PROLONGED use of systemic glucocorticosteroids (SGCs) in people with atopic dermatitis (AD) is associated with a higher risk of multiple adverse events, according to a nationwide cohort study.
Although SGCs can provide rapid relief during severe AD flares, current treatment recommendations advise limiting their use to short-term courses due to concerns about side effects. However, repeated and extended prescribing remains common in clinical practice. Researchers sought to investigate whether treatment duration or cumulative steroid dose was the stronger predictor of adverse outcomes.
The retrospective cohort study analysed German statutory health insurance data from individuals with AD who initiated SGC therapy. Researchers used statistical modelling to examine associations between SGC exposure, treatment duration, cumulative dose, and the development of side effects over time.
Osteoporosis, Diabetes and Hypertension Among Key Risks Identified
Longer treatment duration was consistently associated with increased risks of adverse events. Each additional three months of SGC therapy was linked to higher risks of several complications, including mental health disorders (hazard ratio [HR] 1.21), gastritis or duodenitis (HR 1.07), osteoporosis (HR 1.37), hypertension (HR 1.26), and diabetes mellitus (HR 1.35).
Treatment Duration May Matter More Than Cumulative Glucocorticosteroid Dose
The study also found that treatment duration appeared to have a stronger and more consistent association with adverse events than cumulative steroid dose. This suggests that the length of time patients remain on systemic glucocorticosteroids may be a key factor influencing safety outcomes.
The findings reinforce existing recommendations that systemic glucocorticosteroids should be reserved for short-term management of acute and severe AD flares rather than long-term disease control. For patients requiring ongoing systemic treatment, alternative therapies may offer safer long-term management options.
The authors highlight the importance of monitoring patients receiving SGC therapy and considering treatment duration when evaluating risks. The results provide further evidence supporting cautious prescribing practices to minimise preventable complications associated with prolonged corticosteroid exposure in atopic dermatitis.
Reference
Klinger T et al. Duration-Dependent Adverse Events of Systemic Glucocorticosteroids in Atopic Dermatitis: A Nationwide Claims Cohort Study. Dermatol Ther (Heidelb). 2026;DOI: 10.1007/s13555-026-01829-4.
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