Choosing Wisely:

Avoid the use of systemic (oral or injected) corticosteroids in most cases of atopic dermatitis.

Rationale and Comments: Although systemic corticosteroids can lead to rapid clearing of disease and improvement in pruritus, many short- and long-term adverse effects limit their use, including significant growth retardation, adrenal suppression in more than 90%, and rebound flaring and/or worsening of disease at the time of corticosteroid discontinuation. Atopic dermatitis treatment guidance put forth by the American Academy of Dermatology specifically advises against the use of systemic steroids in children with atopic dermatitis, with few exceptions. In general, atopic dermatitis can be adequately controlled with good skin care practices and topical prescription therapies. In patients who have recalcitrant disease, phototherapy and/or steroid-sparing systemic agents may be required for adequate control. Systemic corticosteroids should only be prescribed for severe flares once all other treatment options have been exhausted and should be limited to a short course for the purpose of bridging to a steroid-sparing agent.
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Dermatology
  • Sources:
  • Systematic review
  • Disciplines:
  • Pediatric
  • Dermatologic
  • References: • Proudfoot LE, et al.; European Dermato-Epidemiology Network (EDEN). The European TREatment of severe Atopic eczema in children Taskforce (TREAT) survey. Br J Dermatol. 2013;169(4):901-909.
    • Drucker AM, et al. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement. Br J Dermatol. 2018;178(3):768-775.
    • Yu SH, et al. A systematic review of the safety and efficacy of systemic corticosteroids in atopic dermatitis. J Am Acad Dermatol. 2018;78(4):733-740.
    • Sidbury R, et al. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. 2014;71(2):327-349.
    • Tollefson MM, et al.; American Academy of Pediatrics, Section on Dermatology. Atopic dermatitis: skin-directed management. Pediatrics. 2014;134(6):e1735-e1744.

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