Maintenance Therapy in Atopic Dermatitis: Weekend Versus Daily Topical Corticosteroid

Abstract

Introduction: Atopic dermatitis (AD) requires proactive maintenance to prevent flares. Twice-weekly (weekend) topical corticosteroid (TCS) is recommended, but comparison with daily application is limited. Methods: Systematic review of 6 RCTs (n=1,208) comparing weekend TCS (2 consecutive days/week, mid-potency) versus daily TCS for 6 months after disease clearance. Inclusion: moderate-to-severe AD (EASI ≥12). Primary outcome: time to first flare, number of flares/6 months. Secondary: adverse effects (skin atrophy, telangiectasia). Results: Weekend regimen prolonged time to flare (median 98 days vs 46 days, HR 0.52, p<0.001) and reduced flare number (1.2 vs 2.8 flares/6 months). Daily regimen did not further reduce flares but increased atrophy signs (skin thinning: 14% vs 3%, p=0.001). No adrenal suppression in either group. Discussion: Weekend TCS maintains barrier function and reduces subclinical inflammation. Daily use adds no benefit while increasing steroid toxicity. Conclusion: Twice-weekly weekend topical corticosteroid is superior to daily application for flare prevention in atopic dermatitis.