Effect of Corticosteroid Phobia on Treatment Adherence and Outcome in Women With Lichen Sclerosus: A Prospective Study

Objective: The phenomenon of topical corticosteroid (TC) phobia (TCP) poses a challenge to the adherence of patients requiring prolonged treatments, particularly those with conditions like atopic dermatitis. Nonadherence to treatment significantly contributes to the inadequate control of diseases. This study aimed to evaluate TCP among women suffering from vulvar lichen sclerosus (VLS) and its potential impact on treatment adherence and therapeutic outcomes. Materials and Methods: This observational, prospective study involved adult patients who received their first histological diagnosis of VLS and underwent a 12-week corticosteroid treatment regimen at our Vulva Unit between June 2022 and September 2023. All participants completed the validated TOPICOP questionnaire, which assesses concerns, worries, and beliefs regarding TC usage. Baseline and 12-week control visit assessments were conducted to evaluate subjective and objective parameters of VLS. Patient adherence to treatment was monitored through diary entries. Results: Among the 50 patients included (with a mean age of 64.9 ± 13.5 years), more than half (58%) had prior experience with TC treatments and 10.3% had used corticosteroids for vulvar symptoms without a precise diagnosis. The median global TOPICOP score was 19.4% (interquartile range = 5.6–36.1), with a corresponding median value of 7.0 (interquartile range = 2.0–13.0). A total of 41 patients (82.2%) adhered to the study treatment, which proved highly effective in alleviating symptoms and improving signs of VLS. Multivariate analysis revealed that neither treatment adherence nor effectiveness were significantly associated with the level of TCP. Conclusions: Among our VLS patients, TCP was relatively low and did not negatively impact treatment adherence to corticosteroids. Moreover, TCP did not influence the effectiveness of TC therapy, as it did not affect adherence.