Dataset Information

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

ABSTRACT:

Background

Guidelines discourage the use of systemic corticosteroids for atopic dermatitis (AD), but their use remains widespread.

Objectives

To reach consensus among an international group of AD experts on the use of systemic corticosteroids for AD.

Methods

A 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'.

Results

Sixty 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.

Conclusions

Based on expert opinion from the IEC, routine use of systemic corticosteroids for AD is generally discouraged and should be reserved for special circumstances.

SUBMITTER: Drucker AM

PROVIDER: S-EPMC5901393 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Publications

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

Drucker A M AM Eyerich K K de Bruin-Weller M S MS Thyssen J P JP Spuls P I PI Irvine A D AD Girolomoni G G Dhar S S Flohr C C Murrell D F DF Paller A S AS Guttman-Yassky E E

The British journal of dermatology 20180128 3

<h4>Background</h4>Guidelines discourage the use of systemic corticosteroids for atopic dermatitis (AD), but their use remains widespread.<h4>Objectives</h4>To reach consensus among an international group of AD experts on the use of systemic corticosteroids for AD.<h4>Methods</h4>A 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 ...[more]

PMID: 28865094

Similar Datasets

Project description:ObjectiveAn umbrella review summarising all safety data from systematic reviews of topical corticosteroids (TCS) in adults and children with atopic eczema.MethodsEmbase, MEDLINE, PubMed, Cochrane Database of Systematic Reviews and the Centre of Evidence Based Dermatology map of eczema systematic reviews were searched until 7 November 2018 and Epistemonikos until 2 March 2021. Reviews were included if they assessed the safety of TCS in atopic eczema and searched >1 database using a reproducible search strategy. Review quality was assessed using version 2 of 'A MeaSurement Tool to Assess systematic Reviews' (AMSTAR 2 tool).Results38 systematic reviews included, 34 low/critically low quality. Treatment and follow-up were usually short (2-4 weeks).Key findingsTCS versus emollient/vehicle: No meta-analyses identified for skin-thinning. Two 2-week randomised controlled trials (RCTs) found no significant increased risk with very potent TCS (0/196 TCS vs 0/33 vehicle in children and 6/109 TCS vs 2/50 vehicle, age unknown). Biochemical adrenal suppression (cortisol) was 3.8% (95% CI 2.4% to 5.8%) in a meta-analysis of 11 uncontrolled observational studies (any potency TCS, 522 children). Effects reversed when treatment ceased.TCS versus topical calcineurin inhibitors: Meta-analysis showed higher relative risk of skin thinning with TCS (4.86, 95% CI 1.06 to 22.28, n=4128, four RCTs, including one 5-year RCT). Eight cases in 2068 participants, 7 using potent TCS. No evidence of growth suppression.Once daily versus more frequent TCS: No meta-analyses identified. No skin-thinning in one RCT (3 weeks potent TCS, n=94) or biochemical adrenal suppression in two RCTs (up to 2 weeks very potent/moderate TCS, n=129).TCS twice/week to prevent flares ('weekend therapy') versus vehicle: No meta-analyses identified. No evidence of skin thinning in five RCTs. One RCT found biochemical adrenal suppression (2/44 children, potent TCS).ConclusionsW e found no evidence of harm when TCS were used intermittently 'as required' to treat flares or 'weekend therapy' to prevent flares. However, long-term safety data were limited.Prospero registration numberCRD42018079409.

Dataset Information

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

Background

Objectives

Methods

Results

Conclusions

Publications

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

Similar Datasets

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