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

doi:10.1136/bmj.39195.636319.80

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Hywel C Williams, professor of dermato-epidemiology

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

hywel.williams{at}nottingham.ac.uk

The clinical problem

Atopic eczema affects many adults and up to 20% of children,1 with health costs comparable to diabetes2 and asthma.3 One community survey of 1760 young children in the United Kingdom found that 84% had mild eczema, 14% moderate, and 2% severe eczema.4 Topical corticosteroids are a mainstay of treatment for inflammatory episodes.5 Most long established topical corticosteroids such as betamethasone valerate or hydrocortisone are applied at least twice daily, but three newer preparations (mometasone, fluticasone, and methylprednisolone) have been developed for once daily application. Here, I propose that established preparations need be applied only once daily.

The evidence for change

Ten randomised controlled trials compared once daily versus more frequent application of topical corticosteroids within the same potency group (table⇓). The findings are summarised in a UK Health Technology Assessment report and guidance from the National Institute for Health and Clinical Excellence (NICE).6 7 Another short term study has been published more recently.8 One trial compared once versus twice daily moderately potent topical preparations; eight studies evaluated once versus twice daily …