From Outside Looking In: Systemic Effects of Topical Steroids and Tacrolimus in Atopic Dermatitis

Original Article: Effects of topical corticosteroid versus tacrolimus on insulin sensitivity and bone homeostasis in adults with atopic dermatitis-A randomized controlled study

What are the key takeaways of this article?

In this randomized control trial conducted by Gether et al., the authors assessed possible systemic side effects with the use of topical corticosteroids and tacrolimus in patients with atopic dermatitis (AD). Patients with AD have been found to have an increased risk of both type 2 diabetes and osteoporosis, both of which are known adverse effects of prolonged oral and inhaled corticosteroids. However, these adverse effects are not often considered with topical formulations. Thus, the goal of this study was to assess insulin sensitivity and bone resorption markers after treatment with betamethasone 0.1% ointment or tacrolimus 0.1% ointment, both of which are common therapies for AD. Participants included 36 adults between the ages of 18-75 with comparable AD severity, per EASI score, who underwent 2 weeks of daily treatment with either medication before stepping down to biweekly application for an additional 4 weeks. Unsurprisingly, AD symptoms improved with the treatments and both cutaneous and systemic inflammation were reduced, further solidifying betamethasone and tacrolimus as appropriate therapeutic choices for AD.

With regards to systemic markers, there was a similar increase in insulin sensitivity markers with the use of both betamethasone and tacrolimus after only 2 weeks, which is the opposite finding of the expected hypothesis. The researchers propose that the cutaneous and systemic anti-inflammatory effects of short-term treatment with topical corticosteroids may actually contribute to the increased insulin sensitivity noted in this study and could be an interesting area that requires further study.

The bone resorption marker (CTX) increased slightly with betamethasone use compared to tacrolimus but was not significant. The bone formation marker (P1NP) decreased significantly after 2 and 4 weeks with betamethasone treatment and remained unchanged with tacrolimus treatment. This result was expected based on the hypothesis and may explain the increased risk of osteoporosis associated with the use of topical corticosteroids.

Overall, these findings from Gether et al. shed an interesting light on the possible systemic effects of topical treatments used in AD. This study highlights that these are important factors to consider when prescribing therapies for dermatologic conditions, especially if patients are to be using them chronically. However, as this study assessed short-term treatment, further studies regarding long-term treatments are necessary.

Publication Date: December 4th, 2023

Reference: Gether L, Storgaard H, Kezic S, et al. Effects of topical corticosteroid versus tacrolimus on insulin sensitivity and bone homeostasis in adults with atopic dermatitis-A randomized controlled study. Allergy. 2023;78(7):1964-1979. doi:10.1111/all.15690

Summary By: Taylor Skinner