Strategies for using topical corticosteroids in children and adults with eczema

Harvey, Jane; Axon, Emma; Howells, Laura; Santer, Miriam; Ridd, Matthew J; Lawton, Sandra; Langan, Sinéad; Roberts, Amanda; Ahmed, Amina; Müller, Ingrid; Ming, Long Chiau; Panda, Saumya; Chernyshov, Pavel V; Carter, Ben; Williams, Hywel C; Kim, Thomas; Chalmers, Joanne R

doi:10.1002/14651858.cd013356.pub2

Cited by 32 publications

(33 citation statements)

References 212 publications

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“…− Marcas: no existen datos que comparen las diferentes marcas o versiones genéricas del mismo CST. Así, el metaanálisis de Lax et al 2022 mostró que el uso de corticosteroides tópicos de mediana potencia puede aclarar más rápidamente la inflamación aguda que los corticosteroides de baja potencia 54 , pero que no se encontró mayor diferencia en eficacia entre CST de mediana o alta potencia ni entre los de alta o muy alta potencia. Asimismo, en una revisión de 7 ensayos con 1149 participantes se encontró evidencia de mediana certeza sobre el efecto del manejo proactivo (fin de semana), ya que se observó que la probabilidad del brote disminuyó del 58 al 25% (relación de riesgo (RR): 0.43, IC95%: 0.32-0.57) 54 .…”

Section: C Datos Clínicosunclassified

“…**Punto de buena práctica: Aplicar los antiinflamatorios tópicos (esteroide tópico de mediana potencia o tacrolimús) durante los 2 días de la semana (juntos o separados) disminuye la posibilidad de recaída de dermatitis atópica 54 .…”

Section: S2(104)unclassified

“…**Punto de buena práctica: el uso de corticosteroides tópicos de mediana potencia puede aclarar más rápidamente la inflamación aguda que los corticosteroides de baja potencia 54 .…”

Section: S2(98)unclassified

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Guía de dermatitis atópica para México (GUIDAMEX): lineamientos usando metodología ADAPTE

Larenas‐Linnemann¹,

Rincón-Pérez²,

Luna-Pech³

et al. 2023

GMM

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Section: C Datos Clínicosunclassified

Section: S2(104)unclassified

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Guía de dermatitis atópica para México (GUIDAMEX): lineamientos usando metodología ADAPTE

Larenas‐Linnemann¹,

Rincón-Pérez²,

Luna-Pech³

et al. 2023

GMM

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“…The interventions were co-produced by a team consisting of behavioural psychologists, patient representatives, clinicians (general practitioners, dermatology nurse consultants, dermatologists with expertise in eczema) and researchers before being optimised through extensive user feedback to ensure they were acceptable, feasible, and optimally engaging to target users. The aim of the online interventions was to reduce eczema severity and target core behaviours linked to eczema management: regular use of emollients, appropriate use of topical corticosteroids, 27 avoidance of eczema irritants and triggers, minimisation of scratching, and emotional management.…”

Section: Intervention Plus Usual Care Groupmentioning

confidence: 99%

Eczema Care Online behavioural interventions to support self-care for children and young people: two independent, pragmatic, randomised controlled trials

