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Systemic Corticosteroids for Atopic Dermatitis: International Eczema Council Consensus

This article presents the consensus reached by the International Eczema Council on the use of systemic corticosteroids for the treatment of severe atopic dermatitis. The consensus statements provide guidance on when systemic corticosteroids should be avoided or used in specific situations, highlighting their limited role in the treatment of this condition.

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Systemic Corticosteroids for Atopic Dermatitis: International Eczema Council Consensus

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  1. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement A.M. Drucker, MD, ScM, K. Eyerich MD, PhD, M.S. de Bruin-Weller MD, PhD, J.P. Thyssen MD, PhD, P.I. Spuls, MD, PhD, A.D. Irvine, MD Dsc, G. Girolomoni, MD S. Dhar, MBBS, MD. C. Flohr, D.F. Murrell MD, A.S. Paller MD, E. Guttman-Yassky MD, PhD Journal reference

  2. Dr Aaron Drucker

  3. Introduction What’s already known? • Evidence of the benefits and risks of systemic corticosteroids (CS) in atopic dermatitis is scarce • Systemic CS can cause significant adverse events and rebound flares on discontinuation • Clinical practice guidelines generally recommend against their use • Nevertheless, systemic CS are frequently prescribed for atopic dermatitis patients Roekevisch E et al. JACI. 2014; 133: 429-38.

  4. Methods • Phase 1: Electronic questionnaire sent to International Eczema Council (IEC; http://www.eczemacouncil.org/) members regarding their use of systemic CS • Phase 2: In-person meeting of IEC members to discuss use of systemic CS • Phase 3: Consensus survey of IEC members

  5. Consensus methods • 26 statements accompanied by visual analog scales • “strongly disagree” to “neutral” to “strongly agree” • Consensus reached if <30% of participants marked on the left side of the scale towards “strongly disagree” • Rules developed and made known to participants prior to survey completion

  6. Results - Respondents • 60/77 (79%) IEC Councilors and Associates responded • 52 completed entire survey • Respondents were from: Australia (2) Israel (2) Austria (1) Italy (2) Brazil (1) Japan (5) Canada (2) Korea (3) China (1) Netherlands (4) Denmark (3) Spain (1) France (6) Taiwan (1) Germany (7) Tanzania (1) India (1) UK (3) Ireland (1) USA (13)

  7. Results – Statements reaching consensus 1 • For CHILDREN under the age of 12, given concerns of side effects and rebound flares on discontinuation, systemic corticosteroids should generally be avoided in the treatment of severe atopic dermatitis. • For CHILDREN under the age of 12, given concerns of side effects and rebound flares on discontinuation, systemic corticosteroids may be used rarely for severe atopic dermatitis. • For CHILDREN between 12 and 17 years of age, given concerns of side effects and rebound flares on discontinuation, systemic corticosteroids should generally be avoided in the treatment of severe atopic dermatitis.

  8. Results – Statements reaching consensus 2 • For CHILDREN between 12 and 17 years of age, given concerns of side effects and rebound flares on discontinuation, systemic corticosteroids may be used rarely for severe atopic dermatitis. • For ADULTS 18 and over, given concerns of side effects and rebound flares on discontinuation, systemic corticosteroids should generally be avoided in the treatment of severe atopic dermatitis. • For ADULTS 18 and over, given concerns of side effects and rebound flares on discontinuation, systemic corticosteroids may be used rarely for severe atopic dermatitis.

  9. Results – Statements reaching consensus 3 • Systemic corticosteroids may be used for severe atopic dermatitis when there are no other viable treatment options. • Systemic corticosteroids may be used for severe atopic dermatitis as a bridge to other systemic agents or phototherapy. • Systemic corticosteroids may be used for severe atopic dermatitis in an acute flare in need of immediate relief.

  10. Results – Statements reaching consensus 4 • Systemic corticosteroids may be used for severe atopic dermatitis in anticipation of an important life event (e.g., wedding). • Systemic corticosteroids may be used for severe atopic dermatitis in cases that are the most severe (e.g., erythrodermic). • If used, treatment with systemic corticosteroids for severe atopic dermatitis should be limited to short-term use.

  11. Discussion What does this study add? • Among a large international group of clinicians and researchers, we reached consensus on 12 key statements related to the use of systemic CS for atopic dermatitis • Most respondents (but not enough for consensus) agreed that systemic CS should never be used in children • The major limitation of this project is the limited evidence to support the consensus statements

  12. Conclusions • It is the consensus of the IEC that systemic CS have a limited role in the treatment of severe atopic dermatitis • The divergence between guidelines discouraging systemic CS use versus their frequent use in routine clinical practice are a concern • We hope our paper serves to curb inappropriate over-prescription of systemic CS for patients with atopic dermatitis

  13. Call for correspondence • Why not join the debate on this article through our correspondence section? • Rapid responses should not exceed 350 words, four references and one figure • Further details can be found here: here

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