Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement.
Atopic eczema is a chronic inflammatory disease affecting about 30% of Australian and New Zealand children. Severe eczema costs over AUD 6000/year per child in direct medical, hospital and treatment costs as well as time off work for caregivers and untold distress for the family unit. In addition, it has a negative impact on a child's sleep, education, development and self-esteem. The treatment of atopic eczema is complex and multifaceted but a core component of therapy is to manage the inflammation with topical corticosteroids (TCS). Despite this, TCS are often underutilised by many parents due to corticosteroid phobia and unfounded concerns about their adverse effects. This has led to extended and unnecessary exacerbations of eczema for children. Contrary to popular perceptions, (TCS) use in paediatric eczema does not cause atrophy, hypopigmentation, hypertrichosis, osteoporosis, purpura or telangiectasia when used appropriately as per guidelines. In rare cases, prolonged and excessive use of potent TCS has contributed to striae, short-term hypothalamic-pituitary-adrenal axis alteration and ophthalmological disease. TCS use can also exacerbate periorificial rosacea. TCS are very effective treatments for eczema. When they are used to treat active eczema and stopped once the active inflammation has resolved, adverse effects are minimal. TCS should be the cornerstone treatment of atopic eczema in children.
Department of Paediatric Dermatology, Royal Children's Hospital, Melbourne, Victoria.
Emma
E
Mooney
Department of Dermatology, Waikato Hospital, Hamilton, New Zealand.
Marius
M
Rademaker
University of Melbourne, Melbourne, Victoria.
Rebecca
R
Dailey
Department of Paediatric Dermatology, Royal Children's Hospital, Melbourne, Victoria.
Ben S
BS
Daniel
Department of Dermatology, Canberra Hospital, Canberra, Australian Capital Territory.|Australian National University, Canberra, Australian Capital Territory.
Catherine
C
Drummond
Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales.|Sydney Medical School, University of Sydney, Sydney, New South Wales.
Gayle
G
Fischer
Department Paediatric Dermatology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
Rachael
R
Foster
Department of Paediatric Dermatology, Royal Children's Hospital, Melbourne, Victoria.
Claire
C
Grills
Department Paediatric Dermatology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
Anne
A
Halbert
Department of Dermatology, Waikato Hospital, Hamilton, New Zealand.
Sarah
S
Hill
Department of Paediatric Dermatology, Royal Children's Hospital, Melbourne, Victoria.
Emma
E
King
Department of Paediatric Dermatology, Royal Children's Hospital, Melbourne, Victoria.
Elizabeth
E
Leins
Department of Paediatric Dermatology, Royal Children's Hospital, Melbourne, Victoria.|Department of Dermatology, Royal Melbourne Hospital, Melbourne, Victoria.
Vanessa
V
Morgan
Department of Vascular Biology, Royal Children's Hospital, Melbourne, Victoria.|Department of Paediatrics, Monash University, Melbourne, Victoria.|Murdoch Children's Research Institute, Melbourne, Victoria.
Roderic J
RJ
Phillips
Department of Dermatology, Royal Newcastle Centre, Newcastle, New South Wales.
John
J
Relic
Department of Paediatric Dermatology, Royal Children's Hospital, Melbourne, Victoria.|Department of Dermatology, St Vincent's Hospital, Melbourne, Victoria.
Michelle
M
Rodrigues
Department of Paediatric Dermatology, Royal Children's Hospital, Melbourne, Victoria.|University of Melbourne, Melbourne, Victoria.|Department of Dermatology, Royal Melbourne Hospital, Melbourne, Victoria.|Department of Dermatology, Western Hospital, Melbourne, Victoria.
Laura
L
Scardamaglia
Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales.|Sydney Medical School, University of Sydney, Sydney, New South Wales.
Saxon
S
Smith
Department of Paediatric Dermatology, Royal Children's Hospital, Melbourne, Victoria.|University of Melbourne, Melbourne, Victoria.|Monash University, Melbourne, Victoria.|Department of Dermatology, Eastern Health, Murdoch Children's Research Institute, Melbourne, Victoria.|Murdoch Children's Research Institute, Melbourne, Victoria.
John
J
Su
Department Paediatric Dermatology, Sydney Children's Hospital, Sydney, New South Wales.
Orli
O
Wargon
Department of Paediatric Dermatology, Royal Children's Hospital, Melbourne, Victoria.
David
D
Orchard
D000279:Administration, Cutaneous; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D001284:Atrophy / Q000139:chemically induced; D001315:Australia; D001851:Bone Diseases, Metabolic / Q000139:chemically induced; D002648:Child; D002675:Child, Preschool; D032921:Consensus; D017449:Dermatitis, Allergic Contact / Q000209:etiology; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005128:Eye Diseases / Q000139:chemically induced; D006801:Humans; D006983:Hypertrichosis / Q000139:chemically induced; D017496:Hypopigmentation / Q000139:chemically induced; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects; D010024:Osteoporosis / Q000139:chemically induced; D010913:Pituitary-Adrenal System / Q000187:drug effects; D011693:Purpura / Q000139:chemically induced; D012393:Rosacea / Q000139:chemically induced; D012867:Skin / Q000473:pathology*; D057896:Striae Distensae / Q000139:chemically induced; D013618:Tachyphylaxis; D013684:Telangiectasis / Q000139:chemically induced
D000305:Adrenal Cortex Hormones; D003879:Dermatologic Agents