Corticosteroid Exposure and Cumulative Effects in Eczema: Patient Survey

Investigators found 78% of adults and 58% of caregivers “very” concerned about cumulative effects of topical corticosteroids (TCS).

Patients with eczema report substantial corticosteroid exposure, placing them at increased risk for corticosteroid-related adverse effects. As corticosteroids are used by nearly half of patients for noneczema disorders as well, patients are concerned about cumulative effects of corticosteroids. These are among the findings from a survey published recently in the Annals of Allergy, Asthma & Immunology.

Investigators sought to evaluate corticosteroid exposure and its cumulative effects in patients with eczema.

They conducted a multinational online survey from November 2020 through mid-January 2021 that included 1889 patients of at least 18 years of age and caregivers of 271 child-patients all with a clinical diagnosis of eczema. The survey was emailed to participants on the distribution lists of patient advocacy organizations: the International Topical Steroid Awareness Network (N=4690 emails) and the Allergy & Asthma Network (N=40,240 emails). It was also sent to members of international eczema patient organizations (approximately 7000 emails) and to 364 participants in a market research organization.

The survey included questions to determine disease characteristics, eczema treatment history, topical steroid withdrawal syndrome (TSWS) experience, and socio-demographics and included participants from 70 countries, the majority from Western/Central Europe, Australia/New Zealand, and US/Canada. The 2160 participants represent a 4% response rate, of whom 92% from the patient advocacy organizations completed the survey. Median age of respondents (adult patients and caregivers) was 28.7 years, 85% women. Participants identified as White (61%), Asian (16%), Black (9%), Hispanic (11%).

Participants in the survey indicated a substantial, yet unquantifiable, cumulative corticosteroid load during their lifetime eczema experience.

All participants reported corticosteroid use, average duration of topical corticosteroid (TCS) use (adults 15.3 years; children 3.6 years), and 50% of patients applied TCS 15 to 30 days per month, 75% of patients used TCS 1 to 2 time per day. Usage and duration were unverifiable by TCS prescription potencies.

Adults reported that symptoms first appeared at approximately 3 years of age, with pediatrician diagnosis at about 4 years of age. Caregivers reported first symptoms at approximately 3 months of age with diagnosis at about 6 months. Super potent or potent TCS use was reported by many adults and children, and 54% of adults and 36% of children reported using both potent and super potent TCS.

Investigators noted that 36% of participants reported oral corticosteroid use (23% for eczema) and lifetime averages of more than 8 courses in children and adults. They found it unclear if the increase in new symptoms and conditions that corresponded to a greater number of corticosteroid treatments and longer duration of TCS use was due to treatment or simply progression of disease. They noted many participants reported TSWS following TCS discontinuation. They found that 49% of participants reported corticosteroid use for noneczema atopic conditions.

Investigators found 78% of adults and 58% of caregivers “very” concerned about cumulative effects of TCS. Among participants using prescription-only TCS, 83% of adults and 64% of children reported worsening symptoms over time, most commonly eczema spreading to new areas of the body. About half of participants stopped TCS use for eczema due to ineffectiveness or worsening of symptoms. A small percentage stopped due to symptom resolution. Among participants who stopped usage, 79% of adults and 43% of children reported symptoms consistent with TSWS.

Survey limitations include selection bias, nonresponse bias, self-reported responses, limited generalizability, recall bias, and the preponderance of women participants.

Investigators concluded “Participants in the survey indicated a substantial, yet unquantifiable, cumulative corticosteroid load during their lifetime eczema experience.” Disease progression and onset of new conditions may possibly be related to degree of corticosteroid exposure and investigators believe “Corticosteroids are a critical component and recognized necessity of eczema treatment for many patients,” while urging careful prescribing practices and monitoring.

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. This research was supported by Dermira/Lilly and Sanofi/Regeneron.

References:

Barta K, Fonacier LS, Hart M, et al. Corticosteroid exposure and cumulative effects in patients with eczema: results from a patient survey. Ann Allergy Asthma Immunol. Published online September 29, 2022. doi:10.1016/j.anai.2022.09.031