Table III.

Recommendations for the use of topical corticosteroids for the treatment of atopic dermatitis

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

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.

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.

Proactive, intermittent use of topical corticosteroids as maintenance therapy (1–2 times per week) on areas that commonly flare is recommended to help prevent relapses and is more effective than use of emollients alone.

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

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

No specific monitoring for systemic side effects is routinely recommended for patients with atopic dermatitis.

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