The long-term safety of topical corticosteroids in atopic dermatitis: A systematic review
The long-term safety of topical corticosteroids in atopic dermatitis: A systematic review
Background
Topical corticosteroids (TCS) are a first-line treatment for eczema, but there are concerns about their safety when used long-term.
Objectives
To systematically review adverse effects associated with longer-term use of TCS for eczema.
Methods
Randomised controlled trials (RCTs), cohort and case-control studies reporting adverse effects of TCS (comparators: no TCS treatment, other topicals) in patients with eczema were identified. Included studies had greater than one year of follow-up, minimum cohort size of 50 participants, or minimum 50 per arm for RCTs. Evidence was GRADE-assessed. Prospero registration CRD42021286413.
Results
We found seven studies (two randomised, five observational); two RCTs (n = 2570, including 1288 receiving TCS), two cohort (all received TCS n = 148) and three case-control studies (cases n = 10 322, controls n = 12 201). Evidence from two RCTS (n = 2570, children, three and five years' duration) comparing TCS to topical calcineurin inhibitors found intermittent TCS use probably results in little to no difference in risk of growth abnormalities, non-skin infections, impaired vaccine response and lymphoma/non lymphoma malignancies. The five-year RCT reported only one episode of skin atrophy (n = 1213 TCS arm; mild/moderate potency), suggesting TCS use probably results in little to no difference in skin thinning when used intermittently to treat flares. No cases of clinical adrenal insufficiency were reported in 75 patients using mild/moderate TCS in the three-year RCT. Small associations between TCS and type-2 diabetes and lymphoma were identified in two case-control studies compared to no TCS, but the evidence is very uncertain. No long-term studies concerning topical steroid withdrawal or eye problems were identified.
Conclusion
This review provides some reassuring data on growth and skin thinning when TCS are used intermittently for up to 5 years, but many knowledge gaps remain.
Harvey, Jane
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Lax, Stephanie J.
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Lowe, Alison
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Santer, Miriam
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Lawton, Sandra
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Langan, Sinead M.
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Roberts, Amanda
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Stuart, Beth
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Williams, Hywel
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Thomas, Kim
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October 2023
Harvey, Jane
72ceb343-3da3-4bfa-8fd9-ed206f13a94e
Lax, Stephanie J.
bf86536a-90e8-42fb-925c-f8b41a216851
Lowe, Alison
519ce5cc-beca-4a15-806b-f9fd66a443d3
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Lawton, Sandra
271134af-c3c5-4596-9deb-cfdecc099f8e
Langan, Sinead M.
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Roberts, Amanda
589bdded-6498-4d71-9c74-3ff735e4fcee
Stuart, Beth
aadc0e97-61f0-4e95-9fbb-109b7d2ff59f
Williams, Hywel
805c7100-2f6e-410c-9418-ed0cad29bac7
Thomas, Kim
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Harvey, Jane, Lax, Stephanie J., Lowe, Alison, Santer, Miriam, Lawton, Sandra, Langan, Sinead M., Roberts, Amanda, Stuart, Beth, Williams, Hywel and Thomas, Kim
(2023)
The long-term safety of topical corticosteroids in atopic dermatitis: A systematic review.
Skin Health and Disease Open Access, 3 (5), [e268].
(doi:10.1002/ski2.268).
Abstract
Background
Topical corticosteroids (TCS) are a first-line treatment for eczema, but there are concerns about their safety when used long-term.
Objectives
To systematically review adverse effects associated with longer-term use of TCS for eczema.
Methods
Randomised controlled trials (RCTs), cohort and case-control studies reporting adverse effects of TCS (comparators: no TCS treatment, other topicals) in patients with eczema were identified. Included studies had greater than one year of follow-up, minimum cohort size of 50 participants, or minimum 50 per arm for RCTs. Evidence was GRADE-assessed. Prospero registration CRD42021286413.
Results
We found seven studies (two randomised, five observational); two RCTs (n = 2570, including 1288 receiving TCS), two cohort (all received TCS n = 148) and three case-control studies (cases n = 10 322, controls n = 12 201). Evidence from two RCTS (n = 2570, children, three and five years' duration) comparing TCS to topical calcineurin inhibitors found intermittent TCS use probably results in little to no difference in risk of growth abnormalities, non-skin infections, impaired vaccine response and lymphoma/non lymphoma malignancies. The five-year RCT reported only one episode of skin atrophy (n = 1213 TCS arm; mild/moderate potency), suggesting TCS use probably results in little to no difference in skin thinning when used intermittently to treat flares. No cases of clinical adrenal insufficiency were reported in 75 patients using mild/moderate TCS in the three-year RCT. Small associations between TCS and type-2 diabetes and lymphoma were identified in two case-control studies compared to no TCS, but the evidence is very uncertain. No long-term studies concerning topical steroid withdrawal or eye problems were identified.
Conclusion
This review provides some reassuring data on growth and skin thinning when TCS are used intermittently for up to 5 years, but many knowledge gaps remain.
Text
Skin Health and Disease - 2023 - Harvey
- Version of Record
More information
Accepted/In Press date: 28 June 2023
Published date: October 2023
Additional Information:
Funding Information:
Jane Harvey, Stephanie J. Lax, have declared that they have no conflict of interest. Alison Lowe has worked for AbbVie and has been sponsored to attend conference and educational events by AbbVie and Eli‐Lilly. Sandra Lawton is funded by an honorarium (Thorton and Ross – lecture). Sandra Lawton took part in a Podcast transitioning young people with Eczema (funded by Abbvie). Sinead M. Langan is funded by a Wellcome Senior Clinical fellowship. Sinead M. Langan is an investigator on the European Union Horizon 2020‐funded BIOMAP Consortium ( http://www.biomap‐imi.eu/ ), but not in receipt of industry funding. Miriam Santer, Sandra Lawton, Sinead M. Langan, Amanda Roberts, Beth Stuart, Hywel C. Williams and Kim S. Thomas are ECO co‐applicants. HCW and KST are members of the Harmonising Outcomes Measures for Eczema Executive Group.
Funding Information:
This review forms part of a body of work funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (grant no: RP‐PG‐0216‐20007) to develop an online behavioural intervention to support self‐care of atopic eczema in children, adolescents, and young adults (ECO) and the findings will contribute to development of the intervention by providing data on the best and safest ways to use TCS.
Publisher Copyright:
© 2023 The Authors. Skin Health and Disease published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.
Identifiers
Local EPrints ID: 481268
URI: http://eprints.soton.ac.uk/id/eprint/481268
ISSN: 2690-442X
PURE UUID: a6cdadf9-4d29-42b9-b4af-acfe41864717
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Date deposited: 21 Aug 2023 17:05
Last modified: 18 Mar 2024 03:13
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Contributors
Author:
Jane Harvey
Author:
Stephanie J. Lax
Author:
Alison Lowe
Author:
Sandra Lawton
Author:
Sinead M. Langan
Author:
Amanda Roberts
Author:
Beth Stuart
Author:
Hywel Williams
Author:
Kim Thomas
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