The Open Dermatology Journal




ISSN: 1874-3722 ― Volume 13, 2019
RESEARCH ARTICLE

Family Medicine Trainees’ Knowledge about Topical Corticosteroids in Jeddah, Saudi Arabia



Amal A Kokandi*
Department of Dermatology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

Abstract

Background:

Topical corticosteroids (TCS) are used to treat a variety of dermatological conditions. The fear of side effects sometimes affects the adherence to treatment. The aim of this study was to assess the knowledge and the attitude of family medicine residents under training for the use of TCS.

Methods:

Family medicine trainees attending an educational session were surveyed via live electronic questionnaires.

Results:

A total of 89 (out of 100 who attended the event) people responded to the questionnaire. Undergraduate teaching was the main source of information about TCS. Most of the respondents advised the use of TCS sparingly or using finger-tip unit amount. More than half of them thought TCS can be absorbed and it should not be used to some body areas such as eyelids. Majority of the respondents did not think that TCS use can lead to infections, weight gain or obesity, damage the skin if used for a few weeks, negatively affect health or lead to asthma. More than 40% thought that it is better to stop TCS treatment as soon as possible in atopic dermatitis patients.

Conclusion:

Family medicine trainees have some fears and misconceptions regarding TCS use. There is a need to increase the knowledge about TCS in undergraduate and postgraduate teaching.

Keywords: Topical corticosteroids, Family medicine trainees, Knowledge, Infections, Dermtologists, Dermatological conditions.


Article Information


Identifiers and Pagination:

Year: 2019
Volume: 13
First Page: 13
Last Page: 18
Publisher Id: TODJ-13-13
DOI: 10.2174/1874372201913010013

Article History:

Received Date: 13/03/2019
Revision Received Date: 07/04/2019
Acceptance Date: 12/04/2019
Electronic publication date: 30/04/2019
Collection year: 2019

Article Metrics:

CrossRef Citations:
0

Total Statistics:

Full-Text HTML Views: 470
Abstract HTML Views: 476
PDF Downloads: 192
ePub Downloads: 165
Total Views/Downloads: 1303

Unique Statistics:

Full-Text HTML Views: 251
Abstract HTML Views: 342
PDF Downloads: 121
ePub Downloads: 101
Total Views/Downloads: 815
Geographical View

© 2019 Amal A Kokandi.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Department of Dermatology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia;
Tel: +966126401000; Fax: 0096626400592;
E-mails: akokandi@kau.edu.sa and kokandiaa@hotmail.com





