Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement

Abstract

SummaryBackgroundGuidelines discourage the use of systemic corticosteroids for atopic dermatitis (AD), but their use remains widespread.ObjectivesTo reach consensus among an international group of AD experts on the use of systemic corticosteroids for AD.MethodsA survey consisting of statements accompanied by visual analogue scales ranging from ‘strongly disagree’ to ‘neutral’ to ‘strongly agree’ was distributed to the International Eczema Council (IEC). Consensus was reached in agreement on a statement if < 30% of respondents marked to the left of ‘neutral’ towards ‘strongly disagree’.ResultsSixty of 77 (78%) IEC members participated. Consensus was reached on 12 statements, including that systemic corticosteroids should generally be avoided but can be used rarely for severe AD under certain circumstances, including a lack of other treatment options, as a bridge to other systemic therapies or phototherapy, during acute flares in need of immediate relief, in anticipation of a major life event or in the most severe cases. If used, treatment should be limited to the short term. Most respondents agreed that systemic corticosteroids should never be used in children, but consensus was not reached on that statement. The conclusions of our expert group are limited by a dearth of high‐quality published evidence. If more stringent consensus criteria were applied (e.g. requiring < 20% of respondents marking towards ‘strongly disagree’), consensus would have been reached on fewer statements.ConclusionsBased on expert opinion from the IEC, routine use of systemic corticosteroids for AD is generally discouraged and should be reserved for special circumstances.

European task force on atopic dermatitis position paper: treatment of parental atopic dermatitis during preconception, pregnancy and lactation period

“…Systemic corticosteroids (SCS) are a well‐researched, fast‐acting, body‐own substance class influencing a broad spectrum of regulatory pathways in the human body, some of which are anti‐inflammatory. They are occasionally used in non‐pregnant AD patients for short‐course treatment in acute and severe flares . The risk/benefit ratio is largely unfavourable .…”

Demographics, healthcare utilization and drug use in children and adults with atopic dermatitis in Denmark: a population‐based cross‐sectional study

“…More than half of adult AD patients received at least one prescription of systemic corticosteroids during the study period although they carry a risk of a range of harmful side‐effects . In a recent consensus paper, AD experts agreed that these should generally be avoided and only used under special circumstances . While we were unable to distinguish the indication for use, and some systemic corticosteroids were possibly prescribed to treat, for example asthma or allergic rhinitis, the results emphasize that physicians generally may tend to prescribe these drugs more than it is indicated.…”

Atopic dermatitis in adults: An Australian management consensus

“…The management flow chart is intended for use primarily in the specialist setting rather than in primary care. Algorithm originated from concepts presented in Lynde, 2017 (Canada), Simpson, 2017 (International Eczema Council, IEC), Saeki, 2017 (Japan), Drucker, 2017 (IEC: Systemic corticosteroid guidance) and Gooderham, 2017 (maintenance data topical corticosteroids [TCS] and topical calcineurin inhibitors [TCI]) …”