PA16 How should topical corticosteroids be reduced or stopped once an eczema flare is controlled? A systematic review

Abstract

Topical corticosteroids (TCS) are widely used to treat flares of atopic dermatitis (eczema). NICE advises against abrupt TCS discontinuation due to risk of rebound or disease worsening. However, no evidence review evaluates optimal or safe methods for stopping or tapering TCS in eczema. Variation in clinical advice may contribute to patient confusion and suboptimal adherence. We describe approaches to stopping or tapering TCS in the medical literature and any identified associated safety or effectiveness outcomes. Embase, Cochrane Specialist Register, MEDLINE, CINAHL, Web of Science, Epistemonikos and ProQuest were searched on 15 December 2025. Eligible studies assessed when and how TCS were reduced or stopped after an eczema flare. Abstracts and full texts were screened independently by R.V. and M.F. Data extraction was undertaken by R.V., with 10% checked by L.S.A. and H.R. In total, 6608 titles and abstracts were screened, and subsequently 275 full texts. Twenty-eight studies (53 regimens or arms) included a defined run-in TCS phase and reported outcomes within 4 weeks of reduction or discontinuation. Potent TCS were most commonly used for flare treatment (29), followed by moderate (9), very potent (6) then mild disease (3). Potency was not stated in one study, and six combined TCS with an additional agent. TCS were applied once daily in 24 and twice daily in 27 cases, with durations ranging from 4 to 42 days. Stopping or tapering methods included abrupt stopping or switch to emollient (n = 29), switch to proactive therapy (9) and tapering regimen (13). Tapering methods included frequency reduction alone (n = 6), frequency reduction followed by proactive therapy (n = 4), switch to alterative agent short term (n = 1) or long term (3), and transition or dovetailing of TCS to topical calcineurin inhibitors (n = 1). There is limited evidence to support methods for stopping or tapering topical corticosteroids in eczema, with substantial variation existing in flare treatment regimens and subsequent reduction or stopping, highlighting an important evidence gap.