1. INTRODUCTION

Topical corticosteroids (TCS) are used to treat different dermatological conditions. They are the mainstay treatment options in some conditions such as atopic dermatitis. The side effects of TCS are mainly topical [1Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol 2006; 54(1): 1-15.[http://dx.doi.org/10.1016/j.jaad.2005.01.010] [PMID: 16384751] ] and they are rare if used properly. The fear of the side effects of TCS can lead to inadequate treatment of skin diseases such as atopic dermatitis [2Charman CR, Morris AD, Williams HC. Topical corticosteroid phobia in patients with atopic eczema. Br J Dermatol 2000; 142(5): 931-6.[http://dx.doi.org/10.1046/j.1365-2133.2000.03473.x] [PMID: 10809 850] , 3Li Y, Han T, Li W, Li Y, Guo X, Zheng L. Awareness of and phobias about topical corticosteroids in parents of infants with eczema in Hangzhou, China. Pediatr Dermatol 2018; 35(4): 463-7.[http://dx.doi.org/10.1111/pde.13527] [PMID: 29786146] ]. TCS are prescribed by dermatologists and other specialties. General physicians and family medicine practitioners are among them. The attitude and knowledge of the physician prescribing these will affect the way the patients use TCS. A recent study from Riyadh showed that the knowledge about TCS is inadequate among practicing primary care physicians [4Alsukait SF, Alshamlan NM, Alhalees ZZ, Alsuwaidan SN, Alajlan AM. Topical corticosteroids knowledge, attitudes, and practices of primary care physicians. Saudi Med J 2017; 38(6): 662-5.[http://dx.doi.org/10.15537/smj.2017.6.17586] [PMID: 28578448] ]. Australian general practitioners’ advice given to parents about TCS, has been shown to possibly carry unintentional risk messages contributing to non-adherence to treatment of paediatric atopic dermatitis [5Smith SD, Harris V, Lee A, Blaszczynski A, Fischer G. General practitioners knowledge about use of topical corticosteroids in paediatric atopic dermatitis in Australia. Aust Fam Physician 2017; 46(5): 335-40.[PMID: 28472581] ]. TCS phobia is the main cause of non-adherence to treatment [6Li AW, Yin ES, Antaya RJ. Topical corticosteroid phobia in atopic dermatitis: A systematic review. JAMA Dermatol 2017; 153(10): 1036-42.[http://dx.doi.org/10.1001/jamadermatol.2017.2437] [PMID: 28724 128] ] and treatment failure in atopic dermatitis patients and carers of patients. TCS phobia has been shown to improve with patients’ education [7Gonzales F, Ramdane N, Delebarre-Sauvage C, Modiano P, Duhamel A, Lasek A. Monitoring of topical corticosteroid phobia in a population of parents with children with atopic dermatitis using the TOPICOP® scale: Prevalence, risk factors and the impact of therapeutic patient education. J Eur Acad Dermatol Venereol 2017; 31(3): e172-4.[http://dx.doi.org/10.1111/jdv.13961] [PMID: 27608366] ]. Physicians (non-dermatologists) have concerns about using TCS more than dermatologists [8Mueller SM, Tomaschett D, Vogt DR, Itin P, Cozzio A, Surber C. Topical corticosteroid concerns from the clinicians’ perspective. J Dermatolog Treat 2017; 28(5): 464-8.[http://dx.doi.org/10.1080/09546634.2016.1255307] [PMID: 27807 999] ]. Additionally, pharmacists (from France and Australia) have low levels of confidence regarding the use of TCS [9Raffin D, Giraudeau B, Samimi M, Machet L, Pourrat X, Maruani A. Corticosteroid phobia among pharmacists regarding atopic dermatitis in children: A national french survey. Acta Derm Venereol 2016; 96(2): 177-80.[http://dx.doi.org/10.2340/00015555-2157] [PMID: 26039683] , 10Smith SD, Lee A, Blaszczynski A, Fischer G. Pharmacists’ knowledge about use of topical corticosteroids in atopic dermatitis: Pre and post continuing professional development education. Australas J Dermatol 2016; 57(3): 199-204.[http://dx.doi.org/10.1111/ajd.12339] [PMID: 25846602] ]. It is important for general physicians to have detailed knowledge about TCS in order to be able to give good advice to patients.

The aim of this study was to assess the knowledge and the attitude of family medicine residents under training toward TCS. In addition, TCS phobia was assessed as well.

2. MATERIALS AND METHODS

2.1. Setting and Participants

Participants were family medicine residents attending an educational event about common skin problems in a primary health care practice. The levels of residents were: the first and second years (R1 and R2) in their training program comprising 4 levels. Some of them had some experience before joining the program and some of them recently graduated from medical schools. This is a regular educational activity and it includes different specialties in each session. They were invited to answer an anonymous questionnaire about topical corticosteroids using an online program (mentimeter). They were only asked to log in to the site with a special code number.

Table 1
Knowledge questions responses by family medicine trainees about TCS.


As the participation was voluntary and no personal data was collected, consent was not taken . The study protocol was approved by the Unit of Biomedical Ethics Research Committee at King Abdulaziz University Hospital (Reference number 875-18).

2.2. Questionnaire

The first part of the questions included some respondents’ characteristics: gender and the residency level of respondents (R1, R2 and others).

