Do people with eczema and their carers understand topical steroid potency? Results of two surveys.

Topical corticosteroids (TCSs) are classified into four potencies: mild, moderate, potent and very potent. Confusion arises from the wide range of products available, none of which have potency level printed on the tubes or packaging. An online survey of patients and carers of people with eczema showed that only 17% of 984 respondents knew how many potencies there are; 315 respondents to a second survey provided 1520 assignments of the potency of commonly used TCSs, 55.5% correct, 21% underestimates and 23.5% overestimates. Some errors were extreme: 12 (8%) of those using a very potent TCS considered it mild while 9 (27%) using a mild TCS considered it potent or very potent. Other themes expressed in free-text comments included inadequate and conflicting advice about using TCSs and lack of warnings about long-term adverse effects, particularly topical steroid withdrawal (TSW). Ninety-five percent of respondents wanted TCSs to be clearly labelled with potency.