Short-term systemic corticosteroid therapy may be useful in atopic dermatitis
Optimal delivery or duration of systemic corticosteroids in atopic dermatitis (AD) cannot be established as there is not enough strong evidence in existing literature, suggests a recent study.
Findings from previous reports generally agreed that use of systemic steroids should be limited to short courses as a bridge to steroid-sparing therapies.
Systemic side effects were as follows: osteoporosis, osteonecrosis, Cushing syndrome, adrenal insufficiency, diabetes, glucose intolerance, gastro-oesophageal reflux, gastritis, peptic ulcer disease, weight gain, emotional lability and behavioural changes.
Other side effects included growth suppression in children, glaucoma, cataracts, myopathy, hypertension, dysaesthesia, myalgia, pseudotumour cerebri, hyperlipidaemia, malignancy, thrombosis, skin atrophy, rebound flaring and sleep disturbance.
The investigators searched PubMed, Embase, Scopus, Web of Science and Cochrane Library to systematically review published studies on efficacy and safety of systemic corticosteroid use (oral, intramuscular and intravenous) in AD. Included were systematic reviews, guidelines and treatment reviews of systemic corticosteroid use among patients of all ages with AD (52 reviews and 12 studies).
The study was limited by the incomplete and heterogeneous reporting of baseline clinical severity, corticosteroid delivery and dose, and treatment response across studies, according to the investigators.
In a previous systematic review of published trials of topical corticosteroids (TCS) or topical calcineurin inhibitors (TCIs) treatments in patients <12 years with AD, Siegfried and colleagues found robust data supporting long-term use of TCIs, while data supporting long-term TCS use were limited to low- to mid-potency products. [BMC Pediatr 2016;16:75]
“Our review identifies a lack of information on the safety of commonly prescribed, long-term monotherapy with mid- to high-potency TCS in paediatric AD, and supports standard-of-care maintenance therapy with TCIs and intermittent use of low- to mid-potency TCS for flares,” said Siegfried.