A systematic review of topical corticosteroid withdrawal (“steroid addiction”) in patients with atopic dermatitis and other dermatoses

Hajar, Tamar; Leshem, Yael Anne; Hanifin, Jon M.; Nedorost, Susan T.; Lio, Peter A.; Paller, Amy S.; Block, Julie; Simpson, Eric L.

doi:10.1016/j.jaad.2014.11.024

Cited by 159 publications

(161 citation statements)

References 38 publications

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“…Due to the chronic and chronically relapsing nature of AD there can be a lifelong need for treatment, with a significant risk of adverse events. These include skin atrophy, and to a lesser extent striae and telangiectasias, while the risk of a rebound phenomenon when tapering TCSs is exaggerated if used appropriately [24,25]. The risk of systemic side effects is low and correlated to the potency of the TCS, the extent and degree of skin inflammation, and the age of the patient.…”

Section: Topical Therapiesmentioning

confidence: 99%

Emerging Treatment Options in Atopic Dermatitis: Topical Therapies

Nygaard

Deleuran

Vestergaard³

2017

Dermatology

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Atopic dermatitis is a chronic inflammatory skin disorder affecting children and adults, with the majority presenting mild to moderate disease severity. The use of topical corticosteroids (TCSs) in combination with emollients has been the mainstay for treating mild to moderate atopic dermatitis since the 1950s, and as a supplement to systemic treatment in severe disease. However, while very effective, TCSs are often accompanied by poor adherence due to corticophobia (fear of using corticosteroids in patients or doctors), unwanted side effects, and in some cases insufficient clinical response. Topical calcineurin inhibitors (TCIs) are able to inhibit the activation of T-lymphocytes and thereby diminish inflammation. In some patients the use of TCIs has been limited due to a localized burning sensation on the first days of treatment, and also due to fear of other adverse effects. Consequently, there has been a need for the development of new topical products for atopic dermatitis. Novel topical therapies are in the pipeline and comprise both new doses and formulations of well-known pharmaceutical molecules and novel approaches targeting unique inflammatory pathways and mechanisms of disease, with a promise of higher efficacy and less harmful side effects. We review topical drugs in the pipeline for atopic dermatitis, and focus on those available in the clinicaltrials.gov database with a first received date from January 1, 2014 to May 31, 2017.

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Section: Topical Therapiesmentioning

confidence: 99%

Emerging Treatment Options in Atopic Dermatitis: Topical Therapies

Nygaard

Deleuran

Vestergaard³

2017

Dermatology

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“…An additional concern with prolonged or inappropriate use of TCSs is a condition known as TCS withdrawal (32,33). Alternatively known as topical corticosteroid-induced rosacea-like dermatitis, topical steroid-dependent face, or red skin syndrome, TCS withdrawal is a condition that involves the exacerbation of AD symptoms after discontinuation of TCS treatment (26,33,34).…”

Section: Topical Corticosteroidsmentioning

confidence: 99%

Addressing treatment challenges in atopic dermatitis with novel topical therapies

Silverberg

Nelson²,

Yosipovitch

2016

Journal of Dermatological Treatment

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Atopic dermatitis (AD), a chronic inflammatory skin disease affecting children and adults, presents as mildto-moderate disease in the majority of patients. Pruritus, one of the key diagnostic criteria for AD, is associated with reduced quality of life and disease aggravation. Current treatments include emollients and topical pharmaceutical agents. Topical corticosteroids (TCSs) are commonly used, but are associated with safety concerns with cutaneous and systemic side effects. Topical calcineurin inhibitors (TCIs) inhibit T-lymphocyte activation, but their use is limited because of application-site infections and a boxed warning for potential malignancy risk. Despite recent reports indicating there is no malignancy risk, long-term treatment with TCIs is still considered with hesitancy. In addition, while both TCSs and TCIs provide some relief of pruritus, it often takes over a week for improvement to occur. The development of a more specific anti-inflammatory treatment which is easy to use and targets pruritus could provide clinically meaningful improvements for patients with AD. The majority of emerging therapies for AD are focused on inhibiting phosphodiesterase 4 (PDE4), an enzyme which is increased in inflammatory disorders such as AD. This review will update readers on the recent advances in topical therapies, including PDE4 inhibitors, for the treatment of AD. ARTICLE HISTORY

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“…The structure of skin in these areas, characterized by a thin epidermis, extensive vascularization or many epidermal appendages and nerve endings, causes it to be more absorbent [20,69]. Therefore, TCS should not be used under occlusion in these areas [4,20,49,67], and patients prescribed TCS should be closely monitored [20,72,73] and educated about proper uses [16].…”

Section: Topical Corticosteroidsmentioning

confidence: 99%

Crisaborole and its Potential Role in Treating Atopic Dermatitis: Overview of Early Clinical Studies

Zane¹,

Chanda²,

Jarnagin³

et al. 2016

Immunotherapy

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Atopic dermatitis (AD), a chronic, relapsing, inflammatory skin disease that is characterized by intense pruritus and eczematous lesions with up to 90% of patients presenting with mild to moderate disease. Current topical treatments for AD have not changed in over 15 years and are associated with safety concerns. In AD, overactivity of phosphodiesterase 4 (PDE4), leads to inflammation and disease exacerbation. Crisaborole Topical Ointment, 2%, is a novel, nonsteroidal, topical anti-inflammatory PDE4 inhibitor currently being investigated for the treatment of mild to moderate AD. Preliminary studies in children and adults demonstrated favorable efficacy and safety profiles. Crisaborole may represent an anti-inflammatory option that safely minimizes the symptoms and severity of AD and that can be used for both acute and long-term management.

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A systematic review of topical corticosteroid withdrawal (“steroid addiction”) in patients with atopic dermatitis and other dermatoses

Cited by 159 publications

References 38 publications

Emerging Treatment Options in Atopic Dermatitis: Topical Therapies

Emerging Treatment Options in Atopic Dermatitis: Topical Therapies

Addressing treatment challenges in atopic dermatitis with novel topical therapies

Crisaborole and its Potential Role in Treating Atopic Dermatitis: Overview of Early Clinical Studies

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