The International Eczema Council (IEC) is recommending that the routine use of systemic corticosteroids for atopic dermatitis be discouraged and instead, it should be reserved for special circumstances.
In September, the council issued guidelines for the use of systemic corticosteroids for atopic dermatitis. The guidelines were published in the British Journal of Dermatology.
A goal of the survey was to assess how and when physicians prescribe corticosteroids for atopic dermatitis, said lead author Aaron Drucker, M.D., an early career scientist at Women’s College Research Institute in Toronto.
“There are many papers that show these drugs are being used a lot, particularly in patients who have moderate or severe atopic dermatitis. Hopefully, our guidelines can provide some guidance as to when systemic corticosteroids are appropriate. We want to see if our recommendations limit usage,” Dr. Drucker said.
The guidelines are based on a survey of 60 council members. A consensus was reached on 12 statements.
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 be limited to short-term.
Most respondents agreed that systemic corticosteroids should never be used in children, but consensus was not reached on that statement.
Treatment in adults 18 and over with systemic corticosteroids for severe atopic dermatitis should be limited to short-term use: 94 percent consensus
For children under the age of 12, corticosteroids should mostly be avoided due to concerns over side effects and rebound flares on discontinuation: 86 percent consensus. And, 84 percent agreed that this should apply to children and teens between 12 and 17.
Systemic corticosteroids may be used for severe atopic dermatitis in adults when there are no other viable treatment options: 81 percent consensus.
Systemic corticosteroids may be used rarely for severe disease in adults: 80 percent consensus.