Background

Systemic corticosteroids are often used to treat atopic dermatitis (AD). However, few studies have assessed the safety and efficacy of systemic corticosteroids in AD.

Objective

To systematically review the literature on efficacy and safety of systemic corticosteroid use (oral, intramuscular, and intravenous) in AD.

Methods

PubMed, Embase, Medline, Scopus, Web of Science, and Cochrane Library were searched. We included systematic reviews, guidelines, and treatment reviews of systemic corticosteroid use among patients of all ages with a diagnosis of AD (52 reviews and 12 studies).

Results

There was general consensus in the literature to limit the use of systemic steroids to short courses as a bridge to steroid-sparing therapies. Systemic side effects include growth suppression in children, osteoporosis, osteonecrosis, adrenal insufficiency, Cushing syndrome, hypertension, glucose intolerance, diabetes, gastritis, gastroesophageal reflux, peptic ulcer disease, weight gain, emotional lability, behavioral changes, opportunistic infections, cataracts, glaucoma, myopathy, myalgia, dysaesthesia, pseudotumor cerebri, hyperlipidemia, malignancy, thrombosis, skin atrophy, sleep disturbance, and rebound flaring.

Limitations

Baseline clinical severity, corticosteroid delivery and dose, and treatment response were reported incompletely and heterogeneously across studies.

Conclusions

Evidence is not strong enough to determine optimal delivery or duration of systemic corticosteroids in AD.

中文翻译：

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系统性皮质类固醇激素在特应性皮炎中的安全性和有效性的系统评价

背景

全身性皮质类固醇通常用于治疗特应性皮炎（AD）。但是，很少有研究评估全身性皮质类固醇在AD中的安全性和有效性。

客观的

为了系统地回顾有关在全身性使用皮质类固醇激素（口服，肌内和静脉内）的疗效和安全性的文献。

方法

搜索PubMed，Embase，Medline，Scopus，Web of Science和Cochrane图书馆。我们纳入了诊断为AD的所有年龄段患者的全身性皮质类固醇使用的系统评价，指南和治疗评价（52条评价和12项研究）。

结果

文献中普遍同意将全身性类固醇的使用限制在短期内，以作为保留类固醇疗法的桥梁。全身性副作用包括儿童的生长受到抑制，骨质疏松，骨坏死，肾上腺功能不全，库欣综合征，高血压，葡萄糖耐受不良，糖尿病，胃炎，胃食管反流，消化性溃疡疾病，体重增加，情绪不稳，行为改变，机会性感染，白内障，青光眼，肌病，肌痛，感觉异常，假性脑瘤，高脂血症，恶性肿瘤，血栓形成，皮肤萎缩，睡眠障碍和反弹性扩张。

局限性

在所有研究中，基线临床严重性，皮质类固醇递送和剂量以及治疗反应均不完全且异质地报道。

结论

没有足够的证据来确定全身性糖皮质激素在AD中的最佳递送或持续时间。