TY - JOUR
T1 - The definition of response and inadequate response to topical corticosteroid treatment in atopic dermatitis and related skin inflammatory diseases
T2 - A GA2LEN ADCARE statement paper
AU - Zuberbier, Torsten
AU - Abuzakouk, Mohamed
AU - Angelova Fischer, Irena
AU - Arruda, Luisa Karla
AU - Augustin, Matthias
AU - Beck, Lisa
AU - Bernstein, Jonathan
AU - Bindslev-Jensen, Carsten
AU - Bertolín-Colilla, Marta
AU - Bangert, Christine
AU - Calderón-Llosa, Oscar
AU - Canonica, Giorgio Walter
AU - Roldan-Castor, Mary Anne
AU - Casis-Hao, Roxanne J.
AU - Cherrez-Ojeda, Ivan
AU - Choo, Karen Jui Lin
AU - Chularojanamontri, Leena
AU - Cork, Michael J.
AU - Craig, Timothy J.
AU - Criado, Paulo Ricardo
AU - Custovic, Adnan
AU - Çetinarslan, Tubanur
AU - Çalıcıoğlu, Furkan
AU - de Bruin-Weller, Marjolein
AU - Douladiris, Nikolaos
AU - Ensina, Luis Felipe
AU - Erdem Öztürk, Yasemin
AU - Ertaş, Ragip
AU - Ferrucci, Silvia Mariel
AU - Rosário Filho, Nelson
AU - Flohr, Carsten
AU - Fluhr, Joachim
AU - Fomina, Daria
AU - Gregoriou, Stamatios
AU - Gotua, Maia
AU - Giménez-Arnau, Ana Maria
AU - Hoetzenecker, Wolfram
AU - Jack, Carolyn
AU - Criado, Roberta Fachini Jardin
AU - Katoh, Norito
AU - Katoulis, Alexandros
AU - Kökçü Karadağ, Şefika İlknur
AU - Larenas-Linnemann, Desiree
AU - Lee, Haur Yueh
AU - Lima, Herminio
AU - Mansour, Eli
AU - Mortz, Charlotte G.
AU - Morelo Rocha Felix, Mara
AU - Morris, Victor
AU - Moschione Castro, Ana
AU - Mota Veloso Bruscky, Dayanne
AU - Mukhina, Olga
AU - Nguyen, Dinh Van
AU - Nosbaum, Audrey
AU - Ozceker, Deniz
AU - Özkaya, Esen
AU - Oztas Kara, Rabia
AU - Parisi, Claudio A.S.
AU - Peter, Jonny
AU - Puig, Luis
AU - Ramon, German Dario
AU - Rincón-Pérez, Catalina
AU - Sahiner, Umit Murat
AU - Schmid-Grendelmeier, Peter
AU - Serra-Baldrich, Esther
AU - Sevimli Dikicier, Bahar
AU - Smith, Catherine H.
AU - Staubach, Petra
AU - Stevanovic, Katarina
AU - Su Kucuk, Ozlem
AU - Teovska Mitrevska, Natasa
AU - Thaci, Diamant
AU - Torres, Maria Jose
AU - Torres, Tiago
AU - Trócoli Zanetti, Maria Eduarda
AU - Tuchinda, Papapit
AU - Vadasz, Zahava
AU - Vakirlis, Efstratios
AU - Vieira Duarte, Gleison
AU - Virtanen, Hannele
AU - Werfel, Thomas
AU - Wollenberg, Andreas
AU - Worm, Margitta
AU - Yew, Yik Weng
AU - Pereira, Manuel P.
N1 - Publisher Copyright:
© 2026 The Author(s).
