American Academy of Pediatrics – Section on Dermatology

View all recommendations from this society

Released January 27, 2021

Avoid the use of systemic (oral or injected) corticosteroids in most cases of atopic dermatitis.

Although systemic corticosteroids can lead to rapid clearing of disease and improvement in pruritus, many short- and long-term adverse effects limit
their use, including significant growth retardation, adrenal suppression in more than 90%, and rebound flaring and/or worsening of disease at the time
of corticosteroid discontinuation. Atopic dermatitis treatment guidance put forth by the American Academy of Dermatology specifically advises against
the use of systemic steroids in children with atopic dermatitis, with few exceptions.

In general, atopic dermatitis can be adequately controlled with good skin care practices and topical prescription therapies. In patients who have
recalcitrant disease, phototherapy and/or steroid-sparing systemic agents may be required for adequate control. Systemic corticosteroids should
only be prescribed for severe flares once all other treatment options have been exhausted and should be limited to a short course for the purpose
of bridging to a steroid-sparing agent.

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

Members of the American Academy of Pediatrics Section on Dermatology submitted the top 5 topics for Choosing Wisely items based on a review of the literature and expert opinion of the most common dermatologic problems seen in primary care pediatrics. The list was then peer reviewed and approved by more than a dozen relevant AAP Committees, Councils and Sections. The AAP Executive Committee and Board of Directors granted final approval of the list.

AAP’s disclosure and conflict of interest policy can be found at


Proudfoot, LE, Powell, AM, Ayis, S, et al. The European Treatment of severe Atopic eczema in children Taskforce (TREAT) survey. Br J Dermatol. 2013;169(4):901–909 Drucker AM, Eyerich K, de Bruin-Weller MS, et al. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement. Br J Dermatol. 2018;178(3):768–775

Yu SH, Drucker AM, Lebwohl M, Silverberg JI. A systematic review of the safety and efficacy of systemic corticosteroids in atopic dermatitis. J Am Acad Dermatol. 2018;78(4):733–740

Sidbury R, Davis DM, Cohen DE, 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(2):327–349

Tollefson MM, Bruckner AL; American Academy of Pediatrics, Section on Dermatology. Atopic dermatitis: skin-directed management. Pediatrics. 2014;134(6):e1735-e1744