Routine use of systemic corticosteroids is generally discouraged for atopic dermatitis, according to research published online Sept. 2 in the British Journal of Dermatology.Guidelines discourage the use of systemic corticosteroids for atopic dermatitis but their use remains widespread. Dr.Aaron M. Drucker, from Alpert Medical School of Brown University in Providence, R.I., and colleagues address the use of systemic corticosteroids for atopic dermatitis. The International Eczema Council (IEC) was surveyed with a series of statements accompanied by visual analogue scales ranging from strongly disagree to neutral to strongly agree; 60 of 77 IEC members participated
The researchers tried to reach consensus among an international group of atopic dermatitis experts on the use of systemic corticosteroids for atopic dermatitis.A survey consisting of statements accompanied by visual analog 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.”Sixty of 77 (79%) IEC members participated. Consensus was reached on 12 statements, including that systemic corticosteroids should generally be avoided but can be used rarely for severe atopic dermatitis 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 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.
It was concluded that based on expert opinion from the IEC, routine use of systemic corticosteroids for atopic dermatitis is generally discouraged and should be reserved for special circumstances.
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