171 International survey: Effects of cumulative exposure to corticosteroids in patients with eczema, including topical steroid withdrawal syndrome (TSWS)

      Patients with eczema have a lifetime of exposure to corticosteroids (topical (TCS), oral (OCS), inhaled, nasal sprays etc). The survey examined cumulative effects of corticosteroid exposure, sociodemographic characteristics, disease attributes, history of eczema treatment, and experience and knowledge of topical steroid withdrawal syndrome (TSWS). Surveyed total lifetime corticosteroid use of all types. 91% reported TCS use with an average duration of 15.3 years, applying 1-2 times daily, for 15-30 days a month, on an average body surface area (BSA) of 24%. Adult and child body diagram was used to assess eczema symptom location and severity from the PO-SCORAD tool, and to determine % of BSA where TCS were used most often. OCS for eczema or other conditions was 36%, with an average of 8 OCS courses during their lifetime. Adults (83%) and children (64%) had new and/or worsening symptoms overtime. A description of TSWS was included - 79% of adults and 43% of children had symptoms consistent with TSWS. Body diagram assessed TSWS BSA, symptoms, and severity. Over 90% of all adults with TSWS report burning, skin shedding/profuse flaking, and flushing or darkening depending on skin tone. Survey distribution was by email or social media to patients by patient organizations and panels between 11/2020–1/2021, and completed by those 18 years of age and older diagnosed with eczema or a caregiver of a child with eczema. All participants (n=2,160) completed the survey; 87.4% were adults while 12.5% were caregivers of children. Respondents were from 70 countries; 85% of adults were female; 55% of the children were male. Cumulative corticosteroid exposure over a lifetime of eczema is substantial and associated with development of new conditions, including TSWS.