Recommendations for Topical Corticosteroid Use and the Role of Alternative, Advanced Targeted Topical Treatments in the Treatment of Chronic Inflammatory Skin Diseases

J Clin Aesthet Dermatol. 2025;18(5–6 Suppl 1):10–13.

by Douglas DiRuggiero, DMSc, MHS, PA-C; Jaclyn Agopian, MPAP, PA-C; Andrew Baker, MBA, MPAS, PA-C; Amber Blair, PA-C; Matthew Brunner, MHS, PA-C, CAQ-Derm, DFAAPA; Avery Dinallo, DNP, FNP-C, DCNP; Justin Love, MPAS, PA-C; Kristin Rygg, MPAS, PA-C; Aaron Sookhoo, MMS, PA-C; Melodie Young, MSN, A/GNP-c; Robert Higham, MPAS, PA-C; Melissa Seal, PhD; and Diane Hanna, DNP, DCNP, FAANP

Dr. DiRuggiero is with the Skin Cancer and Cosmetic Dermatology Center in Rome, Georgia. Ms. Agopian is with the American Skin Institute in Sherman Oaks, California. Mr. Baker is with DOCS Dermatology in Columbus, Ohio. Ms. Blair is with Dermatology Laser and Vein Specialists of the Carolinas, PLLC in Charlotte, North Carolina. Mr. Brunner is with the Elevate-Derm Conference and the Dermatology and Skin Surgery Center P.C. in Stockbridge, Georgia. Dr. Dinallo is with Mountain Pine Dermatology in Meridian, Idaho. Mr. Love is with the Department of Dermatology at Loma Linda University in Loma Linda, California. Ms. Rygg is with Apex Dermatology in Littleton, Colorodo. Mr. Sookhoo is with Suncoast Skin Solutions in Brandon, Florida. Ms. Young is with Mindful Dermatology and Modern Research Associates in Dallas, Texas. Mr. Higham and Drs. Seal and Hanna are with Arcutis Biotherapeutics Inc. in Westlake Village, California.

Funding: Medical writing assistance was provided by Arcutis Biotherapeutics, Inc.

Disclosures: Dr. DiRuggiero is a an advisory board and/or speakers bureau member for Abbvie, Amgen, Arcutis, Dermavant, Galderma, Incyte, Johnson and Johnson, Lilly, Novartis, Sanofi/Regeneron, and UCB. Ms. Young has been an investigator for AbbVie, Alumis, Amgen, AnaptysBio, ASLAN Pharmaceuticals, Boehringer Ingelheim, Cara Therapeutics, Incyte, Janssen, Lilly, Novartis, Pfizer, Sanofi, Takeda, and UCB; received consulting fees from Arcutis, Dermavant, Janssen, LEO Pharma, Novartis, Sanofi, Sun Pharma, and UCB; and received honoraria for speakers bureaus from Amgen, Arcutis, Boehringer Ingelheim, Dermavant, Janssen, LEO Pharma, Lilly, Sun Pharma, and UCB. Mr. Brunner has received grants from AbbVie; is a speaker bureaus member for AbbVie, BMS, Boehringer Ingelheim, Johnson and Johnson, LEO Pharma, and Sun Pharma; and is a consultant for AbbVie, Amgen, Arcutis Biotherapeutics, Boehringer Ingelheim, BMS, Lilly, Incyte, Johnson and Johnson, LEO Pharma, Novartis, Organon, Pfizer, UCB, Sanofi Genzyme/Regeneron, and Sun Pharma. Mr. Baker is a board and/or speakers bureau member for Novartis, Arcutis, BMS, SUN Pharma, Incyte, Boehringer Ingelheim, Sanofi, LEO Pharma, Johnson and Johnson, and Castle Biosciences. Mr. Love is a speaker/consultant for Sanofi/Regenerson, Lilly, Abbvie, Johnson and Johnson, Galderma, UCB, Arcutis, Dermavant/Organon, and LEO Pharma. Mr. Sookhoo reports conflicts of interest with the FSDPA, Johnson and Johnson, Abbvie, Arcutis, Pfizer, Regeneron/Sanofi, Verrica, Galderma, BMS, UCB, Botanix, and LEO Pharma. Ms. Blair is a consultant for Arcutis, BMS, Galderma, Incyte, Johnson and Johnson, Lilly, SDPA, Pfizer, and UCB. Ms. Rygg is a consultant for Arcutis, BMS, Galderma, LEO Pharma, Incyte, Ferndale, Novartis, Pfizer, and Sanofi and is a speaker for Arcutis, Biersdorf, Galderma, L’Oréal, Verrica, and Almirall. Ms. Agopian and Dr. Dinallo report no conflicts of interest. Mr. Higham and Drs. Seal and Hanna are employees of Arcutis Biotherapeutics, Inc.

