9 In a similar study of 52 children with eczema treated with mid potency topical steroid to lesional skin for two weeks, subsequent daily application of emollient significantly improved xerosis and pruritus compared to no application of emollient.
In a trial of 570 adults with moderate to severe AD, 36% clinical improvement (as determined by the eczema area and severity index) was seen for both tacrolimus 0.1% ointment and hydrocortisone butyrate 0.1% ointment (mid potency steroid), and both were superior to tacrolimus 0.03% ointment.
22 In a study of 51 children (aged 3 months to 6 years) with extensive eczema (≥35% BSA), fluticasone propionate (a mid potency steroid) applied twice daily for 3 to 4 weeks was associated with no cutaneous adverse effects and only mild HPA suppression in 2/43 children.
Circadian and ultradian rhythms are maintained during treatment with high-potency and mid-potency CS in healthy skin.
10 Clocortolone pivalate is a mid-potency topical glucocorticoid available as a 0.1% cream.
Commonly used options include low potency (class VII and VI; eg, hydrocortisone, desonide), mid-potency (class III V; eg, triamcinolone, mometasone, fluticasone) to high-potency (class I II; eg, fluocinonide, desoximetasone, betamethasone dipropionate, clobetasol, halobetasol) corticosteroids.
The authors concluded that both TCIs are more effective than placebo, that tacrolimus is more effective than low-potency topical steroids or pimecrolimus, and that tacrolimus is comparably effective as mid-potency topical steroids.
In a multicenter randomized trial of 121 of patients (aged 6 months to 18 years) with moderate to severe AD, Epiceram was associated with similar clinical improvement (SCORAD severity index, pruritus, and sleep score) at 28 days compared to mid-potency topical steroid (fluticasone), though the topical steroid was associated with more rapid improvement.
16 In another study of 55 children (aged 4 months to 12 years) with AD, treatment with prednicarbate emollient cream 0.1% (mid-potency corticosteroid) daily for three weeks resulted in global evaluation improvement without evidence of hypothalamic pituitary adrenal (HPA) axis suppression.
64 In a three-week study of 57 patients with AD, patients treated for 3 weeks concomitantly with a mid-potency steroid (clocortolone pivalate) and tacrolimus 0.1% ointment showed significant improvements in a variety of clinical parameters (including excoriation, induration, erythema, crusting, and lichenification) compared to monotherapy with either medication.
All of the participants were given the same amount of cannabis -- approximately one joint's worth -- and all of the cannabis was of the same mid-level potency.
