Clinical Question

Which strategies for using topical corticosteroids in the treatment of eczema increase effectiveness and avoid adverse effects?

Evidence-Based Answer

High- and medium-potency topical corticosteroids increase treatment success compared with low-potency topical corticosteroids, but there is no difference in effectiveness between high- and medium-potency topical corticosteroids. (Strength of Recommendation [SOR]: C, limited-quality disease-oriented evidence.) Application of topical corticosteroids once daily is probably as effective as twice daily. Weekend therapy (i.e., application on two consecutive days per week) likely prevents eczema relapses without an increased risk of adverse effects.¹ (SOR: B, inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition that is common worldwide and has a significant impact on quality of life. It affects up to 20% of children and 5% of adults.¹ Topical corticosteroids are the most commonly prescribed treatment, and prescribing patterns vary widely in the United States.² The authors of this review sought to identify the most effective strategies for topical corticosteroid use to treat eczema in adults and children, including different potencies, frequencies, and techniques of application. They also identified potential adverse effects.