ABSTRACT: Safety concerns associated with topical corticosteroids (TCS) have been increasingly recognized and well documented in medical literature for many decades. In response, advanced targeted topical (ATT) therapies have emerged as safer, effective alternatives for managing chronic inflammatory skin diseases. In this review, a group of experienced dermatology nurse practitioners (NPs) and physician assistants/associates (PAs) summarize key consensus statements from a 2025 physician–expert-panel literature review and consensus statement publication addressing the safety and efficacy of TCS and the role of ATT therapies for chronic inflammatory skin diseases. It highlights practical recommendations for incorporating ATT therapies into clinical practice and emphasizes the vital role of NPs and PAs in monitoring cumulative corticosteroid exposure to minimize the risk of both cutaneous and systemic adverse effects associated with TCS use. KEYWORDS: Consensus statements, topical corticosteroids (TCS), monitoring, systemic adverse effects, cutaneous adverse effects, advanced targeted topical (ATT) therapies

Introduction

Corticosteroids are commonly used to treat inflammatory dermatoses due to their anti-inflammatory, antiproliferative, and immunosuppressive properties.¹ However, these same mechanisms can lead to adverse events that are frequently overlooked and underreported, despite extensive research exploring their connection to corticosteroid use. Safety concerns associated with topical corticosteroids (TCS) have been well documented in medical literature for many decades.^2–4 Cutaneous side effects (skin atrophy, striae, stinging, burning, and dyschromia) have been noted by dermatology clinicians since the first published utilization of TCS (compounded 17-hydroxycorticosterone-21-acetate) by Witten and Sulzburger in 1952.⁵ Beyond the skin, however, systemic adverse effects and events (hypothalamic-pituitary-adrenal axis suppression, osteoporosis, menstrual abnormalities, and topical steroid withdrawal) are increasingly recognized in both short- and long-term TCS use.^6–16 The risks of cutaneous and systemic adverse events occur more frequently with utilization of higher potency TCS and prolonged use, but it should be noted that complications have been reported with both short-term and long-term intermittent use.^16–18 TCS continue to be the most commonly prescribed treatment for psoriasis vulgaris and atopic dermatitis,¹⁹ likely due to the cost, insurance coverage, and limited effectiveness of previously available nonsteroidal topical options, such as topical calcineurin inhibitors.