The second part included questions about knowledge of TCS and the sources of information about topical corticosteroids;

  • If TCS come in different formulations, how to advise patients when prescribing TCS?
  • Most common side effects of TCS.

The last part included questions modified from the topical corticosteroid phobia in atopic dermatitis (TOPICOP) questionnaire [11Moret L, Anthoine E, Aubert-Wastiaux H, et al. TOPICOP©: A new scale evaluating topical corticosteroid phobia among atopic dermatitis outpatients and their parents. PLoS One 2013; 8(10)e76493[http://dx.doi.org/10.1371/journal.pone.0076493] [PMID: 24146878] , 12Stalder J-F, Aubert H, Anthoine E, et al. Topical corticosteroid phobia in atopic dermatitis: International feasibility study of the TOPICOP score. Allergy 2017; 72(11): 1713-9.[http://dx.doi.org/10.1111/all.13189] [PMID: 28439896] ]: there were 9 questions in the format of a sentence followed by options of “Yes”, “To some extent”, “No”, and “Not sure”. These were:

  • A significant amount of TCS are absorbed into the bloodstream
  • Use of topical corticosteroids in eczema can lead to infections
  • Topical corticosteroids can lead to weight gain or obesity
  • Use of topical corticosteroids for a few weeks usually damage the skin
  • Topical corticosteroids will affect the future health negatively
  • Topical corticosteroids can lead to asthma
  • Topical corticosteroids cannot be used on certain skin areas such as eyelids
  • It is better to wait as long as you can before treating atopic dermatitis patients with topical corticosteroids
  • It is better to stop topical corticosteroids treatment as soon as you can in atopic dermatitis patients.

2.3. Statistical Analysis

Descriptive statistics were used to represent responses to questions. The analysis was conducted using SPSS 16.0 (SPSS, IBM, Armonk, NY).

3. RESULTS

3.1. Respondent Characteristics:

A total of 100 physicians attended the event. Of these, 89 answered at least one question (89% response rate). They were 49 females, 32 males and 8 missing responses. There were 46 at R1 level, 32 at R2 level, 4 others at a different level and 7 missing responses.

3.2. Topical Corticosteroid Knowledge

Responses of family medicine trainees to questions about TCS are shown in Table 1. Nearly half of the respondents had information about TCS from undergraduate level teaching (47.19%). Other sources included web-based educational activities, postgraduate educational activities, reference books, general practice books and others. Only one responder’s source of information was dermatology journals and pharmaceutical companies.

The majority of the respondents knew that TCS come in different formulations (85.39%). Two responders were of the opposite view while 3 were not sure about it.

Regarding how patients were advised when TCS were prescribed, more than 40% gave the advice based on fingertip unit. About 30% advised to use TCS sparingly or in the smallest amount possible. Fourteen respondents (15.73%) were not sure or did not think about it and only 2 responders advised using TCS generously.

Less than half of the respondents (44.94%) believed that thinning of the skin (atrophy) is the most common side effect of TCS. Hypopigmentation and hyperpigmentation were the second most common side effects reported (24.72%). Thirteen respondents (14.61%) believed that TCS do have any side effect if used appropriately. Only one believed that growth retardation is the most common side effect of TCS and 2 reported stinging/itching while some were not sure (5.62%).

3.3. Topical Corticosteroid Phobia

Responses of family medicine trainees to the questions of TCS phobia are shown in Table 2. More than half of the respondents believed that a significant amount of TCS can be absorbed or it can be absorbed to some extent (16.85% and 49.44% respectively). An equal number of respondents did not think that a significant amount of TCS can be absorbed or were not sure (12.36% each). Less than half of the respondents believed that the use of TCS in eczema will not lead to infections (43.82%). On the other hand, around a quarter of the respondents (24.72%) thought that TCS can lead to infections and a similar percentage (23.6%) of the respondents were not sure. More than half of the respondents did not believe that TCS can lead to weight gain or obesity (76.4%), or using TCS for a few weeks can damage the skin (56.18%). Additionally, a similar percentage of the respondents neither thought that TCS will affect future health negatively (74.16%), nor these can lead to asthma (91.01%).

