Sherry H Yu1, Aaron M Drucker2, Mark Lebwohl3, Jonathan I Silverberg4. 1. Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts. 2. Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island; Division of Dermatology, Department of Medicine and Women's College Research Institute, Women's College Hospital, Toronto, Canada. 3. Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York. 4. Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, Illinois; Department of Preventive Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois; Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, Illinois. Electronic address: JonathanISilverberg@Gmail.com.
Abstract
BACKGROUND: Systemic corticosteroids are often used to treat atopic dermatitis (AD). However, few studies have assessed the safety and efficacy of systemic corticosteroids in AD. OBJECTIVE: To systematically review the literature on efficacy and safety of systemic corticosteroid use (oral, intramuscular, and intravenous) in AD. METHODS: PubMed, Embase, Medline, Scopus, Web of Science, and Cochrane Library were searched. We included systematic reviews, guidelines, and treatment reviews of systemic corticosteroid use among patients of all ages with a diagnosis of AD (52 reviews and 12 studies). RESULTS: There was general consensus in the literature to limit the use of systemic steroids to short courses as a bridge to steroid-sparing therapies. Systemic side effects include growth suppression in children, osteoporosis, osteonecrosis, adrenal insufficiency, Cushing syndrome, hypertension, glucose intolerance, diabetes, gastritis, gastroesophageal reflux, peptic ulcer disease, weight gain, emotional lability, behavioral changes, opportunistic infections, cataracts, glaucoma, myopathy, myalgia, dysaesthesia, pseudotumor cerebri, hyperlipidemia, malignancy, thrombosis, skin atrophy, sleep disturbance, and rebound flaring. LIMITATIONS: Baseline clinical severity, corticosteroid delivery and dose, and treatment response were reported incompletely and heterogeneously across studies. CONCLUSIONS: Evidence is not strong enough to determine optimal delivery or duration of systemic corticosteroids in AD.
BACKGROUND: Systemic corticosteroids are often used to treat atopic dermatitis (AD). However, few studies have assessed the safety and efficacy of systemic corticosteroids in AD. OBJECTIVE: To systematically review the literature on efficacy and safety of systemic corticosteroid use (oral, intramuscular, and intravenous) in AD. METHODS: PubMed, Embase, Medline, Scopus, Web of Science, and Cochrane Library were searched. We included systematic reviews, guidelines, and treatment reviews of systemic corticosteroid use among patients of all ages with a diagnosis of AD (52 reviews and 12 studies). RESULTS: There was general consensus in the literature to limit the use of systemic steroids to short courses as a bridge to steroid-sparing therapies. Systemic side effects include growth suppression in children, osteoporosis, osteonecrosis, adrenal insufficiency, Cushing syndrome, hypertension, glucose intolerance, diabetes, gastritis, gastroesophageal reflux, peptic ulcer disease, weight gain, emotional lability, behavioral changes, opportunistic infections, cataracts, glaucoma, myopathy, myalgia, dysaesthesia, pseudotumor cerebri, hyperlipidemia, malignancy, thrombosis, skin atrophy, sleep disturbance, and rebound flaring. LIMITATIONS: Baseline clinical severity, corticosteroid delivery and dose, and treatment response were reported incompletely and heterogeneously across studies. CONCLUSIONS: Evidence is not strong enough to determine optimal delivery or duration of systemic corticosteroids in AD.
Authors: Marissa T Ayasse; Adnan Ahmed; Maria L Espinosa; Christina J Walker; Muhammad Yousaf; Jacob P Thyssen; Jonathan I Silverberg Journal: Arch Dermatol Res Date: 2020-11-22 Impact factor: 3.017
Authors: Kristin J Meyers; Jonathan I Silverberg; Maria Jose Rueda; Robert Goodloe; Evangeline J Pierce; Walter Deberdt; Dennis R Brinker Journal: Dermatol Ther (Heidelb) Date: 2021-04-30