Subsequently, these concerns have led to increased scrutiny of corticosteroid use by regulatory agencies, (eg, Canada, United Kingdom, and India),^20–22 academic societies (eg, International Eczema Council, British Dermatological Nursing Group/‌British Association of Dermatologists, American Academy of Family Physicians),^23–25 as well as patient advocacy groups (eg, National Eczema Society, National Eczema Association).^25,26 These worldwide agencies have called for the limiting of TCS use due to the emerging risks and safety concerns associated with steroid use. Despite these calls to action and the development of newer advanced targeted topical (ATT) therapies, TCS have largely remained the primary first-line and maintenance topical prescription options for patients with chronic inflammatory skin diseases such as psoriasis vulgaris, seborrheic dermatitis, and atopic dermatitis. Despite widespread awareness of corticosteroid-associated risks, standardized monitoring guidelines for at-risk patients remains limited^23,27–32 and varies across specialties, often disallowing proper monitoring and documentation of cumulative steroid exposure across routes of administration (topical, oral, inhaled, intralesional, and intramuscular). The absence of consistent monitoring guidelines not only makes clinical decision-making more challenging, but it can also slow progress in accepting newer, evolving treatment practices. As a result, the adoption of newer, targeted nonsteroidal topical treatments can be hindered, in part, due to the outdated treatment guidelines that have yet to reflect these advances.^33,34

To address these gaps, a recent expert panel of dermatologists conducted a comprehensive literature review and developed consensus statements to guide safe and effective use of TCS and ATT in clinical practice. In this brief review, a group of experienced dermatology nurse practitioners (NPs) and physician assistants/associates (PAs) will summarize and present key statements reached by this panel of dermatologists with expertise in treating inflammatory skin disease. The expert panel performed a comprehensive literature search of PubMed, Scopus, and Google Scholar using a combination of keywords “topical,” “steroid,” “non-steroid,” “efficacy,” “adverse effects,” and “malpractice,” and “inflammatory skin diseases.”³⁵ Initially, 350 articles met the criteria, but ultimately only 24 manuscripts were selected as relevant to the research question at hand, and from these articles, the panel of four dermatologists were able to establish 10 consensus statements and provide insightful recommendations. A modified Delphi process was then utilized to reach consensus for each of the statements, which required a supermajority approval for adoption. Additionally, each consensus statement was assigned a Strength of Recommendation Taxonomy (SORT) criteria value of either A, B, or C. By focusing on the quantity, quality, and strength of evidence in medical literature, this system was utilized to grade the strength of evidence in medical literature: Grade A indicates consistent, high-quality, patient-oriented evidence, and randomized, controlled trial data; Grade B reflects less consistent, limited-quality, patient-oriented evidence; Grade C recommendations are based on consensus, disease-oriented evidence, case series, and/or opinion.

Consensus statement summary

1. The need for a cautious approach in prescribing TCS for chronic conditions due to associated risks (SORT level A).
2. Multiple TCS usage can burden the healthcare system and patients; and long-term use in chronic conditions is not ideal (SORT level C).
3. ATT therapies (crisaborole, delgocitinib, roflumilast, ruxolitinib, and tapinarof), considered as alternatives to corticosteroids, can be safe and effective options for both short-term and long-term treatment of inflammatory skin diseases for which they have been studied (SORT level A).
4. Many patients can access these ATT therapies affordably through specialized pharmacies, which can mitigate some financial barriers often encountered with traditional pharmacy routes. (SORT level C).

Overall, the physician-expert consensus panel advocates for a more individualized approach for treating inflammatory skin diseases, recommending the use of ATT therapies for both short- and long-term management. This strategy aims to reduce, and when possible, avoid the risks associated with corticosteroid use, regardless of the duration. Consistent with the expert-panel review article, as well as recent literature, the authors of this article provide the following suggestions and recommendations with the use of TCS and ATT therapies in patients with chronic inflammatory skin diseases.

Best practices for prescribing topical and systemic corticosteroids. A recent survey of adults and children with atopic dermatitis revealed that patients frequently used TCS in ways that exceed expert guidelines—applying them once daily for more than 15 days per month, covering over 20 percent of their body surface area,³⁶ and using them on areas not originally prescribed. To manage risks of adverse events, clinicians should focus TCS use in acute settings, prescribe the lowest potency steroid needed and, when prescribing more than one topical steroid of varying strengths, ensure clear patient understanding of the instructions for each topical steroid prescribed. Patient counseling on the appropriate application amount, frequency of application, and appropriate location for application as well as duration of use, is critical to reduce the risks of adverse events. For many patients, monthly limits on the number of prescriptions might restrict access to necessary treatments across all health needs per month. It should be noted that polypharmacy for inflammatory dermatoses can lead to access challenges, causing prescriptions being delayed, denied, or improperly substituted. This could lead to medication errors, poor adherence, inappropriate use of higher-potency therapies, and ultimately, poor disease control.

