May 2026 digest

From “Response” to “Reassurance”

Topical corticosteroids (TCS) remain the cornerstone of atopic dermatitis (AD) management worldwide. Yet, despite decades of clinical use, a paradox persists: while clinicians rely on TCS as first-line therapy, many patients remain uncertain, and sometimes fearful, about how to use them safely over time. This tension is increasingly visible in discussions around topical corticosteroid concern and topical steroid withdrawal (TSW), amplified by patient testimonies and digital communities.

In this context, the recent GA²LEN ADCARE consensus (DOI: 10.1016/j.waojou.2026.101380) represents an important and timely contribution. By proposing standardized definitions of response and inadequate response to TCS, it addresses a long-standing gap in clinical practice and research. The emphasis on relative improvement—typically ≥50% across validated clinician- and patient-reported outcomes—and pragmatic evaluation timepoints around two weeks reflects an effort to align therapeutic decision-making with measurable, clinically meaningful change. Importantly, the rejection of rigid escalation rules in favor of nuanced, context-dependent judgment acknowledges the complexity of AD care and the heterogeneity of patient trajectories.

Beyond methodology, the consensus also implicitly reframes TCS use as a dynamic process: induction, control, and maintenance, with flexibility guided by clinical expertise and shared decision-making. It recognizes the need to integrate patient-reported outcomes and highlights the persistent lack of long-term safety data stratified by potency, anatomical site, and exposure. In doing so, it opens the door to a more structured yet adaptable approach to TCS therapy.

However, from a patient-centered perspective, a critical gap remains. The consensus clarifies how to define response, but does not fully address what patients most often ask: how much is safe, for how long, and under what conditions? While concepts such as fingertip units, potency classes, and licensed durations are discussed, they are not translated into practical quantitative guidance for long-term or proactive use. This is particularly relevant in the era of maintenance strategies, where intermittent application—often twice weekly—has become standard practice to prevent relapses.

This gap is not merely technical; it lies at the heart of current TCS concerns. Uncertainty about dosing and long-term exposure fuels anxiety, contributes to underuse or erratic use, and may ultimately impair disease control. Conversely, the absence of practical frameworks may also allow inappropriate or prolonged use without adequate monitoring. The lack of shared, patient-accessible benchmarks risks perpetuating both undertreatment and overtreatment.

The International Society of Atopic Dermatitis (ISAD) has recently sought to address this issue through complementary initiatives. A two-round international survey of clinicians explored real-world practices in TCS maintenance therapy, including prescribed quantities (grams per month), potency choices, and proactive versus reactive strategies across age groups. These data suggest broad convergence toward intermittent, low-to-moderate intensity regimens, with greater variability in adolescents and site-specific practices. While not prescriptive, such findings begin to delineate pragmatic patterns that could inform clinical guidance and patient education.

In parallel, ISAD has engaged in structured dialogue on TCS concern and TSW, bringing together clinicians, researchers, and patient representatives. This initiative deliberately avoids polarized terminology and instead focuses on clarifying definitions, identifying research priorities, and fostering mutual understanding. One key insight is that patient concerns are not solely driven by misinformation, but also by genuine gaps in evidence and communication—particularly regarding long-term safety and individual susceptibility.

Taken together, these efforts suggest that the next step beyond defining response is moving toward defining safe and effective trajectories of use. Such trajectories would integrate clinical outcomes, exposure metrics, patient experience, and disease instability over time. In this respect, composite frameworks combining clinician-reported measures, symptoms such as itch and sleep, and patterns of flare and remission appear particularly relevant. The integration of monthly TCS quantities, as already captured in SCORAD scoring, may also provide a valuable indicator of adapted treatment.

Finally, the global health dimension should not be overlooked. In many settings, TCS remain the most accessible and cost-effective therapy for AD. Clarifying their safe use is therefore not only a matter of optimizing care in high-resource settings, but also of ensuring equitable, evidence-based treatment worldwide. Practical guidance on maintenance and dosing may prove as important as defining response thresholds, particularly where specialist follow-up remains limited.

The GA²LEN ADCARE consensus represents a significant step toward harmonizing the definition of TCS response. Yet to fully address current challenges surrounding TCS use, this framework should be complemented by patient-centered, quantitative, and longitudinal guidance on how these treatments are used in practice. Bridging this gap—from response to reassurance—may help restore confidence, improve adherence, and support sustainable disease control in AD.

16th Rajka-ISAD Beijing 2026

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