Cochrane · systematic review · CD013356
Strategies for using topical corticosteroids in children and adults with eczema
Lax, SJ, Harvey, J, Axon, E, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
SkinAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
28
current version
GRADE rated
24
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 4 · 14.3%Very low 8 · 28.6%Low 9 · 32.1%Moderate 7 · 25%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Moderate‐potency compared to mild‐potency topical corticosteroid
Population: children and adults with mild to severe eczema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinician‐reported signs of eczema: IGA (number with cleared or marked improvement); short term (earliest time within 1‐5 weeks) Moderate‐potency vs mild‐potency topical corticosteroid | OR 2.07 [1.41, 3.04] | 4 studies · 449 participants | Moderate Downgraded: risk of bias |
Patient‐reported symptoms of eczema: 1‐5 weeks Moderate‐potency vs mild‐potency topical corticosteroid | no estimate extracted | 5 studies · 449 participants | Low Downgraded: risk of bias, imprecision |
Local adverse events: skin thinning; end of treatment (2‐5 weeks) Moderate‐potency vs mild‐potency topical corticosteroid | no estimate extracted | 4 studies · 472 participants | Low Downgraded: risk of bias, imprecision |
Systemic adverse events: abnormal cortisol; end of treatment (6‐28 days) Moderate‐potency vs mild‐potency topical corticosteroid | no estimate extracted | 2 studies · 33 participants | Very low Downgraded: risk of bias, imprecision |
Potent compared to mild‐potency topical corticosteroid
Population: children and adults with mild to severe eczema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinician‐reported signs of eczema: IGA (number with cleared or marked improvement); short term (earliest time point within 1‐4 weeks) Potent vs mild‐potency topical corticosteroid | OR 3.71 [2.04, 6.72] | 9 studies · 458 participants | Moderate Downgraded: risk of bias |
Patient‐reported symptoms of eczema: 1‐18 weeks Potent vs mild‐potency topical corticosteroid | no estimate extracted | 5 studies · 483 participants | Moderate Downgraded: risk of bias |
Local adverse events: skin thinning; end of treatment (2‐18 weeks) Potent vs mild‐potency topical corticosteroid | no estimate extracted | 5 studies · 440 participants | Low Downgraded: risk of bias, imprecision |
Systemic adverse events: abnormal cortisol; end of treatment (6‐30 days) Potent vs mild‐potency topical corticosteroid | no estimate extracted | 3 studies · 82 participants | Very low Downgraded: risk of bias, imprecision |
Potent compared to moderate‐potency topical corticosteroid
Population: children and adults, most with moderate to severe eczema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinician‐reported signs of eczema: IGA (number with cleared or marked improvement); short term (earliest time point within 1‐4 weeks) Potent vs moderate‐potency topical corticosteroid | OR 1.33 [0.93, 1.89] | 15 studies · 1173 participants | Moderate Downgraded: risk of bias |
Patient‐reported symptoms of eczema: PGA; short‐term (week 1) Potent vs moderate‐potency topical corticosteroid | no estimate extracted | 2 studies · 192 participants | Low Downgraded: risk of bias, imprecision |
Local adverse events: skin thinning; end of treatment (1 to 3 weeks) Potent vs moderate‐potency topical corticosteroid | no estimate extracted | 10 studies · 541 participants | Low Downgraded: risk of bias, imprecision |
Systemic adverse events: abnormal cortisol; end of treatment (6 days to 4 weeks) Potent vs moderate‐potency topical corticosteroid | no estimate extracted | 3 studies · 99 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Very potent compared to potent topical corticosteroid
Population: adults with mild to severe eczema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinician‐reported signs of eczema: IGA (number with cleared or marked improvement); short term (earliest time point within 1‐2 weeks) Very potent vs potent topical corticosteroid | OR 0.53 [0.13, 2.09] | 3 studies · 243 participants | Low Downgraded: risk of bias, imprecision |
Patient‐reported symptoms of eczema: PGA (number judging excellent); short term (day 8) Very potent vs potent topical corticosteroid | no estimate extracted | 1 study · 116 participants | Very low Downgraded: risk of bias, imprecision |
Local adverse events: skin thinning; end of treatment (day 11‐day 22) Very potent vs potent topical corticosteroid | no estimate extracted | 2 studies · 233 participants | Very low Downgraded: risk of bias, imprecision |
Systemic adverse events: abnormal cortisol Very potent vs potent topical corticosteroid | no estimate extracted | 1 study · 117 participants | Very low Downgraded: risk of bias, imprecision |
Twice daily or more compared to once daily topical corticosteroid
Population: children and adults, most with moderate to severe eczema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinician‐reported signs of eczema: IGA (number with cleared or marked improvement); short term (earliest time point within 1‐4 weeks) Twice daily or more vs once daily topical corticosteroid | OR 0.97 [0.68, 1.38] | 15 studies · 1970 participants | Moderate Downgraded: risk of bias |
Patient‐reported symptoms of eczema: PGA (number with cleared or marked improvement); short term (earliest time point within 1‐4 weeks) Twice daily or more vs once daily topical corticosteroid | OR 1.91 [0.62, 5.83] | 2 studies · 300 participants | Low Downgraded: risk of bias, inconsistency |
Local adverse events: skin thinning; end of treatment (2‐6 weeks) Twice daily or more vs once daily topical corticosteroid | no estimate extracted | 11 studies · 1423 participants | Low Downgraded: risk of bias, imprecision |
Systemic adverse events: abnormal cortisol; end of treatment (1‐6 weeks) Twice daily or more vs once daily topical corticosteroid | no estimate extracted | 4 studies · 249 participants | Very low Downgraded: risk of bias, imprecision |
Longer‐term compared to shorter‐term duration of use of topical corticosteroid
Population: adults or children with eczema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinician‐reported signs of eczema Longer‐term vs shorter‐term duration of use of topical corticosteroid | no estimate extracted | 0 studies · 0 participants | Ungraded |
Patient‐reported symptoms of eczema Longer‐term vs shorter‐term duration of use of topical corticosteroid | no estimate extracted | 0 studies · 0 participants | Ungraded |
Local adverse events Longer‐term vs shorter‐term duration of use of topical corticosteroid | no estimate extracted | 0 studies · 0 participants | Ungraded |
Systemic adverse events Longer‐term vs shorter‐term duration of use of topical corticosteroid | no estimate extracted | 0 studies · 0 participants | Ungraded |
Weekend therapy compared to no topical corticosteroid
Population: children and adults with mild to severe eczema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinician‐reported signs of eczema: number of participants with one or more relapses (16‐20 weeks) Weekend therapy vs no topical corticosteroid | RR 0.43 [0.32, 0.57] | 7 studies · 1149 participants | Moderate Downgraded: risk of bias, inconsistency |
Patient‐reported symptoms of eczema: PGA (number judging excellent/good); end of treatment (20 weeks + 4 weeks acute phase) Weekend therapy vs no topical corticosteroid | RR 2.25 [1.71, 2.96] | 1 study · 343 participants | Moderate Downgraded: risk of bias |
Local adverse events: skin thinning; end of treatment (16‐20 weeks + 2‐4 weeks acute phase) Weekend therapy vs no topical corticosteroid | no estimate extracted | 7 studies · 1050 participants | Low Downgraded: risk of bias, imprecision |
Systemic adverse events: abnormal cortisol; end of treatment (16 weeks + 4 weeks acute phase) Weekend therapy vs no topical corticosteroid | no estimate extracted | 5 studies · 5 participants | Very low Downgraded: risk of bias, imprecision |