Long-term topical corticosteroid treatment for atopic dermatitis: an in-depth analysis of safety, efficacy, withdrawal, and patient experiences

Atopic dermatitis, often referred to as eczema, is classified as a chronic inflammatory skin disorder with increasing prevalence. Topical corticosteroids (TCSs) have remained the first-line treatment for atopic dermatitis for more than 50 years. They are available in a range of potencies and are minimally invasive, generally tolerable, inexpensive, and effective for short courses of treatment (<4 weeks). However, because atopic dermatitis is chronic, patients commonly use TCSs on a near-daily basis for extended periods. This review aimed to evaluate current information regarding the safety, tolerability, efficacy, disease and treatment trajectory, adherence, and patient perspective of long-term TCS use for atopic dermatitis. One recognized the effect of long-term use, TCS tachyphylaxis, is particularly concerning. Because uncontrolled atopic dermatitis can have serious complications, tachyphylaxis often perpetuates TCS treatment escalations. Despite the use of high-potency formulas, disease control remains difficult to maintain, which presents a second alarming effect: the rebound sequelae of TCS discontinuation, frequently described as topical steroid withdrawal (TSW). This review places special attention on TSW, particularly the syndrome’s definition, prognostic factors, physical symptoms and presentations, onset location and histologic features, secondary outcomes, resolution, and patient response.