What are some sample topical corticosteroids (steroid creams or ointments) for treating atopic dermatitis?

Topical Corticosteroids for Atopic Dermatitis

For adults with atopic dermatitis, topical corticosteroids are strongly recommended as first-line treatment and should be selected based on potency class (I-VII), with the least potent preparation required to control symptoms being used. 1

Classification of Topical Corticosteroids

• Topical corticosteroids are grouped into 7 classes based on potency 1:
  • Class I: Very high potency (e.g., clobetasol propionate 0.05%)
  • Class II-III: High potency (e.g., fluticasone propionate 0.05%)
  • Class IV-V: Medium potency (e.g., triamcinolone acetonide 0.1%)
  • Class VI-VII: Low potency (e.g., hydrocortisone 1%)

Selection of Appropriate Topical Corticosteroid

• Consider anatomical site when selecting potency 1:

  • Lower potency agents should be used on face, neck, genitals, and body folds
  • Medium to high potency can be used on trunk and extremities
  • Very high potency should be limited to short courses due to risk of atrophy 1

• Triamcinolone acetonide 0.1% cream is FDA-approved for inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses, including atopic dermatitis 2

• Medium potency steroids can be utilized for longer courses due to more favorable adverse event profile 1

Application Guidelines

• Most studies involve twice daily application, though once daily may be sufficient for potent topical corticosteroids 1

• Treatment should not be applied more than twice daily 1

• For maintenance therapy between flares, intermittent use of medium potency topical corticosteroids (twice weekly) is strongly recommended to reduce disease flares and relapse 1

• A study showed patients treated with fluticasone propionate 0.05% cream for maintenance were 7.0 times less likely to have an AD relapse compared to vehicle (95% CI: 3.0-16.7; P < .001) 1

Potential Side Effects and Precautions

• Main risk with potent topical corticosteroids is suppression of the pituitary-adrenal axis 1

• Other potential side effects include skin atrophy, telangiectasias, and hypopigmentation, especially with prolonged use of higher potency steroids 3

• Use the least potent preparation required to keep eczema under control, and when possible, corticosteroids should be stopped for short periods 1

• "Corticophobia" (fear of using topical corticosteroids) can lead to undertreatment; proper education about benefits and risks is important 1, 3

Alternative and Adjunctive Treatments

• For patients concerned about topical corticosteroid side effects, consider:

  • Tacrolimus 0.03% or 0.1% ointment (strongly recommended) 1, 4
  • Pimecrolimus 1% cream for mild-to-moderate disease (strongly recommended) 1
  • Crisaborole ointment for mild-to-moderate disease (strongly recommended) 1
  • Ruxolitinib cream for mild-to-moderate disease (strongly recommended) 1

• Emollients should be used in conjunction with topical corticosteroids and are most effective when applied after bathing 1

• Antihistamines may be useful as short-term adjuvants during relapses with severe pruritus, primarily for their sedative properties 1

Common Pitfalls to Avoid

• Undertreatment due to fear of topical corticosteroids 1

• Using inappropriately high potency corticosteroids on sensitive areas like face, neck, and body folds 1

• Failing to transition to maintenance therapy after controlling acute flares 1

• Not considering alternative non-steroidal options for patients with steroid concerns or those who have failed topical corticosteroid therapy 3