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Br J Dermatol. 2018 Mar;178(3):768-775. doi: 10.1111/bjd.15928. Epub 2018 Jan 28.

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

Author information

1
Department of Dermatology, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, U.S.A.
2
Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada.
3
Division of Dermatology, Department of Medicine and Women's College Research Institute, Women's College Hospital, Toronto, Canada.
4
Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.
5
National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands.
6
Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
7
Department of Dermatology, Academic Medical Centre, Amsterdam, the Netherlands.
8
Trinity College Dublin, National Children's Research Centre, Paediatric Dermatology, Our Lady's Children's Hospital, Dublin, Ireland.
9
Department of Medicine, Section of Dermatology, University of Verona, Verona, Italy.
10
Department of Pediatric Dermatology, Institute of Child Health, Kolkata, India.
11
Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, King's College London and Guy's & St Thomas' NHS Foundation Trust, London, U.K.
12
Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
13
Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A.
14
Department of Dermatology, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, U.S.A.

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.

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