Long term control of Atopic Eczema

  • How to best use topical steroids
    • Which potency?
    • How often should they be used for control?
    • How to minimise side effects?
  • If calcineurin inhibitors are to be used, how should they be best combined with topical steroids

Atopic Dermatitis

Which potency of topical corticosteroid?

  • Mild or moderate or potent?
  • For long term use mild corticosteroids are usually safe on the face and folds. They are usually ineffective for moderate eczema elsewhere.
  • Moderate products are more quickly acting and may therefore result in much less medication being used Potent preparations such as Cutivate work fast.
  • Stronger corticosteroids work faster but have more potential side effects if used long term

Potency of Cutivate:

  • Mild – Hydrocortisone
  • Moderate – Eumovate (Clobetasone butyrate)
  • Potent – Cutivate (Fluticasone propionate)
  • Very potent – Dermovate (Clobetasol propionate)

Atopic Eczema

How often should topical corticosteroids be used?

    • Twice a day applications may not in general be more effective than if used daily.

[Hoare C et al Health Technol Assess 2000;4:1-191]

  • Long term daily use of topical corticosteroids can risk both skin and systemic side effects.
  • Twice a week application of Cutivate has been shown to be effective in maintaining control of atopic eczema.

Consensus from 4 studies

Intermittent, twice weekly Cutivate can maintain remission in moderate to severe atopic dermatitis

4 double blind randomized controlled studies in 772 adults and children showed the once the acute episode of moderate to severe eczema had been treated effectively that twice weekly Cutivate when added to standard emollient reduced the risk of relapse to more than 16 weeks

  • 1. Van der Meer et al Br J Derm 1999.140: 1115-1121
  • 2. Glazenberg et al J Eur Acad Dermatol Ven 2003 17(3) 184
  • 3. Berth-Jones J et al BMJ 2003:326:1367-1370
  • 4. Hanifin et al Br J Derm 147;528-537

How to minimize side effects of topical corticosteroids?

  • Use a potent product for a short time to gain control of the inflammation.
  • Maintain control with twice weekly application of a potent steroid
  • Moisturise the skin frequently and reduce other skin irritants such as soap.
  • Explore intermittent use of other agents if a top up in eczema control is required.
  • Use minimal corticosteroids on the face, folds and around the eyes