They sure are modern conveniences, standing still in the mainstream of today’s dermatologic medications.
Every day, in dermatological practice, they are the first choices among treatments of all eczema/dermatitis including atopic dermatitis, besides lots of other inflammatory skin diseases.

It is very graceful corticosteroids give us a prompt relief!
From an intolerable serious eczematous inflammation of AD with intense itch.
But the progress will vary.

In ideal cases, applications effect properly so as to get ease and end in about a cure.
In others, symptoms may revive several times, but when reapplying, they can always feel better. These are well managed cases.

However, there are stubborn cases which aggravate at once when they stop applying.
Certain cases fall in this category.
It was buzzed as a rebound phenomenon due to topical corticosteroids withdrawal, but many dermatologists did not agree the idea.

Or in severer cases, patients can not be good even though they continue applying.
Rank of applied corticosteroids will go up and up until it reaches to the strongest ones, although, not everybody can be cured by that.

Corticosteroids just cure current eczema.
It is quite natural that symptoms, i.e. eczema, come back soon when original causes of the disease, AD, stay behind.
The root cause of AD is its constitution, which is based on a genetic skin barrier disturbance and easily reacts to numerous objects, so we cannot eliminate it.
There are so many items AD patients react to that if only a few known allergens are avoided, it may not be helpful enough.
As corticosteroids are able to cover reactions of whatever cause, they are very convenient.

If we don’t rely on corticosteroids, patients can protect themselves by regulating themselves to calm down their irritability and avoiding as many as possible allergens.

Corticosteroids not only cease, but also suppress inflammations.
While we use them to control symptoms, they also work to prevent evoking another reaction.
So when we stop using them, eczematous lesions relapse easily.

In Japan, dermatologists utilize the nature of corticosteroids as a "proactive treatment" protocol.
After all visible eczema have gone, they instruct their patients to continue applying corticosteroids about two times a week to everywhere once they had eczema.
To cure invisible inflammations.
Cure? Corticosteroids suppress originated microscopic allergies to emerge as an eczema. That’s not a cure, but just a temporary control.
Discontinuation of such preventive measures may trigger worsening.
Continuously suppressed reactivity might explode when released.
Like in the red skin syndrome, or in other words, the withdrawal rebound phenomenon.

At first, corticosteroids ointments take effects dramatically.
However, AD patients need not temporal, but lifelong use of them.
Many patients feels declining effectiveness after years.
Then stronger corticosteroids will be prescribed to settle the situation.

In Japanese early literature about corticosteroids, they explained the declining efficacy of topical corticosteroids as tachyphylaxis.
Though, today, the word tachyphylaxis indicate another pharmacologic mechanism of losing effectiveness due to saturation.
No matter what the mechanism, it surely is a big problem if the effectiveness of any corticosteroids ointments/creams/lotions/sprays etc. may go down.

It is easy to change prescription to a stronger medicine, but difficult to a weaker one.
Even when most or total exanthema has been gone, many patients disagree to rank down their corticosteroids.
Always saying, in case of relapsing.
Then, they can be at ease. The wonder drug is always within easy reach of them.
Doctors can also be labelled easily as a skilled dermatologist only by prescribing stronger corticosteroids.
Corticosteroids ointments are such fascinating drugs.

In recent years in Japan, as well as in other countries, large quantities of topical corticosteroids applications to babies and toddlers are recommended to prevent children’s AD.
Because, an inflamed skin means a weak barrier.
Future allergens easily penetrate into bodies to be sensitized.
So, to prevent developing AD, they think it is important to restore skin barrier not only by moisturizing, but also ceasing eczema or dermatitis through thorough corticosteroids applications.

Until just several years ago, only moisturizing was mandatory.
But now, preventive corticosteroids are a must, too.
Treatments escalate all the time.
Pediatricians see children of weak skin every day, instruct them to moisturize fully every day, they obey the order diligently and then, nevertheless, AD evoke.
Doctors think it was not enough and plan the next strategy for them.
The conclusion become endless corticosteroids applications…

I think preventive use of corticosteroids should be minimized, because corticosteroids have certain whole body and local adverse effects to children and adults.
Doctors must not forget these whole massive dose of corticosteroids used involve risks of local skin atrophy, teleangiectasia, redness, hirsutism, dryness, fragile skin, delayed healing of wounds and systemic weakening against physical and mental stressors, affecting to the proper process of growth and infectious tendency.
Yet, modern tide is to make much of immediate cure of their appearances.

I said we can not change our built-in constitutions.
(I think NAET can change our constitution.)
But the newer medicines for AD, for example dupilumab (sold as the name of dupixent) get nearer to change immunologic constitutions of AD patients even if temporally.
Whatever allergens stimulate the body, allergic reactions does not progress through the interleukin 4 and interleukin 13 receptor inhibition while using dupilumab.

Of course the effect will be as long as it lasts in their bodies, so patients needs to be injected continuously for the rest of their lives.
It costs very expensive but help so well, that it might even save applying corticosteroids in some day.
However, the indication of dupilumab should strictly be limited only for the severest AD patients, because it costs too high enough to deprive much from the national health insurance.
So it is with other new AD medicines in preparation, such as the interleukin 31 inhibitor or yanus kinase inhibitors.
Corticosteroids applications of popular prices will be necessitated again and remain as a main stream in AD treatments.

It toss around, loved and hated by doctors and patients of AD, that is corticosteroids.

2019.8.(translated in 2020.2.)