org/0000-0002-0194-9854
                http://orcid.org/0000-0002-7831-7740
                Article
                PONE-D-19-34348
                10.1371/journal.pone.0236797
                7390350
                32726366
                05c1eb8d-4680-4bcf-ab1d-62349e947fd7
                © 2020 Kang et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 12 December 2019
                : 14 July 2020
                Page count
                Figures: 3, Tables: 6, Pages: 15
                Funding
                Funded by: Ministry of Food and Drug Safety
                Award ID: 14172MFDS159
                Award Recipient :
                Funded by: National Research Foundation (NRF), Ministry of Education
                Award ID: 2019R1A6A1A03031807
                This research was supported by a grant (14172MFDS159) from Ministry of Food and Drug Safety and Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2019R1A6A1A03031807). The funders (including MFDS and Ministry of Education) provided support in the expenses related to research progress, but the funding organizations did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of our authors are articulated in the ‘author contributions’ section. The author Nam Gyu Kim's current affiliation is Wellmarker Bio Co, but they were not affiliated with that company during their involvement in this study, and Wellmarker Bio Co had no part in the research presented here
                Categories
                Research Article
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Pharmacists
                Medicine and Health Sciences
                Pharmaceutics
                Drug Therapy
                Steroid Therapy
                Corticosteroid Therapy
                Medicine and Health Sciences
                Health Care
                Patients
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Physicians
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Physicians
                Research and Analysis Methods
                Research Design
                Survey Research
                Surveys
                Medicine and Health Sciences
                Pharmaceutics
                Drug Therapy
                Medicine and Health Sciences
                Pharmacology
                Drug Research and Development
                Drug Discovery
                Research and Analysis Methods
                Research Design
                Survey Research
                Questionnaires
                Custom metadata
                Most of all relevant data except the focus group interview are within the manuscript and its Supporting Information files. However, raw dataset of focus group discussion cannot be shard publicly because of not permitting for access to conficential data by submitted documentation to IRB(1511/001-012). SNU Research Ethics Team ( http://snuethics.snu.ac.kr) imposed the restrictions our qualitative data and they can decide the data availability for request that meet the criteria for access to confidential data (contact via 82-2-880-5153).

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