Closely monitor patients when prescribing topical and systemic corticosteroids. Decisions around system monitoring should consider the overall corticosteroid exposure and is dependent on the individual patient’s clinical presentation and previous steroid use. While literature characterizing cumulative-lifetime corticosteroid load in patients have not been published, studies correlating cumulative TCS load with risk of adverse events, such as risk of fracture due to decreased bone mineral density, glaucoma, and cataracts, and topical steroid withdrawal syndrome, demonstrate the importance of monitoring the amount and duration of TCS use in the context of their overall corticosteroid use.^37–39 It is important to note that some adverse events can persist even after corticosteroids are discontinued, reinforcing the need for ongoing assessment of these patients.^37–39 However, current monitoring recommendations have primarily focused on systemic corticosteroids,^32,40 often overlooking risks associated with cumulative exposure across all forms of administration. Our authors recommend broadening the monitoring of endocrine, ophthalmologic, orthopedic, and other systems to include cumulative steroid load across all delivery modalities (oral, topical formulations, inhaled therapies, ophthalmic and otic drops, and nasal sprays); which might require collecting a more detailed patient history of concurrent treatments. Collecting information about prior and concomitant steroid use across modalities and point of care (telehealth, urgent care, emergency rooms, clinician office), even for conditions beyond dermatology, is critical in understanding total corticosteroid load and thus appropriately assessing the risk of adverse effects. Holistic monitoring in collaboration with other treating clinicians—such as rheumatology, orthopedics, family medicine, pediatrics, and ophthalmology—supports continuity of care, particularly in complex cases involving high-dose or long-term corticosteroid use. Monitoring strategies should consider factors such as weight-based systemic dosing, extent of topical application, and anticipated duration of treatment. Not all patients will require every element of assessment, and monitoring frequency should be tailored accordingly. A thorough understanding of a patient’s total corticosteroid exposure can help determine when closer monitoring is warranted or when it might be appropriate to integrate ATT therapies.⁴¹

Incorporate advanced targeted topical therapies in treatment algorithm.Consistent with the replacement of older treatments with novel oral and injectable biologic agents, newly developed ATT therapies come with robust clinical data to support their use for inflammatory diseases for which they have been studied. The short- and long-term safety and efficacy of ATT therapies have been demonstrated in chronic inflammatory skin diseases. Specifically, development programs for these treatments include long-term open-label trials to assess safety and efficacy for at least 52 weeks. Clinical trials of TCS have been conducted but were largely limited to short duration treatment periods, hence they are not approved for long-term use, and received a SORT level C recommendation from the physician panel for the statement regarding their long-term use in chronic skin conditions.

Review excipients and preservatives carefully. Topical formulations that contain vehicle excipients that support the skin barrier do not elicit an innate immune response such as irritant or contact dermatitis. In addition to the epidermal barrier damage that can be caused by corticosteroids directly, some TCS formulations commonly include vehicle excipients, such as penetration enhancers and emulsifiers. Penetration enhancers can increase drug delivery into the skin, while certain emulsifiers (eg, sodium alkyl sulfates, sodium lauryl sulfates) act as detergents, which further disrupt the stratum corneum and extract epidermal lipids such as ceramides. When selecting topical treatments, it is important to review excipients and preservatives carefully—particularly penetration enhancers and excipients such as propylene glycol, formaldehyde, alcohols, or fragrances, which can contribute to irritation, discomfort, or contact dermatitis, especially in patients with compromised epidermal barriers.^42–46 Contact hypersensitivity can also occur with both corticosteroids and certain vehicle components, some of which can be more allergenic than others. In contrast, some ATT therapies approved by the United States Food and Drug Administration have been developed with attention to tolerability and barrier support, using vehicles designed to minimize irritation and enhance overall patient comfort.⁴⁷

