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What Are Systemic Corticosteroids?

Systemic corticosteroids are medications that may be used to treat severe atopic dermatitis (AD). They are a type of immunosuppressant, drugs that suppress or interfere with the immune system response. The American Academy of Dermatology (AAD) states that immunosuppressants are recommended for adult and pediatric patients whose disease is not controlled through the use of emollients, topical therapies, and/or phototherapy, as well as those patients whose medical, physical, or psychological states are greatly affected by their skin disease. In addition, the AAD cautions that systemic corticosteroids should be avoided if possible because of potential side effects, and the use of systemic corticosteroids should be reserved for severe exacerbations and for short-term use.1,2

How systemic corticosteroids work

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

Systemic corticosteroids reduce the production of the chemicals that cause inflammation. In AD, the immune system responds abnormally, causing an abundance of chemicals that cause inflammation, redness, and swelling. Corticosteroids reduce the production of the chemicals that cause inflammation. Short-term use of systemic corticosteroids can help in severe exacerbations of AD, including severe itching, however they have not been shown to control symptoms or induce remission long-term.1

Side effects of systemic corticosteroids

Although systemic corticosteroids can rapidly improve symptoms of AD, experts caution that their use should be time-limited and well thought-out because of the potential side effects. A rebound flare – an increase of symptoms and severity of disease – is commonly seen when systemic corticosteroids are stopped. Systemic corticosteroids also have significant potential long-term side effects, including diabetes, high blood pressure, gastric ulcers, weight gain, osteoporosis, skin thinning (atrophy), glaucoma, growth retardation, and uncontrollable emotional outbursts.1,2

Patients who receive long-term systemic corticosteroids may require antibiotics for opportunistic infections and calcium and vitamin D supplementation. In addition, these patients may require blood pressure monitoring, regular eye exams, adrenal function tests, and testing to measure bone density (in adults) and growth (in children).1

Dosage and scheduling of systemic corticosteroids

The formulations of systemic corticosteroids used in people with AD are most often prednisone, prednisolone, and triamcinolone acetonide. Prednisone and prednisolone come in tablet and oral solutions, and triamcinolone acetonide is an intramuscular injection. The dosage is based on the body weight of the individual patient, and dosing is tapered to decrease the risk of side effects. However, even with tapering, a flare of AD may occur when the medication is discontinued.1

Importance of good skin care for atopic dermatitis

Systemic treatments like corticosteroids do not rule out the need for topical treatments or good skin care. Good skin care is always a necessary component in treating and preventing relapses of AD and includes the frequent use of moisturizers, regular bathing, avoiding irritants, and avoiding scratching.

Emily Downward | June 2017
  1. Sidbury R, et al. Guidelines of care for the management of atopic dermatitis. J Am Acad Dermatol. 2014;71:327-49.
  2. Simon D, Bieber T. Systemic therapy for atopic dermatitis. Allergy. 2014;69:46-55.