Table 2
Family medicine trainees TCS phobia questions responses.


More than half of the surveyed (68.54%) people believed that TCS cannot be used on certain skin areas such as eyelids. The rest thought “to some extent” (2.25%) or “cannot” (8.99%) or were “not sure” (14.61%).

On questioning if it is better to wait as long as possible before treating atopic dermatitis patients with TCS, majority (77.53%) answered no. On questioning if it is better to stop TCS treatment as soon as possible in atopic dermatitis patients, less than half of the respondents answered yes (41.57%), 12.4% “to some extent”, 20.22% “no” and 19.1% were “not sure”.

The missing data were partly due to the interruption of internet connection and partly due to unwillingness of the respondents to answer.

4. DISCUSSION

Topical corticosteroids (TCS) are an important modality of treatment in different skin problems. Their proper use is essential to avoid the suboptimal therapeutic effect. Although there are side effects known to the use of TCS, they are mostly topical side effects and usually will not appear unless their prolonged use or high potency in a vulnerable area is exposed. The fear of the use of TCS by patients is described and has been studied in different areas of the world. In this study, the knowledge and the attitude of family medicine residents under training toward TCS through an electronic survey were assessed during an educational activity. The responders were in their first phase of the training program (first and second year of training).

The main source of information about TCS was the undergraduate teaching (47.19%). Owing to the minimal teaching of dermatology, teaching in the undergraduate levels, this is reflected usually on the level of knowledge about topics related to diagnosis and treatments of skin diseases. This is an international problem which led to proposals for improving this lack by searching undergraduate societies and performing other activities [13Fulchand S, Kilgour JM. Founding an undergraduate society: A student-led initiative to improve dermatology education. Br J Dermatol 2016; 174(6): 1415-6.[http://dx.doi.org/10.1111/bjd.14473] [PMID: 26873769] ].

Most of the respondents knew that there are different formulations of TCS as part of clinical experience which is the true answer to this question. Few respondents did not know or were not sure about this information. More than 40% advised using TCS based on finger-tip unit, followed by using them sparingly or in the smallest amount possible. Only 2 responders advised the generous use of TCS. This reflect the cautious approach by family medicine trainees, similar to what is followed by Australian general practitioners and pharmacists [5Smith SD, Harris V, Lee A, Blaszczynski A, Fischer G. General practitioners knowledge about use of topical corticosteroids in paediatric atopic dermatitis in Australia. Aust Fam Physician 2017; 46(5): 335-40.[PMID: 28472581] , 10Smith SD, Lee A, Blaszczynski A, Fischer G. Pharmacists’ knowledge about use of topical corticosteroids in atopic dermatitis: Pre and post continuing professional development education. Australas J Dermatol 2016; 57(3): 199-204.[http://dx.doi.org/10.1111/ajd.12339] [PMID: 25846602] ]. On the other hand, Australian dermatologists agreed that the label “use sparingly” should be removed from pharmacists’ labels on TCS prescriptions [14Smith SD, Lee A, Blaszczynski A, Fischer G. Attitudes of Australian dermatologists to the use and safety of topical corticosteroids in paediatric atopic dermatitis. Australas J Dermatol 2016; 57(4): 278-83.[http://dx.doi.org/10.1111/ajd.12402] [PMID: 26391107] ]. “The more appropriate advice on product labelling would be ‘apply enough to cover the affected areas’” as suggested by the dermatology working group guidelines [15Bewley A. Expert consensus: Time for a change in the way we advise our patients to use topical corticosteroids. Br J Dermatol 2008; 158(5): 917-20.[http://dx.doi.org/10.1111/j.1365-2133.2008.08479.x] [PMID: 18294 314] ]. This question reflects physician cautiousness or phobia regarding the amount of TCS to be used.

