American Academy of Dermatology

View all recommendations from this society

Released August 19, 2015; sources updated July 9, 2018; Updated October 18, 2021

Don’t use systemic (oral or injected) corticosteroids as a long-term treatment for dermatitis.

The potential complications of long-term treatment with oral or injected corticosteroids outweigh the potential benefits. Although the short-term use of systemic corticosteroids is sometimes appropriate to provide relief of severe symptoms, long-term treatment could cause serious short- and long-term adverse effects in both children and adults. In extreme cases that have failed to respond to other appropriate treatments, the benefits of systemic corticosteroids must be weighed against these potentially serious risks.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Dermatology (AAD) is strongly committed to dermatologists serving as effective stewards of limited health care resources by assisting patients in making informed health care decisions. As such, the AAD leadership created a workgroup to develop this list with specific skills and expertise in evidence based research, public health quality and payer policy. Members of this workgroup include dermatologists who are current members of the Academy’s Board of Directors, Council on Science and Research, Council on Government Affairs, Health Policy and Practice, Research Agenda Committee, Clinical Guidelines Committee, Access to Dermatology Care Committee, Patient Safety and Quality Committee, Resource-Based Relative Value Scale Committee and the Workgroup on Innovative Payment Delivery. The workgroup identified areas to be included on this list based on the greatest potential for overuse/misuse, quality improvement and availability of strong evidence based research as defined by the recommended criteria listed below. The recommended list was reviewed and approved by the AAD Council on Science and Research and the AAD Board of Directors.

  • Supported by available scientific evidence (e.g., existing AAD appropriate use criteria and/or existing AAD clinical guidelines)
  • Strongest consensus inappropriate score from the AAD Appropriate Use Criteria (AUC)
  • Strong (wording/level of evidence) recommendations from the guidelines about discouraged practice
  • Greatest potential for improvement in outcomes for patients
  • Greatest potential for overuse/misuse by physicians

AAD’s disclosure and conflict of interest policy can be found at www.aad.org.

Sources

Yu S, Drucker AM, Lebwohl M, Silverberg JI. A systematic review of safety and efficacy of systemic corticosteroids in atopic dermatitis. J Am Acad Dermatol. DOI: https://doi.org/10.1016/j.jaad.2017.09.074.

Sidbury R, Davis DM, Cohen DE, Cordoro KM, Berger TG, Bergman JN et al. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol 2014;71:327-49.

Diepgen TL, Andersen KE, Chosidow O, Coenraads PJ, Elsner P, English J et al. Guidelines for diagnosis, prevention and treatment of hand eczema. J Dtsch Dermatol Ges 2015;13:e1-22.

Usatine RP , Riojas M. Diagnosis and management of contact dermatitis. Am Fam Physician 2010;82:249-55.

Krejci-Manwaring J, McCarty MA, Camacho F, Manuel J, Hartle J, Fleischer A, Jr. et al. Topical tacrolimus 0.1% improves symptoms of hand dermatitis in patients treated with a prednisone taper. J Drugs Dermatol 2008;7:643-6.

Silvestre-Salvador JF, Heras Mendaza F, Hervella Garcés M, et al. Guidelines for the Diagnosis, Treatment, and Prevention of Hand Eczema. Guía para el diagnóstico, el tratamiento y la prevención del eccema de manos. Actas Dermosifiliogr. 2020;111(1):26-40. doi:10.1016/j.ad.2019.04.005