Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement Emma Mooney, 1 Marius Rademaker, 2 Rebecca Dailey, 3 Ben S. Daniel, 1 Catherine Drummond, 4,18 Gayle Fischer, 5,13 Rachael Foster, 6 Claire Grills, 1 Anne Halbert, 6 Sarah Hill, 2 Emma King, 1 Elizabeth Leins, 1 Vanessa Morgan, 1,7 Roderic J. Phillips, 8,9,16 John Relic, 10 Michelle Rodrigues, 1,11 Laura Scardamaglia, 1,3,7,12 Saxon Smith, 5,13 John Su, 1,3,14,15,16 Orli Wargon 17 and David Orchard 1 Reproduced from the Australasian Journal of Dermatology 2015; 56(4): 241-251 with the permission of the authors, the Australasian College of Dermatologists and the publisher Wiley Publishing Asia Pty Ltd. © 2015 The Australasian College of Dermatologists. MedicineToday 2015; 16(12): 40-50 1 Department of Paediatric Dermatology, 9 Department of Vascular Biology, Royal Children’s Hospital, 3 University of Melbourne, 7 Department of Dermatology, Royal Melbourne Hospital, 8 Department of Paediatrics, Monash University, 15 Monash University, 11 Department of Dermatology, St Vincent’s Hospital, 12 Department of Dermatology, Western Hospital, 14 Department of Dermatology, Eastern Health, 16 Murdoch Children’s Research Institute, Melbourne, Victoria, 4 Department of Dermatology, Canberra Hospital, 18 Australian National University, Canberra, Australian Capital Territory; 5 Department of Dermatology, Royal North Shore Hospital, 13 Sydney Medical School, University of Sydney, 17 Department Paediatric Dermatology, Sydney Children’s Hospital, Sydney, 10 Department of Dermatology, Royal Newcastle Centre, Newcastle, New South Wales; 6 Department Paediatric Dermatology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia; and 2 Department of Dermatology, Waikato Hospital, Hamilton, New Zealand. Correspondence: Dr David Orchard, Dermatology, Royal Children’s Hospital, 50 Flemington Road, Parkville Victoria 3052, Australia. Email: david.orchard@ rch.org.au Emma Mooney, MB BS. Marius Rademaker, DM. Rebecca Dailey, MD. Ben S. Daniel, MB BS. Catherine Drummond, FACD. Gayle Fischer, FACD. Rachael Foster, FACD. Anne Halbert, FACD. Sarah Hill, FRACP. Emma King, NP. Elizabeth Leins, MN. Vanessa Morgan, FACD. Roderic J. Phillips, FRACP. John Relic, FACD. Michelle Rodrigues, FACD. Laura Scardamaglia, FACD. Saxon Smith, FACD. John Su, FACD. Orli Wargon, FACD. David Orchard, FACD. Conflict of interest: None. PEER REVIEWED FEATURE ABSTRACT Atopic eczema is a chronic inflammatory disease affecting about 30% of Australian and New Zealand children. Severe eczema costs over AUD 6000/year per child in direct medical, hospital and treatment costs as well as time off work for caregivers and untold distress for the family unit. In addition, it has a negative impact on a child’s sleep, education, development and self esteem. The treatment of atopic eczema is complex and multifaceted but a core component of therapy is to manage the inflammation with topical corticosteroids (TCS). Despite this, TCS are often underutilised by many parents due to corticosteroid phobia and unfounded concerns about their adverse effects. This has led to extended and unnecessary exacerbations of eczema for children. Contrary to popular perceptions, TCS use in paediatric eczema does not cause atrophy, hypopigmentation, hypertrichosis, osteo- porosis, purpura or telangiectasia when used appropriately as per guidelines. In rare cases, prolonged and excessive use of potent TCS has contributed to striae, short-term hypothalamic– pituitary–adrenal axis alteration and ophthalmological disease. TCS use can also exacerbate periorificial rosacea.TCS are very effective treatments for eczema. When they are used to treat active eczema and stopped once the active inflammation has resolved, adverse effects are minimal. TCS should be the cornerstone treatment of atopic eczema in children. 40 MedicineToday ❙ DECEMBER 2015, VOLUME 16, NUMBER 12 Downloaded from Medicine Today for personal use only. No other uses permitted without permission. © 2015 The Australasian College of Dermatologists.