Appropriate use of topical corticosteroids

According to treatment guidelines recently developed in Europe, Asia, and the United States, topical corticosteroid remain the mainstay of treatment for adults and children with atopic dermatitis, even in severe cases in which they may be used in combination with systemic therapies. Topical corticosteroids are recommended when patients have failed to respond to a consistent eczema skin care regimen, including the regular use of moisturizers (emollients), appropriate anti-bacterial measures, and trying to eliminate any possible allergens that may be contributing to the underlying problem.

Goals for treating atopic dermatitis:

1. Prevent flares: Practice a consistent skin care regimen. Use gentle, non-irritating products, use moisturizers regularly, reduce bacterial colonization and infection (for example, with the use of dilute bleach baths), and identify and eliminate any possible allergens, irritants or triggers.
2. Induce remission: Use topical corticosteroids once or twice daily for up to 14 days. Once or twice daily application is recommended for most preparations. More frequent administration does not provide better results. Low-potency steroids should be used on the face and with caution around the eyes.
3. Maintain control:
   a. Eliminate all possible underlying allergens, irritants, and triggers.
   b. Use appropriate moisturizers frequently and liberally.
   c. Apply topical corticosteroids twice weekly to problem areas.
   d. Stay in close contact with your provider and consider adding other therapies such as calcineurin inhibitors or phototherapy if eczema is not responsive to medication or control is hard to maintain. Also, consider patch testing by a specialist who can test an extended allergen series, including corticosteroids and all potentially allergenic components of corticosteroids, as well as other skin care and environmental allergens.
4. Rescue flares using TCS: the sooner applied, the more quickly controlled–then   back to maintenance therapy. Your doctor may prescribe a stronger steroid to be  used immediately for flares for a few days and then ask you to go to a weaker steroid once the flare has improved.

Do not use daily TCS continuously for more than two to four weeks.

Your provider should strive to help create a safe and effective long-term treatment plan that does not include daily use of topical corticosteroids, especially on more sensitive areas. Close follow up and careful monitoring with good communication will help ensure this. Do not ask for multiple refills without evaluation or questioning the usage pattern.

Side effects are rarely reported with low to mid-potency topical corticosteroids. According to the report, topical corticosteroid withdrawal syndrome generally occurs after inappropriate, prolonged frequent use of high-potency topical corticosteroids. Concern for this side effect should not prevent the appropriate management of patients with chronic inflammatory skin disease. As with all medications, steroids are associated with some risk.