Atopic dermatitis: Topical corticosteroids recommendations

  • Topical corticosteroids are recommended for AD-affected individuals who have failed to respond to good skin care and regular use of emollients alone.

Level of Evidence: I Strength of Recommendation: A

  • A variety of factors should be considered when choosing a particular topical corticosteroid for the treatment of AD, including patient age, areas of the body to which the medication will be applied, and other patient factors such as degree of xerosis, patient preference, and cost of medication.

Level of Evidence: III Strength of Recommendation: C

  • Twice-daily application of corticosteroids is generally recommended for the treatment of AD; however, evidence suggests that once-daily application of some corticosteroids may be sufficient.

Level of Evidence: II Strength of Recommendation: B

  • Proactive, intermittent use of topical corticosteroids as maintenance therapy (1-2 times/wk) on areas that commonly flare is recommended to help prevent relapses and is more effective than use of emollients alone.
Level of Evidence: II Strength of Recommendation: B

  • The potential for both topical and systemic side effects, including possible hypothalamic-pituitary-adrenal axis suppression, should be considered, particularly in children with AD in whom corticosteroids are used.

Level of Evidence: I Strength of Recommendation: C

  • Monitoring by physical examination for cutaneous side effects during long-term, potent steroid use is recommended.

Level of Evidence: III Strength of Recommendation: B

  • No specific monitoring for systemic side effects is routinely recommended for patients with AD.

Level of Evidence: III Strength of Recommendation: C

  • Patient fears of side effects associated with the use of topical corticosteroids for AD should be recognized and addressed to improve adherence and avoid undertreatment.

Level of Evidence: III Strength of Recommendation: B


Navigate section 2 of the AD guideline: Topical therapy

Citation note 

When referencing this guideline in a publication, please use the following citation: Eichenfield LF, Tom WL, Berger TG, Krol A, Paller AS, Schwarzenberger K, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014 Jul;71(1):116-32.

 


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