Abstract
Background: Systemic corticosteroids are often used to treat atopic dermatitis (AD). However, few studies have assessed the safety and efficacy of systemic corticosteroids in AD. Objective: To systematically review the literature on efficacy and safety of systemic corticosteroid use (oral, intramuscular, and intravenous) in AD. Methods: PubMed, Embase, Medline, Scopus, Web of Science, and Cochrane Library were searched. We included systematic reviews, guidelines, and treatment reviews of systemic corticosteroid use among patients of all ages with a diagnosis of AD (52 reviews and 12 studies). Results: There was general consensus in the literature to limit the use of systemic steroids to short courses as a bridge to steroid-sparing therapies. Systemic side effects include growth suppression in children, osteoporosis, osteonecrosis, adrenal insufficiency, Cushing syndrome, hypertension, glucose intolerance, diabetes, gastritis, gastroesophageal reflux, peptic ulcer disease, weight gain, emotional lability, behavioral changes, opportunistic infections, cataracts, glaucoma, myopathy, myalgia, dysaesthesia, pseudotumor cerebri, hyperlipidemia, malignancy, thrombosis, skin atrophy, sleep disturbance, and rebound flaring. Limitations: Baseline clinical severity, corticosteroid delivery and dose, and treatment response were reported incompletely and heterogeneously across studies. Conclusions: Evidence is not strong enough to determine optimal delivery or duration of systemic corticosteroids in AD.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 733-740.e11 |
| Journal | Journal of the American Academy of Dermatology |
| Volume | 78 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 2018 |
Funding
Supported by the Agency for Healthcare Research and Quality (grant K12 HS023011) and the Dermatology Foundation (to Dr Silverberg). Disclosure: Dr Drucker is a consultant for Sanofi and RTI Health Solutions, is an investigator for Regeneron and Sanofi, receives research funding from Regeneron and Sanofi, and has received honoraria (speaker and educational programming honoraria) from Astellas Canada, Prime Inc, and Spire Learning. Dr Lebwohl is an employee of Mount Sinai, which receives research funds from Abbvie, Amgen, Boehringer Ingelheim, Celgene, Eli Lilly, Janssen/Johnson & Johnson, Kadmon, Medimmune/Astra Zeneca, Novartis, Pfizer, Regeneron, and ViDac. Dr Silverberg is an employee of Northwestern University Feinberg School of Medicine, which receives research funds from GlaxoSmithKline; he is a consultant for Abbvie, Eli Lilly, Galderma, GlaxoSmithKline, Kiniksa, Leo, Medimmune, Menlo, Pfizer, Realm-1, Regeneron-Sanofi, and Roivant and a speaker for Regeneron-Sanofi. Dr Yu has no conflicts of interest to declare.
Keywords
- adrenal insufficiency
- atopic dermatitis
- atopic eczema
- corticosteroids
- eczema
- intramuscular
- intravenous
- oral
- rebound flaring
- systemic side effects
ASJC Scopus subject areas
- Dermatology
