Under the Microscope: Topical Steroid Bias

Dr. Aaron Drucker headshot next to microscope

By Hope Hamashige

Published On: Jul 10, 2024

Last Updated On: Jul 10, 2024

The National Eczema Association (NEA) is the largest private nonprofit funder of research for adult and pediatric eczema, investing more than $4 million to date. Ever wonder what exactly our research grant recipients are working on? Under the Microscope is where we provide an inside look at research from one of our latest grant recipients, including what they are studying and its potential impact on the eczema community.

A new look at an old treatment

Topical corticosteroids are one of the oldest and most frequently-prescribed treatments for eczema. Although topical steroids have been in use for decades, many patients and medical professionals have deep-seated fears that they can lead to serious side effects, particularly if they are used long-term and at higher potencies.

This fear has real consequences for some people with eczema. Dr. Aaron Drucker, a dermatologist and clinician-scientist at Women’s College Hospital and the University of Toronto said that many patients and healthcare providers are so hesitant to use topical steroids that some people’s eczema stays uncontrolled.

It is with this in mind that Dr. Drucker launched a multi-year research project in January 2023 to evaluate, as thoroughly as possible, the safety of long-term use of topical steroids. This research is funded by an Eczema Champion Research Grant from NEA that he was initially awarded in 2022 and received a second year of support in 2023. He plans to determine the likelihood of individuals developing five serious side effects — hypertension, glaucoma, cataracts, diabetes and/or bone fractures — over time while using topical corticosteroids. 

“There is a real bias against using topical steroids on the part of a lot of patients and some providers,” said Dr. Drucker. “Millions of people around the world use topicals, so it is incredibly important to really understand how safe they are and how best to use them.” 

Settling an old question

Over the more than 50 years that topical corticosteroids have been in use, there have been studies to determine their side effects. Dr. Drucker noted that while there is little evidence in the existing literature that connects topical corticosteroids with hypertension, glaucoma or cataracts, a few found connections to diabetes and/or bone fractures. 

Dr. Drucker hopes to improve on the existing literature by employing advanced pharmacoepidemiologic methods to provide the most reliable evidence to date on the side effects of topical corticosteroids. His approach allows him to consider not only the use of topical corticosteroids, but to account for the potency of the treatment, the duration of use and the unique formulations of different types of topical corticosteroids. He will also be able to account for confounding factors, such as whether a person was taking other medications, including oral corticosteroids, that can influence outcomes. 

Dr. Drucker is using health data from two Canadian provinces, British Columbia and Ontario, to conduct this work. These high-quality data sets include information on millions of Canadians of diverse backgrounds and ages who used topical corticosteroids between 2002 and 2021. The quality of the data and the advanced methodology should yield solid information on the odds of developing side effects based on the total topical steroid use and the potency of the treatment. 

“We have developed a method of looking at this question that is going to give us more reliable and more nuanced answers than much of what we have seen in the past,” said Dr. Drucker.

A focus on education

Even though the number of treatments for eczema has grown dramatically in recent years, it remains critical to understand the safety profile of topical corticosteroids. Dr. Drucker noted that topical steroids are still widely used and, at times, are the best treatment option. 

Dr. Drucker added that he expects to publish the results of his research in the next few years. He believes that whatever the findings, they will be important for patients and healthcare providers and will finally give them reliable advice about how to use topical corticosteroids. 

“If what we find is reassuring, patients need to know that,” said Dr. Drucker. “If what we find is cautionary, they need to know what the real risks are, and we hope to give them the best evidence possible.”

NEA grants and their impact

NEA is dedicated to increasing the number of scientists, research projects and research dollars devoted to eczema, in pursuit of better therapies, better care, better outcomes –– and one day, potentially, a cure. Learn more about our eczema research grants, their impact and how you can get involved.

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