Conclusion

Both cutaneous and systemic safety concerns with continuous and intermittent use of TCS is well established in the literature, yet they continue to be utilized as both first-line and maintenance treatments for chronic inflammatory skin diseases, despite a paucity of dedicated clinical trials within the indication for which they are labeled. In addition, lack of labeled indications, poor or absent provider chart documentation of cumulative steroid use, and unrecorded or neglected proper patient counseling about appropriate use and potential side effects could result in medical-legal risks for practitioners.

Alternatively, there are a growing number of publications and randomized, controlled trials to support the use of ATT therapies such as crisaborole, delgocitinib, roflumilast, ruxolitinib, and tapinarof in chronic inflammatory skin diseases. These therapies have been shown to be effective, well tolerated, and generally safe for both short- and long-term treatment of conditions such as atopic dermatitis and psoriasis in pediatric and adult patients.³⁵

Moreover, the physician–expert-consensus panel recommendations provide a strong call to action for clinicians to limit the use of TCS, especially high and very high-potency TCS, to an acute setting for inflammatory diseases and abstain from long-term therapy. Additionally, clinicians should more readily incorporate newer ATT therapies into practice, supporting patient outcomes while minimizing the risks associated with topical and systemic corticosteroid use.

Lastly, as frontline clinicians in medical dermatology, NPs and PAs play a critical role in optimizing patient care. By embracing and adopting newly developed and approved ATT therapies and implementing monitoring protocols for corticosteroid use, we can move beyond the traditional overreliance of corticosteroids, specifically topical corticosteroids. Capturing comprehensive steroid exposure data across formulations is not yet standard of practice. We must strive to thoughtfully assess, document, and consider screening and referring for the most common adverse events associated with corticosteroid use (Table 1). This proactive approach not only optimizes patient outcomes but it reinforces our commitment to safety in the management of chronic inflammatory skin diseases. There is an unmet need across all specialties for a comprehensive multidisciplinary approach and guidelines to screen, monitor, and mitigate adverse events associated with cumulative corticosteroid use to advance patient care across the patient’s lifespan.

