Corticosteroid Exposure and Cumulative Effects in Patients With Eczema

Patients with eczema and atopic conditions often experience substantial corticosteroid (CS) exposure. This study aimed to determine total self-reported CS exposure and perceived response or adverse effects of topical corticosteroids (TCS) in individuals with eczema.

Participants included 2160 patients 18 years or older who (median age 28.7 years) completed the survey (4% response rate); 1889 were patients and 271 were caregivers of a child (median age 4.9 years) diagnosed with eczema by a medical professional. Subjects were contacted via e-mail lists from patient support and topical steroid awareness organizations.

The 26-question survey assessed participant demographics, eczema severity and distribution, treatment history for eczema, CS use in noneczema conditions, and experience with topical steroid withdrawal syndrome (TSWS). TSWS was self-diagnosed based on a description to participants as a rebound response consisting of burning and severe itch, edema, and profuse shedding of skin after discontinuing TCS. Analyses of the survey responses were descriptive.

All participants reported using a form of CS to treat their eczema, with 91% using a TCS. Time of over the counter TCS use was 14.0 years in adults and 3.7 years in children, whereas prescription TCS use was 15.3 years in adults and 3.6 years in children. TCS use 1 to 2 times daily was most common, with 50% using TCS 15 to 30 days each month. Oral CS were used for eczema in 23% of cases, with 43% of adults and 35% of children reporting 6 or more courses of oral CS to treat eczema or other conditions during their lifetime. Forty nine percent of participants reported use of various CS formulations for noneczema conditions: most commonly for asthma (oral or inhaled CS). Reasons for discontinuing TCS for eczema included ineffectiveness, new or worsening symptoms, or side effects more often than symptom resolution. Seventy nine percent of adults and 43% of children noted symptoms consistent with TSWS.

Patients in the survey had substantial cumulative CS exposure during the course of their lifetime eczema experience and higher exposures corresponded with poorer outcomes.

This study highlights that TCS are widely used in eczema management and TCS exposure may be associated with significant side effects without much therapeutic benefit. The majority of participants in this study were female members of advocacy organizations, which may limit the generalizability of the results. Additional limitations include lack of data regarding skin care and moisturizing routines along with irritant avoidance practices. Further, clinical details, such as eczema severity and symptoms, consistent with TSWS were self-reported, introducing recall bias, and were not confirmed by medical providers. This highlights the need to closely monitor patients using TCS, and providers should consider the use of corticosteroid-sparing agents when possible.