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OUR FOCUS THIS MONTH

What will the Patient be told next? The Pharmacy Counter in Atopic Dermatitis Care

Prof. Alain TAÏEB
President ISAD

For families dealing with childhood atopic dermatitis (AD), treatment decisions are rarely shaped by the dermatologist alone. Pharmacists and pharmacy workers are often among the healthcare professionals encountered most frequently—when prescriptions are dispensed, emollients are purchased, or parents simply ask whether a treatment is “safe.” Yet this important part of the therapeutic pathway has received surprisingly little attention.

A new French national survey published as a Research Letter in the British Journal of Dermatology provides a timely reminder. Among 406 pharmacy-based healthcare professionals, almost all reported counseling patients with AD, but only one-quarter had undertaken continuing education in dermatology and fewer than 10% regularly read dermatology literature. Most recommendations were appropriate: moisturizers and gentle cleansers were advised by approximately 95% of respondents. However, 30% frequently recommended probiotics and almost one in five advised food avoidance. Perhaps most strikingly, greater self-reported confidence did not necessarily translate into more evidence-based counseling: highly confident respondents were more likely to recommend food avoidance, thermal treatments and water softeners.¹

A French national survey published a decade ago showed substantial topical corticosteroid concern among pharmacists, raising the possibility that professional caution could reinforce parental fears precisely when treatment was being dispensed.² Earlier work had already demonstrated how conflicting messages from healthcare professionals contribute to topical corticosteroid phobia and poor adherence in AD.³

The issue is therefore broader than any single inappropriate recommendation. Misinformation does not originate only on social media. It can also result from inconsistent messages within the healthcare system itself. Parents today navigate a complex information environment involving topical corticosteroid fears, topical steroid withdrawal (TSW), elimination diets, “natural” therapies, microbiome products and an expanding range of systemic treatments. A dermatologist may spend considerable time explaining why an anti-inflammatory treatment is necessary, only for confidence to be weakened later by a warning at the pharmacy counter. Conversely, a well-informed pharmacist can reinforce the treatment plan, identify adherence problems and help families distinguish evidence-based care from commercially attractive but poorly supported alternatives.

The new survey should therefore not be interpreted as criticism of pharmacists. Pharmacy professionals are both frontline and last-line healthcare providers in the treatment pathway: advice is given not only when families request an OTC product but also when prescribed treatment is dispensed. The authors note that several OTC or complementary approaches continue to be recommended despite limited evidence and suggest that the relatively low uptake of continuing dermatology education may contribute to this gap.¹ 

Pharmacists should instead be regarded as essential partners in therapeutic education. The infrastructure is already there: almost all respondents in this survey reported providing AD advice. What is needed is easier access to concise, regularly updated and independent educational resources aligned with dermatology recommendations. Digital education can reinforce this pathway. Structured online behavioral interventions have shown that appropriately designed digital support can improve eczema self-management for children, young people and their families.⁴ Such tools should not replace interaction with healthcare professionals, but they offer a means of providing patients with consistent information between consultations. The next step may be to connect these approaches: dermatologists, pharmacists, patient organizations and validated online resources delivering the same core messages, rather than leaving families to reconcile contradictory advice themselves.

Educating patients alone is insufficient if healthcare professionals themselves convey discordant messages. Better collaboration with pharmacists may be particularly important for topical treatment adherence, where fear and uncertainty remain common and where a few words spoken when the prescription is dispensed can either strengthen or undermine the therapeutic alliance. In an era of TSW concerns, social-media misinformation and increasingly sophisticated AD therapies, perhaps the question is no longer simply “What did we tell the patient?” It is also: “What will the patient be told next?”

References

1. Santer M, Muller I, Becque T, et al. Eczema Care Online behavioural interventions to support self-care for children and young people: two independent, pragmatic, randomized controlled trials. BMJ. 2022;379:e072007.
2. Dours L, Plasson A, Le Vilain-Abraham F, et al. Over-the-counter products and complementary therapies in childhood atopic dermatitis: a national survey of pharmacists. Br J Dermatol. 2026. doi:10.1093/bjd/ljag349.
3. Raffin D, Giraudeau B, Samimi M, et al. Corticosteroid phobia among pharmacists regarding atopic dermatitis in children: a national French survey. Acta Derm Venereol. 2016;96:177–180.
4. Aubert-Wastiaux H, Moret L, Le Rhun A, et al. Topical corticosteroid phobia in atopic dermatitis: a study of its nature, origins and frequency. Br J Dermatol. 2011;165:808–814.

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