Topical and systemic corticosteroids in the modern Management of Atopic Eczema: A scoping review

Topical corticosteroids remain first-line therapy for atopic eczema, while systemic corticosteroids are generally discouraged because of safety concerns. The emergence of biologics and Janus kinase (JAK) inhibitors has substantially altered the therapeutic landscape, necessitating a reassessment of the role of corticosteroids in contemporary management strategies.

A narrative scoping review was conducted using targeted searches of Pubmed and Embase (2010-2024). Priority was given to randomized controlled trials, meta-analyses, large observational studies, and international clinical guidelines addressing topical and systemic corticosteroids, biologics, and JAK inhibitors in atopic eczema.

Topical corticosteroids exert anti-inflammatory and immunosuppressive effects through glucocorticoid receptor-mediated suppression of the Th2-driven cytokines and remain effective and safe when used with appropriate potency, duration, and vehicle selection. Adverse effects are primarily local and potency dependent. Systemic corticosteroids provide rapid symptom relief but are associated with significant acute and chronic toxicities, including rebound flares, adrenal suppression, metabolic complications, and increased infection risk, rendering them unsuitable for long-term disease control. Biologics targeting IL-4, IL-13, and IL-31, as well as oral and topical JAK inhibitors, demonstrate superior long-term efficacy and safety for moderate-to-severe disease and have reduced reliance on systemic corticosteroids. Evidence supports combination and sequencing strategies in which topical corticosteroids are used as adjuncts to targeted systemic therapies.

Topical corticosteroids remain indispensable for flare management and proactive maintenance in atopic eczema. Systemic corticosteroids should be restricted to exceptional, short-term rescue situations. Modern management increasingly positions corticosteroids as targeted, intermittent adjuncts within treatment algorithms centered on biologics and JAK inhibitors.