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ACD statement aims to reduce ‘steroid phobia’

The Australasian College of Dermatologists (ACD) has released a consensus statement on the use of topical corticosteroids for childhood atopic dermatitis (Feb. 6, 2017).

“There is significant misinformation about the use of steroid creams to treat eczema in children. The ACD position statement provides needed recommendations to general practitioners, nurses, and pharmacists on the safe and effective use of steroids,” said the president of the ACD, Dr. Chris Baker, in a media release.

“The advice given by dermatologists to parents of children with eczema on the use of steroids is unfortunately frequently undermined by misinformation among the general community, pharmacists, and general practitioners,” said Dr. Gayle Fischer, an associate professor at the University of Sydney.

She continued, “it is easy to find negative messages about steroids on the internet, but hard to find positive ones. The resulting ‘steroid phobia’ can lead to the poor treatment of eczema in children, further frustration to parents and continued discomfort for the affected child.

“There is a pressing need for the re-education of the community to not be afraid to use steroids and let them know that concerns on long-term adverse effects associated with steroid use are unfounded,” said Dr. Fischer.

The ACD guidelines state that patients should follow product information and apply steroids once or twice a day to all the inflamed skin until atopic dermatitis is cleared. Enough cream should be used so that the entire affected area is covered. The steroid cream should be used for as long as it takes for the atopic dermatitis to clear, then when flares occur.

The key points from the statement include:

  • There is little difference in the clinical effect between 0.5, 1, and 2% hydrocortisone.

  • Diluting a strong steroid with moisturizer does not reduce its clinical effect. Potency reduction is achieved by using a less potent steroid molecule.

  • Most topical steroids can be applied once daily, preferably in the evening or at night.

  • The recommendation ‘use sparingly' is nonsensical and has no value.

This statement was adapted from Mooney E, et al: Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement. Aust J Dermatol Nov. 2015; 56(4):241–251.

The ACD has also released a fact sheet and Q&A on the use of steroids to treat eczema in children. “The fact sheet and Q&A provide practical advice for parents on the safe use of steroids to help treat eczema in their children. Our focus is to improve outcomes for the skin health of individuals and the community as a whole,” said Dr. Baker.

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