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Publications

Journal Article Epublish

PubMed: 42028244 DOI: 10.1016/j.waojou.2026.101380

The definition of response and inadequate response to topical corticosteroid treatment in atopic dermatitis and related skin inflammatory diseases: A GA 2LEN ADCARE statement paper.

World Allergy Organ J 19(5):101380

Authors: Torsten Zuberbier, Mohamed Abuzakouk, Irena Angelova Fischer, Luisa Karla Arruda, Matthias Augustin, Lisa Beck, Jonathan Bernstein, Carsten Bindslev-Jensen, Marta Bertolín-Colilla, Christine Bangert, Oscar Calderón-Llosa, Giorgio Walter Canonica, Mary Anne Roldan-Castor, Roxanne J Casis-Hao, Ivan Cherrez-Ojeda, Karen Jui Lin Choo, Leena Chularojanamontri, Michael J Cork, Timothy J Craig, Paulo Ricardo Criado, Adnan Custovic, Tubanur Çetinarslan, Furkan Çalıcıoğlu, Marjolein de Bruin-Weller, Nikolaos Douladiris, Luis Felipe Ensina, Yasemin Erdem Öztürk, Ragip Ertaş, Silvia Mariel Ferrucci, Nelson Rosário Filho, Carsten Flohr, Joachim Fluhr, Daria Fomina, Stamatios Gregoriou, Maia Gotua, Ana Maria Giménez-Arnau, Wolfram Hoetzenecker, Carolyn Jack, Roberta Fachini Jardin Criado, Norito Katoh, Alexandros Katoulis, Şefika İlknur Kökçü Karadağ, Desiree Larenas-Linnemann, Haur Yueh Lee, Herminio Lima, Eli Mansour, Charlotte G Mortz, Mara Morelo Rocha Felix, Victor Morris, Ana Moschione Castro … and 35 other authors

Affiliations

  • Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
  • Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany.
  • Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
  • Department of Dermatology, Kepler University Hospital, Linz, Austria.
  • Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
  • University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Department of Dermatology, University of Rochester, Rochester, USA.
  • University of Cincinnati, Dept of Medicine, Division of Allergy and Immunology, Cincinnati, OH, USA.
  • Odense Research Center for Anaphylaxis, Odense University Hospital, Odense, Denmark.
  • Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark.
  • Dermatology Department, Hospital del Mar. Hospital del Mar Research Institute, Universitat Autònoma, Universitat Pompeu Fabra, Barcelona, Spain.
  • Department of Dermatology, Medical University of Vienna, Vienna, Austria.
  • SANNA Clínica el Golf, San Isidro, Lima, Peru.
  • Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milano, Italy.
  • Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Italy.
  • Division of Allergy and Immunology Department of Pediatrics College of Medicine - Philippine General Hospital c Manila, Philippines.
  • University of the Philippines Manila-Philippine General Hospital Division of Allergy & Immunology, Manila, Philippines.
  • Espiritu Santo University, Samborondon, Ecuador.
  • Respiralab Research Group, Guayaquil, Ecuador.
  • Department of Dermatology, Singapore General Hospital, Singapore.
  • Department of Dermatology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.
  • Sheffield Children's NIHR Commercial Research Delivery Centre, Sheffield, United Kingdom.
  • Sheffield Dermatology Research, Division of Clinical Medicine, University of Sheffield Medical School, United Kingdom.
  • Penn State University, Hershey, Pa, Vinmec International Hospital, Times City, Hanoi, Vietnam.
  • Centro Universitário Faculdade de Medicina do ABC, Santo André, Brazil.
  • Alergoskin Alergia e Dermatologia SS Ltda, Santo André, Brazil.
  • National Heart and Lung Institute, Imperial College London, United Kingdom.
  • Manisa Celal Bayar University, Department of Dermatology and Venereology, Manisa, Turkey.
  • Health Sciences University, Kayseri Faculty of Medicine, Kayseri City Hospital, Department of Dermatology, Urticaria & Angioedema & Atopic Dermatitis Center of Reference and Excellence Clinic, Turkey.
  • University Medical Center Utrecht, the Netherlands.
  • Clinical & Molecular Allergology Center, Chalkidiki, Greece.
  • CPAlpha Clinical Research Center, Barueri, Brazil.
  • İstanbul University, İstanbul Faculty of Medicine, Department of Dermatology and Venereology, 34093 Çapa-İstanbul, Turkey.
  • Dermatology Unit. IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation of Milan, Italy.
  • Federal University of Parana, Brazil.
  • Kings College London, United Kingdom.
  • Global Allergy and Asthma European Network (GA2LEN) Urticaria and Angioedema Center of Reference and Excellence (UCARE/ACARE), Moscow City Research and Clinical Center of Allergy and Immunology, City Clinical Hospital 52, Moscow Healthcare Department, Moscow, Russia.
  • Department of Clinical Immunology and Allergy, The First Sechenov State Medical University, Moscow, Russia.
  • Department of Pulmonology, Astana Medical University, Astana, Kazakhstan.
  • National and Kapodistrian University of Athens, 1st Department of Dermatology, Andreas Sygros Hospital, Athens, Greece.
  • Center of Allergy and Immunology, UCARE, ADCARE, ACARE and ANACARE Centers, Tbilisi, Georgia.
  • David Tvildiani Medical University, Tbilisi, Georgia.
  • Dermatology Department, Hospital del Mar. Hospital del Mar Research Institute Universitat Autonoma, Universitat Pompeu Fabra, Barcelona, Spain.
  • Affiliation: Department of Dermatology, Kepler University Hospital, Medical Faculty, Linz, Austria.
  • Innovaderm Research, Montreal, Quebec, Canada.
  • North Campus, Kyoto Prefectural University of Medicine, Japan.
  • 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, Attikon General University Hospital, Athens, Greece.
  • Prof.Dr.Cemil Taşcıoğlu City Hospital, Istanbul, Turkey.
  • Center of Excellence in Asthma andnAllergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico.
  • Senior Consultant, Department of Dermatology, Singapore General Hospital, Singapore.
  • Allergy Centre, Singapore General Hospital, Singapore.
  • DUKE-NUS Medical School, Singapore.
  • McMaster University Division of Clinic Immunology and Allergy and Division of Dermatology, Hamilton, ON, Canada.
  • Allergy and Immunology, Department of Internal Medicine, School of Medical Sciences, University of Campinas/UNICAMP, Campinas, Brazil.
  • Department of Dermatology and Allergy Center, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
  • Alergolife Center, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
  • St Luke's General Hospital Carlow/Kilkenny, Kilkenny, Ireland.
  • Clinica Croce, São Paulo, SP, Brazil.
  • Unidade de Alergia e Imunologia Instituto da Criança HCFMUSP, São Paulo, SP, Brazil.

Abstract

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 GA 2LEN 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.

MeSH

Skin, Dermatitis, Adrenal Cortex Hormones, Therapeutics, Dermatitis, Atopic