Systemic corticosteroid medications tend to be overprescribed for patients with atopic dermatitis (AD). According to a consensus statement from the International Eczema Council (IEC), published in the British Journal of Dermatology, systemic corticosteroids should be used only after careful consideration of risks and benefits after the use of topical medications has been optimized.
To reach a consensus on the subject, an international group of experts in AD was surveyed with respect to their opinions on the use of systemic corticosteroids in patients with AD. The survey included statements that were accompanied by visual analogue scale (VAS) responses, which ranged from “strongly disagree” to “neutral” to “strongly agree.” Survey participants indicated with a slider along the VAS whether they agreed or disagreed with a particular statement. Consensus on agreement with a statement was met if ≤30% of participants marked their response on the left side of the VAS — that is, toward “strongly disagree.”
The survey contained 26 statements with accompanying VAS responses, along with 6 open-ended questions. All participants’ responses were anonymous. Of 77 IEC Councilors and Associates, 60 (79%) from 19 different countries responded to the survey, and 52 respondents completed the entire survey. Clinical practice among the experts differed significantly from country to country.
Consensus was reached on the key statements listed below, providing a framework for clinicians who treat people with AD.
- Holistic assessment should be performed to determine need for systemic medication
- AD impact on quality of life should be assessed routinely
- Prior to initiating systemic therapy, alterative or concomitant disease diagnoses should be considered
- Appropriate patient education should be given to optimize adherence to topical medication
- A trial of intensive topical therapy should be maximized
- Local bacterial and viral infection should be diagnosed and treated appropriately
- Probable AD allergic triggers should be diagnosed and treated appropriately
- Phototherapy should be used prior to systemic therapy if it is accessible and practical
- Shared decision making between patients and their clinicians should consider each patient’s unique factors and comorbidities
- Future availability of targeted immunomodulators with fewer side effects may lower the clinical threshold for using systemic therapies
Although the group agreed that systemic corticosteroid use should be limited, several clinical situations in which the use of systemic steroids may be appropriate were identified, including acute flares that require immediate relief, major life events, and a lack of other treatment options. Overall, 72% of participants agreed that systemic corticosteroids might be a short-term bridge to other systemic therapies.
The major strength of the survey was the large, geographically diverse population of IEC expert AD clinicians who participated in the consensus development. Routine use of systemic corticosteroids for patients with AD is typically discouraged and should be reserved for special situations.
Drucker AM, Eyerich K, de Bruin-Weller MS, et al. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement [published online September 2, 2017]. Br J Dermatol. doi: 10.1111/bjd.15928