For the question of the most common side effects of TCS, the answer “none if used appropriately” would be the best response. More than 40% thought that thinning of the skin (atrophy) is the most common side effect of TCS, followed by pigmentation problems and only 14.6% thought that TCS will not cause side effects if used appropriately. Skin atrophy was thought to be the commonest side effect by one-third of general practitioners [5Smith SD, Harris V, Lee A, Blaszczynski A, Fischer G. General practitioners knowledge about use of topical corticosteroids in paediatric atopic dermatitis in Australia. Aust Fam Physician 2017; 46(5): 335-40.[PMID: 28472581] ] and nearly half of the pharmacists as well [10Smith SD, Lee A, Blaszczynski A, Fischer G. Pharmacists’ knowledge about use of topical corticosteroids in atopic dermatitis: Pre and post continuing professional development education. Australas J Dermatol 2016; 57(3): 199-204.[http://dx.doi.org/10.1111/ajd.12339] [PMID: 25846602] ] in Australia. In another study, among UK pharmacists, less than half of the respondents correctly answered as “no” to the question of side effects, such as skin thinning, that are common even when topical corticosteroids are used appropriately [16Lau WM, Donyai P. Knowledge, attitude and advice-giving behaviour of community pharmacists regarding topical corticosteroids. Pharmacy (Basel) 2017; 5(3): 41.[PMID: 28970453] ]. This is in contrast to the perspective of dermatologists in Australia who agreed that TCS do not cause skin atrophy when appropriately used [14Smith SD, Lee A, Blaszczynski A, Fischer G. Attitudes of Australian dermatologists to the use and safety of topical corticosteroids in paediatric atopic dermatitis. Australas J Dermatol 2016; 57(4): 278-83.[http://dx.doi.org/10.1111/ajd.12402] [PMID: 26391107] ]. Our family medicine trainees have some misconceptions towards TCS. This might affect their advice to patients in need for TCS leading to patients concerns or phobia. Topical corticosteroids are sometimes misused to treat hyperpigmentation by nonmedicals. Additionally, pigmentation problems as hyper- and hypopigmentation were reported to be the side effects of TCS when used inappropriately [17Dey VK. Misuse of topical corticosteroids: A clinical study of adverse effects. Indian Dermatol Online J 2014; 5(4): 436-40.[http://dx.doi.org/10.4103/2229-5178.142486] [PMID: 25396124] , 18Sendrasoa FA, Ranaivo IM, Andrianarison M, et al. Misuse of topical corticosteroids for cosmetic purpose in Antananarivo, Madagascar. BioMed Res Int 2017; 20179637083[http://dx.doi.org/10.1155/2017/9637083] [PMID: 28904977] ]. This problem is seen sometimes in our society, although not reported, it might be the cause of being thought as one of the common side effects of TCS.

For the questions related to TCS phobia, “no” would be the most appropriate answer. The majority of the responders did not think that TCS use can lead to infections, weight gain or obesity, damage the skin if used for a few weeks, negatively affect health or lead to asthma. These facts are recognized by the trainees.

On the other hand, more than half of the respondents thought that TCS can be completely absorbed or absorbed to some extent and a large proportion of respondents thought that TCS cannot be used on certain skin areas such as eyelids. These reflect concerns and phobia towards TCS. Additionally, more than two-thirds of the responders responded as no when asked if it is better to wait as long as you can before treating atopic dermatitis patients with TCS. More than 40% thought that it is better to stop TCS treatment as soon as possible in atopic dermatitis patients and only 20 percent thought that this is not necessary. This reflects a very cautious approach towards TCS in treating atopic dermatitis patients by our trainees. In a Korean survey, one third of the respondents had TCS phobia [19Song SY, Jung S-Y, Kim E. Steroid phobia among general users of topical steroids: A cross-sectional nationwide survey. J Dermatolog Treat 2018; 1-6.[http://dx.doi.org/10.1080/09546634.2018.1508817] [PMID: 30081 700] ]. Consistently delivering messages about TCS risks from pharmacists and general practitioners to patients/parents might lead to treatment non-adherence [20Farrugia LL, Lee A, Fischer G, Blaszczynski A, Carter SR, Smith SD. Evaluation of the influence of pharmacists and GPs on patient perceptions of long-term topical corticosteroid use. J Dermatolog Treat 2017; 28(2): 112-8.[http://dx.doi.org/10.1080/09546634.2016.1213353] [PMID: 27424 888] ].

