What Are Systemic Corticosteroids?

Systemic corticosteroids are drugs that may be used to treat severe atopic dermatitis (eczema). They are a type of immunosuppressant. These are drugs that suppress or interfere with the immune system response.^1,2

The American Academy of Dermatology (AAD) recommends immunosuppressants for adults and children whose disease is not controlled through the use of emollients, topical therapies, or phototherapy. These drugs are also recommended for people whose physical and mental health are greatly affected by their skin disease.^1,2

However, the AAD cautions that systemic corticosteroids should be avoided when possible because of potential side effects. The use of systemic corticosteroids should be reserved for severe exacerbations and for short-term use.^1,2

Systemic versus topical corticosteroids

Corticosteroids, also called steroids, mimic the natural corticosteroids produced by the adrenal gland. Some steroids are used in topical formulations that are applied to specific areas of skin affected by atopic dermatitis. Systemic corticosteroids are medicines, usually taken orally or injected, that affect the whole body.

How do systemic corticosteroids work?

Systemic corticosteroids reduce the production of the chemicals that cause inflammation. In atopic dermatitis, the immune system responds abnormally. This causes an abundance of chemicals that cause inflammation, redness, and swelling. Corticosteroids reduce the production of the chemicals that cause inflammation.¹

Short-term use of systemic corticosteroids can help in severe exacerbations of atopic dermatitis, including severe itching. However, they have not been shown to control symptoms or induce remission long-term.¹

What are the possible side effects of systemic corticosteroids?

While systemic corticosteroids can rapidly improve symptoms of atopic dermatitis, experts caution that their use should be limited because of the potential side effects. Side effects can vary depending on the specific drug you are taking.^1,2

Common side effects of short-term use include:^1,2

• Abdominal pain, nausea
• Insomnia
• Headache
• Fever

Long-term use may cause serious side effects, including:^1,2

• Diabetes
• High blood pressure
• Gastric ulcers
• Weight gain
• Low bone density
• Slow growth in children
• Skin thinning (atrophy)
• Glaucoma
• Changes in mood and behavior

A rebound flare, an increase of symptoms and severity of the disease, is commonly seen when systemic corticosteroids are stopped.^1,2

These are not all the possible side effects of systemic corticosteroids. Talk to your doctor about what to expect when taking these drugs. You also should call your doctor if you have any changes that concern you when taking systemic corticosteroids.

Things to know about systemic corticosteroids

People who take long-term systemic corticosteroids may require antibiotics for infections, as well as calcium and vitamin D supplements. They may also require:¹

• Blood pressure monitoring
• Regular eye exams
• Adrenal function tests
• Testing to measure bone density (in adults) and growth (in children)

Systemic treatments like corticosteroids do not rule out the need for topical treatments or good skin care. Good skin care is always a key part in treating and preventing relapses of atopic dermatitis. This includes:

• Frequent use of moisturizers
• Regular bathing
• Avoiding irritants
• Avoiding scratching

Before beginning treatment for atopic dermatitis, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.