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Topical corticosteroids in atopic dermatitis

BMJ 2003; 327 doi: (Published 23 October 2003) Cite this as: BMJ 2003;327:942
  1. David J Atherton, consultant in paediatric dermatology (
  1. Great Ormond Street Hospital for Children, London WC1N 3JH

    Recent research reassures that they are safe and effective in the medium term

    Topical corticosteroids have been the mainstay of treatment for atopic dermatitis over the past 40 years. Hydrocortisone was the first to be used; some 30 additional corticosteroid compounds have now been licensed for treatment of atopic dermatitis. The recent development of the topical immuno-modulators, tacrolimus and pimecrolimus, has provided alternatives to topical corticosteroids, but these remain expensive and are not effective in every case.1 Atopic dermatitis remains a therapeutic challenge, and topical corticosteroids continue to have an important role.

    Topical applications containing corticosteroid compounds vary greatly in potency. In general the more potent ones are associated with the greater risk of adverse effects. When one of the more potent topical corticosteroids is applied for the first time by a patient with atopic dermatitis the benefit is likely to be rapid and striking, often resulting in clearance of the rash within a few days. The snag is that persistent application of a potent preparation will put the patient at risk of unwanted local effects on the skin. These effects vary from barely perceptible, fully reversible thinning, to irreversible telangiectasiae and striae distensae. Worse still, patients find that the initial benefit is generally rather rapidly lost because …

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