CONCLUSION

In conclusion, family medicine trainees have some fears and misconceptions regarding TCS use. There is a need to increase the knowledge about TCS in the undergraduate teaching. Additionally, postgraduate educational activities aimed at family medicine and general practitioners to dermatology topics including topical corticosteroids are needed.

LIST OF ABBREVIATIONS

TCS Topical corticosteroids
TOPICOP Topical Corticosteroid Phobia

ETHICS APPROVAL AND CONSENT TO PARTIIPATE

The study protocol was approved by the Unit of Biomedical Ethics Research Committee at King Abdulaziz University Hospital (Reference number 875-18).

HUMAN AND ANIMAL RIGHTS

No animals/humans were used for studies that are the basis of this research.

CONSENT FOR PUBLICATION

As the participation was voluntary and no personal data was collected, consent was not taken.

FUNDING

None.

CONFLICT OF INTEREST

The author declares no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

The author would like to acknowledge Dr. Abeer Alahmadi (Consultant Family physician and women’s health specialist, Deputy of the Joint Program of Family Medicine-Jeddah, Lecturer and trainer at the Joint Program of Family Medicine) for her technical and administrative support.

REFERENCES

[1] Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol 2006; 54(1): 1-15.[http://dx.doi.org/10.1016/j.jaad.2005.01.010] [PMID: 16384751]
[2] Charman CR, Morris AD, Williams HC. Topical corticosteroid phobia in patients with atopic eczema. Br J Dermatol 2000; 142(5): 931-6.[http://dx.doi.org/10.1046/j.1365-2133.2000.03473.x] [PMID: 10809 850]
[3] Li Y, Han T, Li W, Li Y, Guo X, Zheng L. Awareness of and phobias about topical corticosteroids in parents of infants with eczema in Hangzhou, China. Pediatr Dermatol 2018; 35(4): 463-7.[http://dx.doi.org/10.1111/pde.13527] [PMID: 29786146]
[4] Alsukait SF, Alshamlan NM, Alhalees ZZ, Alsuwaidan SN, Alajlan AM. Topical corticosteroids knowledge, attitudes, and practices of primary care physicians. Saudi Med J 2017; 38(6): 662-5.[http://dx.doi.org/10.15537/smj.2017.6.17586] [PMID: 28578448]
[5] Smith SD, Harris V, Lee A, Blaszczynski A, Fischer G. General practitioners knowledge about use of topical corticosteroids in paediatric atopic dermatitis in Australia. Aust Fam Physician 2017; 46(5): 335-40.[PMID: 28472581]
[6] Li AW, Yin ES, Antaya RJ. Topical corticosteroid phobia in atopic dermatitis: A systematic review. JAMA Dermatol 2017; 153(10): 1036-42.[http://dx.doi.org/10.1001/jamadermatol.2017.2437] [PMID: 28724 128]
[7] Gonzales F, Ramdane N, Delebarre-Sauvage C, Modiano P, Duhamel A, Lasek A. Monitoring of topical corticosteroid phobia in a population of parents with children with atopic dermatitis using the TOPICOP® scale: Prevalence, risk factors and the impact of therapeutic patient education. J Eur Acad Dermatol Venereol 2017; 31(3): e172-4.[http://dx.doi.org/10.1111/jdv.13961] [PMID: 27608366]
[8] Mueller SM, Tomaschett D, Vogt DR, Itin P, Cozzio A, Surber C. Topical corticosteroid concerns from the clinicians’ perspective. J Dermatolog Treat 2017; 28(5): 464-8.[http://dx.doi.org/10.1080/09546634.2016.1255307] [PMID: 27807 999]
