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Systemic Corticosteroid Exposure in Patients with Atopic Dermatitis: A US Population-Based Study
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DOI：10.1007/s13555-026-01667-4.png)
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Abstract
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Clinical guidelines recommend against routine use of systemic corticosteroids in atopic dermatitis (AD) due to associated adverse effects. Real-world adherence to these guidelines is unclear. This retrospective cohort study evaluated US healthcare claims using Optum’s Clinformatics Data Mart Database. We included two cohorts: exposure and diagnosis-based cohorts. Index was defined as the date of first systemic corticosteroid use post-AD diagnosis in the exposure cohort (AD diagnosis must have occurred within 6 months preceding index) or as the date of the first AD diagnosis in the diagnosis-based cohort. Follow-up began on index and continued until end of available data, health insurance discontinuation, death, or systemic corticosteroid discontinuation (exposure cohort) or initiation (diagnosis-based cohort). Patients were aged ≥ 12 years with diagnosed AD between 2017 and 2024 and had continuous health insurance enrollment ≥ 1 year before and after index. Patients were excluded if they had other immune-mediated inflammatory diseases within the 6 months preceding index or had history of malignancy, organ transplant, or HIV/AIDS. Systemic corticosteroid exposure duration was categorized as short term (≥ 1 day to < 30 days), medium term (> 1 month to ≤ 3 months), or long term (continuous/intermittent use for > 3 months). Categorization was informed by expert recommendations and observed prescription patterns. Exposure duration and treatment patterns were assessed in the exposure cohort. Prevalence of systemic corticosteroid use within 6 months post-AD diagnosis was evaluated in the diagnosis-based cohort. The exposure cohort included 29,994 patients; 67.7% had short-term use, 8.5% had medium-term use, and 23.9% had long-term use. Intramuscular systemic corticosteroids accounted for 20.0% of prescriptions; 80.0% received oral systemic corticosteroids. The diagnosis-based cohort included 80,647 patients; the prevalence of systemic corticosteroid use in AD was 20.0%. In the USA, systemic corticosteroids remain widely prescribed. These findings highlight the critical need for broader adoption of effective corticosteroid-sparing therapies in patients with AD. Atopic dermatitis (AD), also known as eczema, is a common condition that appears as a dry, itchy skin rash and affects over 25 million adults and children in the USA. Traditional treatments for AD include oral or injectable steroids. Over the last 10 years, safer and more advanced AD treatments have become available; therefore, treatment guidelines recommend limiting steroids to short-term use. However, it is unclear how well current clinical practice in the USA adheres to treatment guidelines. In this study, we looked back at health insurance information from 2017–2024 to understand how often US patients with AD were prescribed steroids and for how long. In a group of 80,647 patients diagnosed with AD, 20% were prescribed their first steroid within 6 months after diagnosis. In a second group of 29,994 patients with AD who were prescribed steroids, 67.7% received steroids for short-term use (less than 30 days), 8.5% for medium-term use (1–3 months), and 23.9% for long-term use (more than 3 months). In this second group, 20% received steroids as an injection in the muscle, and 80% received steroids to take by mouth. In conclusion, we found that steroids are still commonly used in the USA for managing AD, often for much longer than recommended by treatment guidelines. These findings raise concern given the availability of safer alternative treatments and highlight the need to better align clinical practice with treatment guidelines.
Keywords:
Claims database
Cohort study
Corticosteroid
Dermatitis, atopic
Observational study
Prevalence
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