Rebound phenomenon to systemic corticosteroid in atopic dermatitis

Abstract

Three patients with atopic dermatitis, one boy and two girls, aged between 6 and 17 years, presented eczematous skin, pruritus, scarifications, lichenification and a family history of atopy. During exacerbations, the patients sought emergency care and were prescribed oral corticosteroids for a period of approximately 15 days. Initially, the patients improved but after cessation of therapy or dose reduction, marked worsening occurred with the development of lesions with extreme pruritus, several confluent lesions, scarification and intense exudates, as well as fever and dehydration. The patients' condition was so severe that two were admitted to the allergy unit. The medication was withdrawn and intravenous hydration was administered, together with hydrating skin creams and antihistamine therapy. In addition, weak topical corticosteroids were applied on the most severely affected areas. All three patients progressively improved. We conclude that the patients with atopic dermatitis described herein presented a rebound phenomenon after the use of corticosteroids. We believe that systemic corticosteroids may exacerbate the acute phase of atopic dermatitis, mediated by IgE, accentuating the Th2 pattern in these patients.

Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part II): Systemic Treatment

“…Clinical trials have shown that corticosteroid concentrations in the skin following the administration of a potent TCS (clobetasol propionate 0.05%, hydrocortisone 2.3%, or triamcinolone 0.1%) are similar to those achieved with medium doses of oral prednisone 21 . If the skin is severely damaged, however, the distribution of topical treatments is extremely irregular and oral administration is safer and more controllable.…”

“…Rebound flare is frequently observed after the abrupt cessation of systemic corticosteroids. Increased production of IgE by B cells in AD patients has been reported after treatment with oral prednisolone 21 22 . Once clinical improvement has been achieved, it is very important to taper the dosage gradually over time to minimize the likelihood of a rebound effect.…”

Systemic Treatment of Adult Atopic Dermatitis: A Review

“…They include diabetes, hypertension, gastric ulcer, osteoporosis, glaucoma and Cushing syndrome. Moreover, increased production of immunoglobulin E (IgE) by B cells in AD patients has been reported after treatment with oral prednisolone, potentially supporting the pathogenesis of extrinsic forms of AD [53–55]. Moreover, the dosage of oral prednisolone during short-term treatment of AD should be accurately tapered to avoid the development of serious relapses and rebound of the disease [53].…”

Update on the management of chronic eczema: new approaches and emerging treatment options

“…Cases of rebound flaring of AD after oral corticosteroids have been reported,91 and this highlights the importance using topical therapy both as a mainstay of therapy and particularly during severe flares which may require more intensive systemic therapy.…”