STARTING treatment with a potent topical corticosteroid (TCS) rather than a mild one significantly improves symptom control and quality of life in children with moderate atopic dermatitis (AD) flare-ups, according to new research.
AD is a common inflammatory skin condition affecting up to 20% of children, often managed in primary care with emollients and TCS. While mild steroids are widely used as a first-line treatment, uncertainty remains over whether stronger formulations provide superior long-term benefits. This study aimed to compare the effectiveness of a potent (fluticasone propionate 0.05%) versus a mild (hydrocortisone acetate 1%) TCS in children experiencing moderate flare-ups of AD.
The study followed 209 children aged 3 months to 17 years diagnosed with AD, with 32 subsequently randomised to either a potent or mild TCS. Symptoms were assessed using the Patient-Oriented Eczema Measure (POEM) over 24 weeks of follow-up. The potent TCS group demonstrated significantly lower POEM scores compared to the mild TCS group at 1 week (5.5 versus 12.0; p=0.042), 4 weeks (4.3 versus 12.7; p=0.030), and 24 weeks (3.3 versus 9.4; p=0.023). Quality of life improvements were also significantly greater in the potent TCS group at 4 weeks (1.0 versus 4.5; p=0.014) and 24 weeks (0.0 versus 2.0; p<0.000). These findings indicate that starting with a stronger steroid leads to more rapid and sustained symptom relief compared to a mild TCS.
Although the sample size was small, the study suggests a clear clinical benefit of initiating treatment with a potent TCS in moderate AD flare-ups, challenging the conventional stepwise approach of starting with a mild steroid. Given that most children with AD are treated in primary care, these results provide valuable guidance for GPs, supporting a more proactive approach to symptom management. Future research should further evaluate long-term safety and adherence patterns, but current evidence indicates that potent TCS can play a crucial role in optimising outcomes for children with AD.
Jenna Lorge, EMJ
Reference
van Halewijn KF et al. Effectiveness of potent topical corticosteroids versus mild ones in primary care for children with moderate flare-ups of atopic dermatitis; results of a randomised controlled trial. BMJ Open. 2024;14:e078940.
