The role and risks of systemic corticosteroids in atopic dermatitis: an expert consensus

Abstract Atopic dermatitis (AD) is a chronic inflammatory disease in which systemic corticosteroids (SCS) continue to be frequently prescribed despite guideline recommendations discouraging their routine use because of limited sustained benefit and substantial safety concerns. This expert consensus aimed to define evidence-based thresholds for short- and long-term SCS use in AD and to provide practical recommendations on the role of SCS relative to advanced systemic therapies. A comprehensive literature search of PubMed, Scopus, and Google Scholar identified English-language original studies, systematic reviews, and meta-analyses addressing SCS efficacy, safety, and utilization in AD. Nine dermatologists with extensive AD expertise reviewed eligible articles using Strength of Recommendation Taxonomy (SORT) criteria and, through a modified Delphi process, developed and voted on consensus statements. Of 500 records screened, 27 met inclusion criteria. The panel unanimously adopted 11 consensus statements, eight with SORT strength A and three with strength C. The consensus defines short-term SCS exposure as less than 4 weeks and long-term exposure as 4 weeks or longer, including a single intramuscular dose, and emphasizes that even short courses are associated with serious adverse events and cumulative, dose- and duration-dependent toxicity. Repeated courses are discouraged, and any SCS exposure is considered a systemic therapy trial that should prompt evaluation for transition to advanced systemic therapies, including oral Janus kinase (JAK) inhibitors which offer more favorable long-term benefit–risk profiles and can serve both as rapidly acting, steroid-sparing options for flares and as foundational therapies for long-term disease control. These recommendations provide a pragmatic framework to harmonize clinical practice, reduce unnecessary SCS exposure, and support timely access to advanced systemic treatments for patients with moderate-to-severe AD.