Randomised controlled trial of short bursts of a potent topical corticosteroid versus prolonged use of a mild preparation for children with mild or moderate atopic eczema
Randomised controlled trial of short bursts of a potent topical
corticosteroid versus prolonged use of a mild preparation for children
with mild or moderate atopic eczema
Conclusion of the study should be reversed
Editor-Thomas et al concluded that a short burst of a potent steroid
(0.1% betamethasone valerate) is as effective and as safe as prolonged use
of a weak preparation (1% hydrocortisone) for mild or moderate disease.
Their study lasted only 18 weeks and they only considered skin thinning as
a potential side-effect. Atopic eczema is a life-long condition that
requires regular use of topical preparations often for months to years.
Children will often have concomitant asthma and hay fever and be using
various doses of inhaled and nasal steroids. These steroids are additive
and can suppress the pituitary-adrenal axis as well as affecting growth
idiosyncratically.
The stronger topical steroids will undoubtedly clear the eczema up quicker
but the eczema will inevitably return. Do we then carry on using the
potent preparations only to find that patients are using them more
frequently than is required? The mainstay of treatment is patient
education, the frequent use of emollients and the treatment of superadded
infection with antibiotics.
Indeed, I was delighted to see that there was no significant difference
between the two preparations in the study. It is always good medical
practice to use the lowest possible dose of a medicine that provides the
desired result, thus lowering the risk-benefit ratio. I would therefore
like to propose an alternative conclusion to the study, namely: “A weak
topical steroid is as effective as using a short burst of a potent
preparation” or “ Short bursts of a potent steroid conveys no added
benefit than the regular use of a mild preparation in mild to moderate
atopic eczema in children”.
I would also recommend that if a potent preparation is considered
necessary for childhood eczema, then the child should be referred to
either a paediatrician with an interest in dermatology or to a consultant
dermatologist. These patients require very careful follow up.
David Levy consultant paediatrician
Tameside General Hospital,
Fountain Street,
Ashton Under Lyne,
Lancashire OL6 9RW
1 Randomised controlled trial of short bursts of a potent topical
corticosteroid versus prolonged use of a mild preparation for children
with mild or moderate atopic eczema BMJ 2002;324:768-771
Rapid Response:
An Alternative Conclusion
Randomised controlled trial of short bursts of a potent topical
corticosteroid versus prolonged use of a mild preparation for children
with mild or moderate atopic eczema
Conclusion of the study should be reversed
Editor-Thomas et al concluded that a short burst of a potent steroid
(0.1% betamethasone valerate) is as effective and as safe as prolonged use
of a weak preparation (1% hydrocortisone) for mild or moderate disease.
Their study lasted only 18 weeks and they only considered skin thinning as
a potential side-effect. Atopic eczema is a life-long condition that
requires regular use of topical preparations often for months to years.
Children will often have concomitant asthma and hay fever and be using
various doses of inhaled and nasal steroids. These steroids are additive
and can suppress the pituitary-adrenal axis as well as affecting growth
idiosyncratically.
The stronger topical steroids will undoubtedly clear the eczema up quicker
but the eczema will inevitably return. Do we then carry on using the
potent preparations only to find that patients are using them more
frequently than is required? The mainstay of treatment is patient
education, the frequent use of emollients and the treatment of superadded
infection with antibiotics.
Indeed, I was delighted to see that there was no significant difference
between the two preparations in the study. It is always good medical
practice to use the lowest possible dose of a medicine that provides the
desired result, thus lowering the risk-benefit ratio. I would therefore
like to propose an alternative conclusion to the study, namely: “A weak
topical steroid is as effective as using a short burst of a potent
preparation” or “ Short bursts of a potent steroid conveys no added
benefit than the regular use of a mild preparation in mild to moderate
atopic eczema in children”.
I would also recommend that if a potent preparation is considered
necessary for childhood eczema, then the child should be referred to
either a paediatrician with an interest in dermatology or to a consultant
dermatologist. These patients require very careful follow up.
David Levy
consultant paediatrician
Tameside General Hospital,
Fountain Street,
Ashton Under Lyne,
Lancashire OL6 9RW
David.Levy@tacmail.tamacute.nwest.nhs.uk
No competing interests.
1 Randomised controlled trial of short bursts of a potent topical
corticosteroid versus prolonged use of a mild preparation for children
with mild or moderate atopic eczema BMJ 2002;324:768-771
Competing interests: No competing interests