PY - 2026/5
Y1 - 2026/5
N2 - Background Topical corticosteroids (TCS) remain the first-line treatment for atopic dermatitis (AD) and related inflammatory skin diseases, yet no standardized definition of response exists. This gap contributes to heterogeneity in clinical practice and complicates trial design. We therefore aimed to develop consensus-based definitions of response and inadequate response to TCS therapy through a structured international eDelphi process. Methods A PubMed search (1974–July 2025) identified 403 relevant publications. Candidate statements were drafted from the evidence and refined by the ADCARE Steering Committee, categorized into 3 domains (status quo, unmet need, proposals), and evaluated in a three-round eDelphi survey among certified ADCARE members. Eighty-four dermatologists and allergists from 32 countries participated (Round 1 response rate 98%; Round 2, 80%; Round 3, 76%). Statements were rated on a 5-point Likert scale; consensus was defined as ≥75% agreement (scores 4 or 5). Results In total, 66 of 83 statements reached consensus. In the status quo domain, agreement centred on baseline severity, body surface area, and anatomical site as guiding factors for TCS choice, with potency and licensed duration considered central to safe prescribing. In the unmet-need domain, experts highlighted the absence of standardized definitions, variability in monitoring and escalation strategies, and gaps in long-term evidence and integration of patient-reported outcomes. In the proposal domain, consensus supported relative improvement thresholds (≥50% in EASI, SCORAD, itch NRS, IGA, PGA, POEM) and 14 days as a meaningful evaluation point. Absolute cut-offs, very short (7 days) or long (3 months) timeframes, and rigid escalation rules did not achieve consensus. These parameters were synthesized into concise and extended definitions of TCS response and inadequate response. Conclusions This GA2LEN ADCARE initiative represents the first international consensus on defining TCS response and inadequate response, offering a framework to harmonize clinical practice, enhance trial comparability, and support guideline development.
AB - Background Topical corticosteroids (TCS) remain the first-line treatment for atopic dermatitis (AD) and related inflammatory skin diseases, yet no standardized definition of response exists. This gap contributes to heterogeneity in clinical practice and complicates trial design. We therefore aimed to develop consensus-based definitions of response and inadequate response to TCS therapy through a structured international eDelphi process. Methods A PubMed search (1974–July 2025) identified 403 relevant publications. Candidate statements were drafted from the evidence and refined by the ADCARE Steering Committee, categorized into 3 domains (status quo, unmet need, proposals), and evaluated in a three-round eDelphi survey among certified ADCARE members. Eighty-four dermatologists and allergists from 32 countries participated (Round 1 response rate 98%; Round 2, 80%; Round 3, 76%). Statements were rated on a 5-point Likert scale; consensus was defined as ≥75% agreement (scores 4 or 5). Results In total, 66 of 83 statements reached consensus. In the status quo domain, agreement centred on baseline severity, body surface area, and anatomical site as guiding factors for TCS choice, with potency and licensed duration considered central to safe prescribing. In the unmet-need domain, experts highlighted the absence of standardized definitions, variability in monitoring and escalation strategies, and gaps in long-term evidence and integration of patient-reported outcomes. In the proposal domain, consensus supported relative improvement thresholds (≥50% in EASI, SCORAD, itch NRS, IGA, PGA, POEM) and 14 days as a meaningful evaluation point. Absolute cut-offs, very short (7 days) or long (3 months) timeframes, and rigid escalation rules did not achieve consensus. These parameters were synthesized into concise and extended definitions of TCS response and inadequate response. Conclusions This GA2LEN ADCARE initiative represents the first international consensus on defining TCS response and inadequate response, offering a framework to harmonize clinical practice, enhance trial comparability, and support guideline development.
KW - Adrenal cortex hormones
KW - Atopic
KW - Consensus
KW - Delphi technique
KW - Dermatitis
KW - Inflammatory
KW - Skin diseases
KW - Topical administration
UR - https://www.scopus.com/pages/publications/105035665788
U2 - 10.1016/j.waojou.2026.101380
DO - 10.1016/j.waojou.2026.101380
M3 - Article
AN - SCOPUS:105035665788
SN - 1939-4551
VL - 19
JO - World Allergy Organization Journal
JF - World Allergy Organization Journal
IS - 5
M1 - 101380
ER -