References

1. Gabros S, Nessel TA, Zito PM. Topical corticosteroids. StatPearls. StatPearls Publishing; 2025. Accessed March 26, 2025. https://www.ncbi.nlm.nih.gov/books/NBK532940/weeks.
2. Andersen YMF, Egeberg A, Ban L, et al. Association between topical corticosteroid use and Type 2 diabetes in two European population-based adult cohorts. Diabetes Care. 2019;42(6):1095–1103.
3. Smeeth L, Boulis M, Hubbard R, Fletcher AE. A population based case-control study of cataract and inhaled corticosteroids. Br J Ophthalmol. 2003;87(10):1247–1251.
4. Zhao S, Hwang A, Miller C, Lio P. Safety of topical medications in the management of paediatric atopic dermatitis: an updated systematic review. Br J Clin Pharmacol. 2023;89(7):2039–2065.
5. Sulzberger MB, Witten VH. The effect of topically applied compound F in selected dermatoses. J Invest Dermatol. 1952;19(2):101–102.
6. Hodgens A, Sharman T. Corticosteroids. StatPearls. StatPearls Publishing; 2025.
7. Broersen LH, Pereira AM, Jorgensen JO, Dekkers OM. Adrenal insufficiency in corticosteroids use: systematic review and meta-analysis. J Clin Endocrinol Metab. 2015;100(6):2171–2180.
8. Laugesen K, Jorgensen JOL, Petersen I, Sorensen HT. Fifteen-year nationwide trends in systemic glucocorticoid drug use in Denmark. Eur J Endocrinol. 2019;181(3):267–273.
9. Chotiyarnwong P, McCloskey EV. Pathogenesis of glucocorticoid-induced osteoporosis and options for treatment. Nat Rev Endocrinol. 2020;16(8):437–447.
10. Egeberg A, Schwarz P, Harslof T, et al. Association of potent and very potent topical corticosteroids and the risk of osteoporosis and major osteoporotic fractures. JAMA Dermatol. 2021;157(3):275–282.
11. Brook EM, Hu CH, Kingston KA, Matzkin EG. Corticosteroid injections: A review of sex-related side effects. Orthopedics. 2017;40(2):e211–e215.
12. DiRuggiero D, DiRuggiero M. Beyond skin deep: the systemic impact of topical corticosteroids in dermatology. J Clin Aesthet Dermatol. 2025;18(1–2 Suppl 1):S16–S20.
13. Kimkool P, Brough HA. Topical steroid withdrawal: addressing a controversial dermatological condition. J Invest Dermatol. 2025;–202x(25)00289–1.
14. Shobnam N, Ratley G, Saksena S, et al. Topical steroid withdrawal is a targetable excess of mitochondrial NAD. J Invest Dermatol. 2025;S0022-202X(25)00014-4.
15. Hajar T, Leshem YA, Hanifin JM, et al. A systematic review of topical corticosteroid withdrawal (“steroid addiction”) in patients with atopic dermatitis and other dermatoses. J Am Acad Dermatol. 2015;72(3):541–549.e2.
16. Curtis JR, Westfall AO, Allison J, et al. Population-based assessment of adverse events associated with long-term glucocorticoid use. Arthritis Rheum. 2006;55(3):
    420–426.
17. Manson SC, Brown RE, Cerulli A, Vidaurre CF. The cumulative burden of oral corticosteroid side effects and the economic implications of steroid use. Respir Med. 2009;103(7):975–994.
18. Rice JB, White AG, Johnson M, et al. Quantitative characterization of the relationship between levels of extended corticosteroid use and related adverse events in a US population. Curr Med Res Opin. 2018;34(8):
    1519–1527.
19. Dermatological agents: total prescriptions in (2022). ClinCalc DrugStats Database version 2024.08. ClinCalc LLC. Accessed March 26, 2025. https://clincalc.com/DrugStats/TC/DermatologicalAgents.
20. Health Canada. Safety Brief: Topical Corticosteroids and the Risk of Topical Withdrawal Reactions. Her Majesty the Queen in Right of Canada. July 2022. Accessed March 18, 2025. https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/health-product-infowatch/july-2022.html.
21. Medicines and Healthcare Products Regulatory Agency. MHRA Public Assessment Report: Topical Steroid Withdrawal Reactions: A Review of the Evidence. September 15, 2021. Accessed March 18, 2025. https://www.gov.uk/government/publications/topical-steroid-withdrawal-reactions-a-review-of-the-evidence/topical-steroid-withdrawal-reactions-a-review-of-the-evidence.
22. Coondoo A. Topical corticosteroid misuse: the Indian scenario. Indian J Dermatol. 2014;59(5):451–455.
