Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement

Abstract

Atopic eczema is a chronic inflammatory disease affecting about 30% of Australian and New Zealand children. Severe eczema costs over AUD 6000/year per child in direct medical, hospital and treatment costs as well as time off work for caregivers and untold distress for the family unit. In addition, it has a negative impact on a child's sleep, education, development and self-esteem. The treatment of atopic eczema is complex and multifaceted but a core component of therapy is to manage the inflammation with topical corticosteroids (TCS). Despite this, TCS are often underutilised by many parents due to corticosteroid phobia and unfounded concerns about their adverse effects. This has led to extended and unnecessary exacerbations of eczema for children. Contrary to popular perceptions, (TCS) use in paediatric eczema does not cause atrophy, hypopigmentation, hypertrichosis, osteoporosis, purpura or telangiectasia when used appropriately as per guidelines. In rare cases, prolonged and excessive use of potent TCS has contributed to striae, short-term hypothalamic-pituitary-adrenal axis alteration and ophthalmological disease. TCS use can also exacerbate periorificial rosacea. TCS are very effective treatments for eczema. When they are used to treat active eczema and stopped once the active inflammation has resolved, adverse effects are minimal. TCS should be the cornerstone treatment of atopic eczema in children.

Allergic contact dermatitis in children and proposal for an Australian Paediatric Baseline Series

“…Given that almost half the patch‐tested children in our study ultimately had a diagnosis of atopic dermatitis, as either a primary, secondary or other diagnosis, it was decided to include a number of topical corticosteroids in the proposed series. Although topical steroid allergy is rare, allergic contact dermatitis to topical treatments in atopic dermatitis is not …”

Topical Corticosteroid Concerns in Dermatological Outpatients: A Cross-Sectional and Interventional Study

“…TCC are an important issue in dermatological patients as TCS are a mainstay of treatment for various skin diseases. TCC may lead to non-adherence and poor disease control, resulting in serious long-term consequences, more hospitalisations, and increased health care costs [1,2,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18]. However, study data on TCC are scarce and largely limited to patients with atopic dermatitis or their caregivers.…”

“…Reasonable grounds for concerns about using TCS are side effects seen in misuse (e.g. atrophy, discoloration, hypertrichosis, and systemic effects) [16] or personal ‘bad experience' for any reason. However, TCC is mostly driven by irrational aspects, misconceptions of TCS, ideological orientation, and negative reports by relatives, friends, and media [1,4,5,9,21].…”

“…Poor or inconsistent oral information about dosing and duration might intensify concerns, whereas a good patient-clinician relationship might even provide adherence to TCS despite TCC [1,5,13]. Contradictory information or even a negative attitude of these health care professionals towards TCS might enhance TCC [1,9,16]. Thus, clinicians may play a key role as modulators of TCC [1,4,5,18,19].…”

Pseudoepitheliomatous hyperplasia secondary to allergic contact dermatitis to Grevillea Robyn Gordon

“…Steroid phobia is prevalent in Australia and may be associated with detrimental effects, as in this case. 6,7 …”