Expert consensus: time for a change in the way we advise our patients to use topical corticosteroids

@article{Bewley2008ExpertCT,
  title={Expert consensus: time for a change in the way we advise our patients to use topical corticosteroids},
  author={Anthony Bewley},
  journal={British Journal of Dermatology},
  year={2008},
  volume={158}
}
  • A. Bewley
  • Published 1 May 2008
  • Medicine
  • British Journal of Dermatology
Topical corticosteroids form the mainstay of treatment for many skin conditions. If used appropriately, they are safe and effective, and side‐effects are generally uncommon. Current advice to patients to apply topical corticosteroid preparations ‘sparingly’ or ‘thinly’ contributes to ‘steroid phobia’, increasing the risk of poor clinical response and treatment failure. Such cautionary advice also overlooks the fact that the vast majority of patients are prescribed topical corticosteroids of… 
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111 Citations
Highly Influential Citations
4
Background Citations
23
Methods Citations
4
Results Citations
1

111 Citations

Rational and Ethical Use of Topical Corticosteroids Based on Safety and Efficacy
TLDR
Simultaneous efforts to use political, legal, and other institutions to prevent misuse of these drugs by rationing their availability only through proper prescriptions will greatly help the cause.
An Evidence Based Approach of Use of Topical Corticosteroids in Dermatology
TLDR
Evidence suggests recommended judicious use of mild to moderate steroids (if required) in pregnancy and lactation and there is no risk of any foetal abnormality, but contrary to conventional wisdom, no high-level scientific evidence is found supporting the prescription of these agents in cutaneous lichen planus, sarcoidosis and seborrhoeic dermatitis.
Impact of Medical Specialty on the Prescription Patterns of Topical Corticosteroid Among Healthcare Professionals
TLDR
Physician and pharmacist adherence to clinical guidelines for safe prescription of topical corticosteroids was poor and updating Physicians and pharmacists on practice guidelines is the most urgent recommendation to improve treatment of atopic dermatitis.
A cross sectional study on the prescribing pattern, self medication and adverse reactions associated with topical corticosteroids -
TLDR
The rationale and safe prescribing pattern of corticosteroids, one of the common drugs used by the dermatologists brought a revolutionary change in their practice, is observed but the need for continuous medical education for the clinicians is indicated.
A prospective observational study of prescription pattern of topical steroids in dermatology OPD, BRIMS, Bidar, India
TLDR
The corticosteroids prescribed by brand names (82.05%) were more than generic names (26.01%), information about the strength of the steroid was not mentioned and usage of emollients was less, indicating the need for continuous medical education for the clinicians.
Ethical Use of Topical Corticosteroids
TLDR
A thorough understanding of the skin disease being treated coupled with expertise in the use of the varied potencies and available dosage forms of topical corticosteroids is needed to use these agents optimally.
Pearls in Mitigating Application Pain of Topical Nonsteroidal Agents
TLDR
7 practical strategies for decreasing the pain associated with SSA use: Use a topical corticosteroid for a few days to reduce inflammation before starting the SSA treatment, and use SSAs strategically.
Information and Anxiety Levels of the Parents about Using Topical Corticosteroids on Children
TLDR
An unnecessary phobia regarding steroids is detected in the general population and even in health care workers with increasing education level and the anxiety affected the treatment process negatively; physicians are suggested to consider this fact and provide information to parents prior to treatment to affect the results of the treatment positively.
New Perspectives in the Treatment of Atopic Dermatitis in the Pediatric Population
TLDR
Treatment of children diagnosed with atopic dermatitis (AD) is an art, but all currently available systemic agents for severe AD are either not licensed for children or not advisable on the long term, or both.
Assessment of “corticophobia” as an indicator of non-adherence to topical corticosteroids: A pilot study
TLDR
Using the VAS to assess concerns to use TCS could help identify patients at risk of TCS-non-adherence and facilitate discussion with the patient about potential non-adherent in a more substantiated, non-judgemental way.
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References

SHOWING 1-10 OF 20 REFERENCES
Topical corticosteroid phobia in patients with atopic eczema
TLDR
The need for provision of better information and education to patients and possibly general practitioners regarding the safety, potency and appropriate use of topical corticosteroids is highlighted.
Parental knowledge of topical therapies in the treatment of childhood atopic dermatitis
TLDR
There was poor knowledge of the strengths of some of the most commonly used TCSs, and all steroid/antimicrobial combinations were perceived as being of greater potency than the constituent steroid alone.
Long‐term safety and tolerability of pimecrolimus cream 1% and topical corticosteroids in adults with moderate to severe atopic dermatitis
TLDR
Pimecrolimus demonstrated a favourable safety profile when used to treat adult patients with moderate–severe atopic dermatitis for up to 1 year, and a significant proportion of patients could be maintained without TCS for a year.
The management of moderate to severe atopic dermatitis in adults with topical fluticasone propionate
TLDR
Patients who entered the maintenance phase and were treated with intermittent FP for up to 16 weeks, demonstrated its superior efficacy over placebo, maintaining the improvements achieved after the initial treatment phase, reducing risk of relapse and delaying time to relapse.
Systematic review of treatments for atopic eczema.
TLDR
An up-to-date coverage 'map' of randomised controlled trials (RCTs) of treatments of atopic eczema is produced to assist in making treatment recommendations by summarising the available RCT evidence using qualitative and quantitative methods.
Randomised controlled trial of short bursts of a potent topical corticosteroid versus prolonged use of a mild preparation for children with mild or moderate atopic eczema
TLDR
A short burst of a potent topical corticosteroid is just as effective as prolonged use of a milder preparation for controlling mild or moderate atopic eczema in children.
Superpotent topical steroid treatment of psoriasis vulgaris--clinical efficacy and adrenal function.
Hypothalamic-Pituitary-Adrenal Function and Glucocorticoid Sensitivity in Atopic Dermatitis
TLDR
Evidence of HPA suppression but lack of clinical response to GC treatment excluded significant generalized GC resistance, which would suggest that localized resistance to GCs within the diseased skin may be part of the aetiopathogenesis of severe AD.
Six‐month controlled study of effect of desoximetasone and betamethasone 17‐valerate on the pituitary‐adrenal axis
TLDR
The clinical response to desoximetasone emollient cream was significantly better than to betamethasone valerate cream and the way in which many patients with steroid‐responsive dermatoses use potent topical steroids, namely over a long time period and without occlusion.
Intermittent dosing of fluticasone propionate cream for reducing the risk of relapse in atopic dermatitis patients
TLDR
This poster focuses on the treatment of adults with atopic dermatitis with or without a history of central giant cell granuloma, which has a known chronic relapsing nature and can be fatal in women.
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