23. Stacey SK, McEleney M. Topical corticosteroids: choice and application. Am Fam Physician. 2021;103(6):
    337–343.
24. Drucker AM, Eyerich K, de Bruin-Weller MS, et al. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement. Br J Dermatol. 2018;178(3):768–775.
25. National Eczema Society, British Dermatological Nursing Group, British Association of Dermatologists. Topical Steroid Withdrawal: A Joint Statement by National Eczema Society, the British Dermatological Nursing Group, and the British Association of Dermatologists. February 2024. Accessed March 18, 2025. https://cdn.bad.org.uk/uploads/2024/02/22095550/Topical-Steroid-Withdrawal-Joint-Statement.pdf.
26. National Eczema Association. Education Announcement: Use of Topical Steroids for eczema. July 17, 2021. Accessed March 18, 2025. https://nationaleczema.org/blog/warnings-for-topical-steroids-eczema/.
27. Duru N, van der Goes MC, Jacobs JW, et al. EULAR evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis. 2013;72(12):1905–1913.
28. Hoes JN, Jacobs JW, Boers M, et al. EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis. 2007;66(12):1560–1567.
29. Laurent MR, Goemaere S, Verroken C, et al. Prevention and treatment of glucocorticoid-induced osteoporosis in adults: consensus recommendations from the Belgian Bone Club. Front Endocrinol (Lausanne). 2022;13:908727.
30. van der Goes MC, Jacobs JW, Boers M, et al. Monitoring adverse events of low-dose glucocorticoid therapy: EULAR recommendations for clinical trials and daily practice. Ann Rheum Dis. 2010;69(11):1913–1919.
31. Cooper C, Bardin T, Brandi ML, et al. Balancing benefits and risks of glucocorticoids in rheumatic diseases and other inflammatory joint disorders: new insights from emerging data. An expert consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Aging Clin Exp Res. 2016;28(1):1–16.
32. Fardet L, Kassar A, Cabane J, Flahault A. Corticosteroid-induced adverse events in adults: frequency, screening and prevention. Drug Saf. 2007;30(10):861–881.
33. Elmets CA, Korman NJ, Prater EF, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol. 2021;84(2):432–470.
34. Sidbury R, Alikhan A, Bercovitch L, et al. Guidelines of care for the management of atopic dermatitis in adults with topical therapies. J Am Acad Dermatol. 2023;89(1):e1–e20.
35. Burshtein J, Chovatiya R, Golant A, et al. Risks of topical corticosteroid therapy and role for advanced targeted topical treatments for inflammatory skin diseases: an expert consensus panel. Dermatol Online J. 2025;31(1):10.5070/D331164978.
36. Barta K, Fonacier LS, Hart M, et al. Corticosteroid exposure and cumulative effects in patients with eczema: results from a patient survey. Ann Allergy Asthma Immunol. 2023;130(1):93–99.
37. van Velsen SG, Haeck IM, Knol MJ, et al. Two-year assessment of effect of topical corticosteroids on bone mineral density in adults with moderate to severe atopic dermatitis. J Am Acad Dermatol. 2012;66(4):691–693.
38. Haeck IM, Rouwen TJ, Timmer-de Mik L, et al. Topical corticosteroids in atopic dermatitis and the risk of glaucoma and cataracts. J Am Acad Dermatol. 2011;64(2):275–281.
39. Sheary B. Steroid withdrawal effects following long-term topical corticosteroid use. Dermatitis. 2018;29(4):213–218.
40. Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013;9(1):30–1492-9-30.
41. Rademaker M. Low dose oral steroids can increase fracture risk. Prescriber Update. 2002;23(1):6–7.
42. Danby SG, Draelos ZD, Gold LFS, et al. Vehicles for atopic dermatitis therapies: more than just a placebo. J Dermatolog Treat. 2022;33(2):685–698.
43. Lemery E, Briançon S, Chevalier Y, et al. Surfactants have multi-fold effects on skin barrier function. Eur J Dermatol. 2015;25(5):424–435.
44. Kircik LH. Practical aspects of topical corticosteroid selection. J Drugs Dermatol. 2012;11(12):s3–s4.
45. Som I, Bhatia K, Yasir M. Status of surfactants as penetration enhancers in transdermal drug delivery. J Pharm Bioallied Sci. 2012;4(1):2–9.
46. Jacob SE, Scheman A, McGowan MA. Propylene Glycol. Dermatitis. 2018;29(1):3–5.
47. Zirwas M. Allergy to topical steroids. J Drugs Dermatol. 2012;11(12):s9–s11.