Key points

• RCTs of topical steroids versus placebo suggest a large treatment effect in atopic eczema.

• It is not possible to make recommendations about the "best" topical steroid as no RCT has compared all available preparations of similar potency.

• There is no clear RCT evidence to support the use of twice daily over once daily topical steroid administration.

• There is no RCT evidence that skin thinning is a problem with correct use of topical steroids, although most RCTs have been of short duration and other non-RCT evidence should be considered before coming to firm conclusions.

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