Corticosteroids form the backbone of topical therapy in many dermatological diseases. Many of these drugs are easily available as over-the-counter medications in India and are widely used by dermatologists, general physicians, physicians of other specialities especially paediatricians, doctors practising alternative medicine as well as quacks. This rampant use has led to the phenomenon of misuse or abuse of these drugs resulting in addiction and the various side effects which are sometimes irreversible. However, this rampant misuse and the resultant side effects have resulted in a flood of misgivings regarding TC in the minds of a large number of people causing a phenomenon known as topical corticosteroid phobia (TCP). TCP lies at the opposite end of the pole of addiction and is gradually growing into a menace of epidemic proportions.

The word phobia is defined as an extreme irrational fear, leading to aversion and deliberate avoidance. The person concerned often agrees that the fear is irrational but still cannot help avoiding it [1]. TCP is defined as a fear regarding application of the TC, rational or not [2]. Most researchers agree that TCP is a result of rampant, widespread and sometimes irrational TC use. The common side effects of these compounds such as acne, striae, atrophy and hypopigmentation often initiate this phobia. Abuse of the drug by dermatologists, non-dermatologists and laymen plays a significant role in the development of these side effects to a large extent. Physicians and patients often shun the drug due to the problems that arise from its indiscriminate use. The press, the electronic media and the pharmaceutical industry further confuse the ill-informed patient. Hearsay among laymen, package inserts of medicines, the Internet, media publicity and sometimes the overcautious non-dermatologist physician may add to this fear. These physicians are often unaware of the intricate nuances of TC use including the indications, potency, duration and amount of application of TCs [3]. Ironically the phobia occurs mostly in cases where TC use is actually beneficial, for example, in inflammatory diseases like atopic dermatitis. TC phobia, among patients and doctors, was first reported from Germany in 1992 [3]. Later, Charman et al. published the first study of TCP in patients of atopic dermatitis [4]. The study was based on a questionnaire for 200 patients of atopic dermatitis or their caregivers. 72% of them worried about using the steroid because of possible side effects, and 24% were already non-compliant. Steroid phobia was more commonly found in the female sex, in cases of paternal history of atopic dermatitis and a history of frequent change of clinics [5]. A reluctance to use steroids was seen in 38% of these subjects. Hon et al., in a study of childhood eczema, found that 50% parents requested non-steroidal prescriptions due to concerns about skin atrophy and growth retardation [6]. To measure such TC phobia among parents of children with atopic dermatitis, a questionnaire-based scale called TOPICOP has been developed recently [7].