[9] Raffin D, Giraudeau B, Samimi M, Machet L, Pourrat X, Maruani A. Corticosteroid phobia among pharmacists regarding atopic dermatitis in children: A national french survey. Acta Derm Venereol 2016; 96(2): 177-80.[http://dx.doi.org/10.2340/00015555-2157] [PMID: 26039683]
[10] Smith SD, Lee A, Blaszczynski A, Fischer G. Pharmacists’ knowledge about use of topical corticosteroids in atopic dermatitis: Pre and post continuing professional development education. Australas J Dermatol 2016; 57(3): 199-204.[http://dx.doi.org/10.1111/ajd.12339] [PMID: 25846602]
[11] Moret L, Anthoine E, Aubert-Wastiaux H, et al. TOPICOP©: A new scale evaluating topical corticosteroid phobia among atopic dermatitis outpatients and their parents. PLoS One 2013; 8(10)e76493[http://dx.doi.org/10.1371/journal.pone.0076493] [PMID: 24146878]
[12] Stalder J-F, Aubert H, Anthoine E, et al. Topical corticosteroid phobia in atopic dermatitis: International feasibility study of the TOPICOP score. Allergy 2017; 72(11): 1713-9.[http://dx.doi.org/10.1111/all.13189] [PMID: 28439896]
[13] Fulchand S, Kilgour JM. Founding an undergraduate society: A student-led initiative to improve dermatology education. Br J Dermatol 2016; 174(6): 1415-6.[http://dx.doi.org/10.1111/bjd.14473] [PMID: 26873769]
[14] Smith SD, Lee A, Blaszczynski A, Fischer G. Attitudes of Australian dermatologists to the use and safety of topical corticosteroids in paediatric atopic dermatitis. Australas J Dermatol 2016; 57(4): 278-83.[http://dx.doi.org/10.1111/ajd.12402] [PMID: 26391107]
[15] Bewley A. Expert consensus: Time for a change in the way we advise our patients to use topical corticosteroids. Br J Dermatol 2008; 158(5): 917-20.[http://dx.doi.org/10.1111/j.1365-2133.2008.08479.x] [PMID: 18294 314]
[16] Lau WM, Donyai P. Knowledge, attitude and advice-giving behaviour of community pharmacists regarding topical corticosteroids. Pharmacy (Basel) 2017; 5(3): 41.[PMID: 28970453]
[17] Dey VK. Misuse of topical corticosteroids: A clinical study of adverse effects. Indian Dermatol Online J 2014; 5(4): 436-40.[http://dx.doi.org/10.4103/2229-5178.142486] [PMID: 25396124]
[18] Sendrasoa FA, Ranaivo IM, Andrianarison M, et al. Misuse of topical corticosteroids for cosmetic purpose in Antananarivo, Madagascar. BioMed Res Int 2017; 20179637083[http://dx.doi.org/10.1155/2017/9637083] [PMID: 28904977]
[19] Song SY, Jung S-Y, Kim E. Steroid phobia among general users of topical steroids: A cross-sectional nationwide survey. J Dermatolog Treat 2018; 1-6.[http://dx.doi.org/10.1080/09546634.2018.1508817] [PMID: 30081 700]
[20] Farrugia LL, Lee A, Fischer G, Blaszczynski A, Carter SR, Smith SD. Evaluation of the influence of pharmacists and GPs on patient perceptions of long-term topical corticosteroid use. J Dermatolog Treat 2017; 28(2): 112-8.[http://dx.doi.org/10.1080/09546634.2016.1213353] [PMID: 27424 888]

Endorsements



"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


Browse Contents



Webmaster Contact: info@benthamopen.net
Copyright © 2019 Bentham Open