Using the TOPICOP© scale to measure concerns towards steroid creams - some difficulties we faced

What is it about?

The TOPICOP© scale has been used as a tool by doctors for assessing concerns towards steroid creams. In this Letter to the Editor, we discuss some challenges in its application in clinical research and provide suggestions to improve its use and validity, to better reflect the concerns of our patients. While the TOPICOP© scale is a useful bedside tool that reflects the patient concerns towards steroid creams, we have faced some difficulties in using the scale. Firstly, it can be difficult to assess the validity of the scale given the lack of pre-exsisting gold standard for correlating. While validating the TOPICOP© score with adherence is useful, adherence to steroids is difficult to measure given multiple variables involved. Secondly, while a high score represents high steroid cream phobia, having a low score does not directly equate to no phobia. Rather, it may potentially represent a patient who has poor understanding of steroid safety. Thirdly, a linear scale implies that one end of the scale is good/positive, while the other is bad/negative. However in the case of steroid concerns, this is less appropriate, as some degree of concern and caution about using steroid creams is actually appropriate and desired.

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Why is it important?

The TOPICOP© scale is currently the only validated measure for assessing steroid concerns and is increasingly being used in research studies. It is thus important to understand the limitations of this scale which would affect how the results are interpreted.

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