The Role and Risks of Systemic Corticosteroids in Atopic Dermatitis: An Expert Consensus

Background Atopic dermatitis (AD) is a chronic inflammatory disease affecting millions worldwide. Despite strong recommendations from leading dermatology organizations discouraging routine use of systemic corticosteroids (SCS) in AD, they remain frequently prescribed. This expert consensus provides evidence-based recommendations on the role of SCS in the management of AD. Methods A comprehensive literature search was completed using combination of keywords “atopic dermatitis,” “systemic corticosteroids,” “adverse effects,” “short-term,” “long-term,” and “alternative therapies”. A panel of 9 dermatologists with substantial expertise in management of AD reviewed eligible articles using Strength of Recommendation Taxonomy (SORT) criteria and developed consensus statements. A modified Delphi process was used to approve each statement, and a strength of recommendation was assigned. Results The literature search produced 500 articles, of which 27 met screening criteria for inclusion. The expert panel unanimously voted to adopt 11 consensus statements and recommendations: eight with strength of “A” and three with strength of “C”. Conclusion This expert consensus defines evidence-based thresholds for short- and long-term systemic SCS use in AD, highlights their significant safety risks, and affirms that any SCS exposure constitutes a systemic therapy trial, supporting prompt transition to advanced systemic treatments.