Established corticosteroid creams should be applied only once daily in patients with atopic eczema

doi:10.1136/bmj.39195.636319.80

BMJ 2007;334:1272 (16 June), doi:10.1136/bmj.39195.636319.80

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Established corticosteroid creams should be applied only once daily in patients with atopic eczema

Hywel C Williams, professor of dermato-epidemiology

Centre of Evidence Based Dermatology, Queen's Medical Centre, University of Nottingham NG7 2UH

hywel.williams@nottingham.ac.uk

The first 150 words of the full text of this article appear below.

The clinical problem

Atopic eczema affects many adults and up to 20% of children,¹with health costs comparable to diabetes² and asthma.³ One communitysurvey of 1760 young children in the United Kingdom found that84% had mild eczema, 14% moderate, and 2% severe eczema.⁴ Topicalcorticosteroids are a mainstay of treatment for inflammatoryepisodes.⁵ Most long established topical corticosteroids suchas betamethasone valerate or hydrocortisone are applied at leasttwice daily, but three newer preparations (mometasone, fluticasone,and methylprednisolone) have been developed for once daily application.Here, I propose that established preparations need be appliedonly once daily.

The evidence for change

Ten randomised controlled trials compared once daily versusmore frequent application of topical corticosteroids withinthe same potency group (table

). The findings are summarisedin a UK Health Technology Assessment report and guidance fromthe National Institute for Health and Clinical Excellence (NICE).⁶⁷ Another short term study has been published more recently.⁸One . . . [Full text of this article]