Santer

Müller

Becque

et al. 2022

BMJ

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Objective To determine the effectiveness of two online behavioural interventions, one for parents and carers and one for young people, to support eczema self-management. Design Two independent, pragmatic, parallel group, unmasked, randomised controlled trials. Setting 98 general practices in England. Participants Parents and carers of children (0-12 years) with eczema (trial 1) and young people (13-25 years) with eczema (trial 2), excluding people with inactive or very mild eczema (≤5 on POEM, the Patient-Oriented Eczema Measure). Interventions Participants were randomised (1:1) using online software to receive usual eczema care or an online ( www.EczemaCareOnline.org.uk ) behavioural intervention for eczema plus usual care. Main outcome measures Primary outcome was eczema symptoms rated using POEM (range 0-28, with 28 being very severe) every four weeks over 24 weeks. Outcomes were reported by parents or carers for children and by self-report for young people. Secondary outcomes included POEM score every four weeks over 52 weeks, quality of life, eczema control, itch intensity (young people only), patient enablement, treatment use, perceived barriers to treatment use, and intervention use. Analyses were carried out separately for the two trials and according to intention-to-treat principles. Results 340 parents or carers of children (169 usual care; 171 intervention) and 337 young people (169 usual care; 168 intervention) were randomised. The mean baseline POEM score was 12.8 (standard deviation 5.3) for parents and carers and 15.2 (5.4) for young people. Three young people withdrew from follow-up but did not withdraw their data. All randomised participants were included in the analyses. At 24 weeks, follow-up rates were 91.5% (311/340) for parents or carers and 90.2% (304/337) for young people. After controlling for baseline eczema severity and confounders, compared with usual care groups over 24 weeks, eczema severity improved in the intervention groups: mean difference in POEM score −1.5 (95% confidence interval −2.5 to −0.6; P=0.002) for parents or carers and −1.9 (−3.0 to −0.8; P<0.001) for young people. The number needed to treat to achieve a 2.5 difference in POEM score at 24 weeks was 6 in both trials. Improvements were sustained to 52 weeks in both trials. Enablement showed a statistically significant difference favouring the intervention group in both trials: adjusted mean difference at 24 weeks −0.7 (95% confidence interval −1.0 to −0.4) for parents or carers and −0.9 (−1.3 to −0.6) for young people. No harms were identified in either group. Conclusions Two online interventions for self-management of eczema aimed at parents or carers of children with eczema and at young people with eczema provide a useful, sustained benefit in managing eczema severity in children and young people when offered in addition to usual eczema care. Trial registration ISRCTN registry ISRCTN79282252 .

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“…Proaktivno doziranje: održavanje postignutog efekta i nakon sanacije akutne egzacerbacije hronične dermatoze (najčešće psorijaza ili atopijski dermatitis) primenom kortikosteroidnog preparata 2 puta nedeljno još neki period, do prestanka korišćenja kortikosteroida. Može se kombinovati sa drugim aktivnim medikamentima (kalcineurin inhibitorima ili kalcipotriolom) [17][18] .…”

Section: Strategije Optimizacije Hronične Topikalne Kortikosteroidne ...unclassified

Corticosteroid topical therapy range: Fluocinolone-acetonide gel

Gajinov¹

2022

Galenika Med J

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Since the early days of use, in the mid of twentieth century, topical corticosteroids became the basis of contemporary dermatological therapy, because of their antiinflammatory efficiency, comfort of application free from unpleasant characteristics of previous generations of dermatotherapeutics, tar or antralin. With numerous evidences about potencies of specific corticosteroid molecules for adverse effects, optimal and efficient use of topical corticosteroid is the empiric art of dermatology, based on precise diagnosis, knowledge about the pathophysiology of dermatosis and characteristics of topical medication, and good communication with patients to promote optimal use of therapy. There are numerous strategies for optimization of skin atrophy risk and suboptimal therapeutic efficacy, caused by too restrictive topical drug use. Preferences of patients with chronic dermatoses are an important factor for good adherence with therapy, generally favoring formulations that are easier for application, less occlusive and less time-consuming. In most medical systems Fluocinolon gel is topical steroid formulation continuously present from the early days of use. It is adequate for use both for glabrous and hair-bearing skin and for oral mucosa also. A long history of use, the knowledge about effiancy and adverse effects make fluocinolone gel the important part of topical corticosteroid palette, parallel with new modern formulations.

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Strategies for using topical corticosteroids in children and adults with eczema

Cited by 32 publications

References 212 publications

Guía de dermatitis atópica para México (GUIDAMEX): lineamientos usando metodología ADAPTE

Guía de dermatitis atópica para México (GUIDAMEX): lineamientos usando metodología ADAPTE

Eczema Care Online behavioural interventions to support self-care for children and young people: two independent, pragmatic, randomised controlled trials

Corticosteroid topical therapy range: Fluocinolone-acetonide gel

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