Expert Consensus and Latest Developments in Systemic Corticosteroid Use for Atopic Dermatitis: Embracing a New Era of Personalized Management

The management of atopic dermatitis (AD) is undergoing a revolutionary transformation, driven by scientific breakthroughs, the emergence of targeted therapies, and an increasing emphasis on patient safety and individualized care. Central to this evolution is a clear and expanding consensus among dermatology experts: systemic corticosteroids (SCS), once a cornerstone for managing severe flares, should now be reserved exclusively for short-term rescue therapy during acute, severe episodes. This shift reflects a broader movement toward steroid-sparing strategies, utilizing innovative biologics and small molecules that offer improved efficacy with fewer adverse effects.

Reinforcing the Role of Systemic Corticosteroids: From Mainstay to Emergency Use

Traditionally, systemic corticosteroids were widely employed to provide rapid relief in severe or refractory AD cases. Their quick onset of action made them indispensable during critical exacerbations. However, long-term or repeated use has been associated with a host of safety concerns, including:

• Skin atrophy, striae, and telangiectasia
• Osteoporosis and fracture risk
• Metabolic disturbances such as hyperglycemia and dyslipidemia
• Hypertension and weight gain
• Increased susceptibility to infections due to immunosuppression
• Growth suppression in pediatric populations

Recent guidelines and expert panels now emphasize limiting SCS to short-term rescue interventions during severe flares, accompanied by strict tapering protocols to mitigate rebound phenomena and adverse effects. Monitoring protocols—including growth assessments in children, laboratory checks for metabolic and immune parameters, and infection surveillance—are integral to ensuring safety when SCS are employed.

Dr. James Del Rosso, a leading dermatology expert, underscores this paradigm shift: “While systemic corticosteroids can be effective during critical moments, their risks outweigh benefits when used long-term. The goal is to reserve them strictly for emergencies, replacing them with safer, targeted options.”

The New Therapeutic Landscape: Targeted Biologics and Small Molecules

A therapeutic revolution is reshaping AD management, driven by a deeper understanding of the disease’s immunological pathways. This has led to the development and approval of mechanism-based, steroid-sparing agents that are now central to long-term disease control.

Key Approved and Emerging Therapies

• Dupilumab: An IL-4 receptor alpha monoclonal antibody, remains a cornerstone for moderate-to-severe AD. Notably, recent approvals now extend its use to infants as young as 6 months, enabling early intervention that has the potential to modify disease trajectory.

• Zasocitinib (TYK2 inhibitor): Demonstrated positive phase 3 results as an oral steroid-sparing agent, offering convenience and targeted control. Its approval broadens options for patients seeking oral therapies with a favorable safety profile.

• Rezpegaldesleukin: An IL-2 pathway agonist, has exhibited sustained improvements over 52 weeks—highlighted at recent conferences—indicating a promising long-term, steroid-sparing treatment approach.

• Amlitelimab: An IL-13 pathway inhibitor with long-lasting remission potential, supporting dosing intervals of up to 12 weeks, which enhances adherence and quality of life.

• Lebrikizumab and Rademikibart: Late-stage IL-13 and IL-4Rα inhibitors, respectively, showing promising efficacy data and expanding the armamentarium.

• STAT6 inhibitors (e.g., REX-8756): Representing future personalized, pathway-specific therapies, these agents aim to target key transcription factors involved in AD’s immunopathology.

Key Data and Conference Highlights from 2026

At the South Beach Symposium 2026, several pivotal updates and data points were presented:

• Rezpegaldesleukin: The 52-week durability study demonstrated sustained efficacy with a favorable safety profile, supporting its role as a long-term, steroid-sparing option.

• Zasocitinib: Phase 3 trials reported positive outcomes, reaffirming its position as an effective, oral alternative for long-term management.

• Expanded pediatric approvals of dupilumab now include early intervention in infants, emphasizing a proactive approach aimed at preventing disease progression and improving quality of life.

• The integration of digital health tools—such as adherence applications and remote monitoring—was highlighted for its effectiveness in reducing relapse rates and enhancing patient compliance, with recent multicenter Chinese studies exemplifying these benefits.

Practical Guidance for Clinicians: Stewardship Principles and Personalization

Clinicians are encouraged to adopt stewardship principles in their practice, emphasizing safe, effective, and personalized care:

• Prioritize targeted biologics and small molecules for long-term control of moderate-to-severe AD.
• Reserve systemic corticosteroids strictly for short-term rescue during severe flares, with careful tapering protocols to prevent rebound effects.
• Implement comprehensive monitoring protocols, including:
  • Growth assessments in pediatric patients
  • Regular laboratory testing (immune markers, metabolic panels)
  • Infection surveillance for early detection of immunosuppressive effects
• Leverage digital health interventions, such as adherence apps and teledermatology, to monitor disease activity, enhance compliance, and prevent relapses.

Patient education remains vital—empowering individuals and caregivers with knowledge about medication risks, proper topical therapy use, and adherence strategies to minimize systemic therapy needs.

Insights from Key Thought Leaders

In an insightful interview with Dermatology Times, Dr. James Del Rosso emphasized the transformational impact of early biologic intervention, especially in pediatric populations. He highlighted that initiating targeted therapies early could alter disease course, potentially reducing reliance on systemic corticosteroids over time. Additionally, he pointed out the growing role of digital tools in enhancing adherence and early relapse detection, marking a shift toward more personalized, data-driven management.

The Future of Atopic Dermatitis Management: A Personalized and Safer Approach

The expert consensus remains clear: systemic corticosteroids should be confined to short-term rescue therapy in atopic dermatitis. The rapidly expanding array of targeted agents—with multiple therapies now approved or in late-stage development—heralds a new era characterized by personalized, safe, and effective treatment regimens.

Looking ahead, future therapies are anticipated to feature:

• Enhanced mechanism-specific targeting for precision medicine
• Flexible, patient-tailored dosing regimens
• Integration with digital health platforms for improved adherence and real-time disease monitoring

Clinicians are urged to stay informed, adopt evidence-based, personalized strategies, and routinely monitor to ensure safe, effective, and patient-centered care.

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Summary

In conclusion, systemic corticosteroids are now regarded as a last-resort rescue therapy in atopic dermatitis, with the therapeutic landscape rapidly shifting toward targeted biologics and small molecules. The 2026 South Beach Symposium and emerging clinical data reinforce this paradigm, emphasizing early intervention, digital health tools, and personalized management plans. This evolution promises safer, more effective treatment options and a better quality of life for patients, especially vulnerable pediatric populations.

By embracing these advancements, clinicians can confidently navigate the changing landscape—delivering innovative, safe, and individualized care in the ongoing fight against atopic dermatitis.

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Additional Insight: Horizons in Complex Inflammatory Skin Disease Management

Further reflecting the momentum of this transformative era, Dermatology Times recently concluded its second annual "Horizons in Advanced Practice" meet, where leading experts delved into innovative strategies for managing complex inflammatory skin diseases. This gathering underscored the rapid expansion of targeted therapies, digital integration, and personalized medicine approaches shaping the future of dermatological care, particularly in conditions like AD where systemic and topical therapies are evolving hand-in-hand.