Strategies for using topical corticosteroids in children and adults with eczema

Stephanie J Lax *, Jane Harvey , Emma Axon , Laura Howells , Miriam Santer , Matthew J Ridd

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)peer-review

39 Citations (Scopus)
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Abstract

Background
Eczema is a common skin condition. Although topical corticosteroids have been a first‐line treatment for eczema for decades, there are uncertainties over their optimal use.

Objectives
To establish the effectiveness and safety of different ways of using topical corticosteroids for treating eczema.

Search methods
We searched databases to January 2021 (Cochrane Skin Specialised Register; CENTRAL; MEDLINE; Embase; GREAT) and five clinical trials registers. We checked bibliographies from included trials to identify further trials.

Selection criteria
Randomised controlled trials in adults and children with eczema that compared at least two strategies of topical corticosteroid use. We excluded placebo comparisons, other than for trials that evaluated proactive versus reactive treatment.

Data collection and analysis
We used standard Cochrane methods, with GRADE certainty of evidence for key findings. Primary outcomes were changes in clinician‐reported signs and relevant local adverse events. Secondary outcomes were patient‐reported symptoms and relevant systemic adverse events. For local adverse events, we prioritised abnormal skin thinning as a key area of concern for healthcare professionals and patients.

Main results
We included 104 trials (8443 participants). Most trials were conducted in high‐income countries (81/104), most likely in outpatient or other hospital settings. We judged only one trial to be low risk of bias across all domains. Fifty‐five trials had high risk of bias in at least one domain, mostly due to lack of blinding or missing outcome data.
Original languageEnglish
Article numberCD013356
Pages (from-to)1- 530
Number of pages530
JournalCochrane Database of Systematic Reviews
Volume2022
Issue number3
DOIs
Publication statusPublished - 11 Mar 2022

Bibliographical note

Funding Information:
We firstly thank Dr Heleen Moed and Professor Arnold P. Oranje (1948-2016) who were authors on the original protocol, and Dr Douglas Grindlay for assisting with our original scoping search. The Centre of Evidence Based Dermatology (CEBD) Patient Panel have also been instrumental in shaping this work.

Publisher Copyright:
Copyright © 2022 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.

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