The definition of response and inadequate response to topical corticosteroid treatment in atopic dermatitis and related skin inflammatory diseases: A GA2LEN ADCARE statement paper

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: LEN 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.

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Publication Details

Journal
World Allergy Organization Journal
Published
2026-04-15
DOI
https://doi.org/10.1016/j.waojou.2026.101380
Primary Topic
Dermatology and Skin Diseases
Type
article
Field-Weighted Citation Impact
0.00

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article

The definition of response and inadequate response to topical corticosteroid treatment in atopic dermatitis and related skin inflammatory diseases: A GA2LEN ADCARE statement paper

Leena Chularojanamontri, Maria Eduarda Trocoli Zanetti, Carolyn Jack, Torsten Zuberbier et al.
World Allergy Organization Journal
Dermatology and Skin Diseases
article

The definition of response and inadequate response to topical corticosteroid treatment in atopic dermatitis and related skin inflammatory diseases: A GA2LEN ADCARE statement paper

Leena Chularojanamontri, Maria Eduarda Trocoli Zanetti, Carolyn Jack, Torsten Zuberbier, Marta Bertolín‐Colilla, Marjolein S. de Bruin-Weller, Irena Angelova Fischer, Nikolaos Douladiris, Claudio A.S. Parisi, Bahar Sevimli Dikicier, Natasa Teovska Mitrevska, Christine Bangert, Adnan Ćustović, Esen Özkaya, Mohamed Abuzakouk, Dinh Van Nguyen, Roberta Fachini Jardim Criado, Wolfram Hoetzenecker, Giorgio Walter Canonica, Papapit Tuchinda, German Dario Ramon, Ragıp Ertaş, Petra Staubach, Yasemin Erdem Öztürk, Eli Mansour, Yik Weng Yew, Mara Morelo Rocha Félix, Katarina Stevanovic, Haur Yueh Lee, Hannele Virtanen, Roxanne Casis Hao, Gleison Vieira Duarte, Dayanne Mota Veloso Bruscky, Ana Moschione Castro, Silvia Mariel Ferrucci, Diamant Thaçi, Karen Jui Lin Choo, Paulo Ricardo Criado, Furkan Çalıcıoğlu, Şefika İlknur Kökcü Karadağ, Manuel P. Pereira, Désirée Larenas-Linnemann, JW. Fluhr, Luis Felipe Ensina, Rabia Öztaş Kara, Efstratios Vakirlis, Nelson Rosario Filho, Luisa Karla Arruda, ALEXANDROS KATOULIS, Carsten Flohr, Catherine H. Smith, Jonny Peter, Andreas Wollenberg, Victor Morris, Ana María GimÉnez-Arnau, Esther Serra-Baldrich, Maria Taise Santos Torres, Thomas Werfel, Zahava Vadasz, Mary Anne Roldan-Castor, Lisa Beck, Catalina Rincón-Pérez, Timothy J. Craig, Ozlem Su Kucuk, Stamatios Gregoriou, Tubanur Çetinarslan, Deniz Ozceker, Herminio Lima, Oscar Calderón-Llosa, Matthias Augustin, Peter Schmid-Grendelmeier, Audrey Nosbaum, Luis Puig, Ivan Chérrez-Ojeda, Margitta Worm, Carsten Bindslev-Jensen, Michael J. Cork, Olga Mukhina, Tiago Torres, Maia A. Gotua, Umit Murat Sahiner, Norito Katoh, Daria Fomina, Jonathan A. Bernstein, Charlotte G Mortz
article en

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: LEN 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.

World Allergy Organization JournalVol. 19(5)
Université Claude Bernard Lyon 1 (FR), Sakarya University (TR), Universitat Autònoma de Barcelona (ES), National Skin Centre (SG), Siriraj Hospital (TH), Humanitas University (IT), University of Cape Town (ZA), Universität Hamburg (DE), Manisa Celal Bayar University (TR), Kyoto Prefectural University (JP), Universitat Pompeu Fabra (ES), University of Southern Denmark (DK), Sechenov University (RU), Technological Educational Institute of Central Greece (GR), Universidade de São Paulo (BR), Universidade Estadual de Campinas (UNICAMP) (BR), King's College London (GB), Johannes Gutenberg University Mainz (DE), National and Kapodistrian University of Athens (GR), Aristotle University of Thessaloniki (GR), Singapore General Hospital (SG), Universidade Federal de Pernambuco (BR), Universidad San Ignacio de Loyola (PE), Helsinki University Hospital (FI), McMaster University Medical Centre (CA), Odense University Hospital (DK), Hospital de Sant Pau (ES), University Hospital Augsburg (DE), Philippine General Hospital (PH), Groote Schuur Hospital (ZA), Hospital Italiano de Buenos Aires (AR), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), University Medical Center Utrecht (NL), Bezmiâlem Vakıf Üniversitesi (TR), Universidad Espíritu Santo (EC), Medizinische Hochschule Hannover (DE), Humboldt-Universität zu Berlin (DE), Kyoto Prefectural University of Medicine (JP), Alergo Dermatologia Integrada (BR), Ospedale Maggiore (IT), Sheffield Children's University (GB), Institute for Integrative and Experimental Genomics (DE), University Medical Center of the Johannes Gutenberg University Mainz (DE), Instituto de Física del Sur (AR), Allergy, Asthma and Clinical Research Center (US), Hospices Civils de Lyon (FR), Hospital Médica Sur (MX), Clinical Research Center for Hair and Skin Science (DE), Fraunhofer Institute for Translational Medicine and Pharmacology (DE), Hospital Regional Universitario de Málaga (ES), University Medical Center Hamburg-Eppendorf (DE), Vinmec Times City International Hospital (VN), Hôpital Lyon Sud (FR), Bnai Zion Medical Center (IL), Hacettepe University Hospital (TR), South African Tuberculosis Vaccine Initiative (ZA), Sakarya Eğitim ve Araştırma Hastanesi (TR), Kepler Universitätsklinikum (AT), CK-CARE (CH), Andreas Sygros Hospital (GR), MemorialCare Health System (US), Duke-NUS Medical School (SG), Kayseri Eğitim ve Araştırma Hastanesi (TR), Hospital de Santo António (PT), Sağlık Bilimleri Üniversitesi (TR), Hospital Del Mar (ES), Institute of public health of Republic of Macedonia (MK), Instituto Brasileiro de Museus (BR), David Tvildiani Medical University (GE), Istanbul Eye Hospital (TR), Innovaderm (Canada) (CA), University General Hospital Attikon (GR), Astana Medical University (KZ), VinUniversity (VN), Faculdade de Medicina do ABC (BR), Stadtspital Waid (CH), Associação Brasileira de Alergia e Imunologia (BR), Sociedade Brasileira de Oncologia Clínica (BR), Research Center of Neurology (RU), St. Luke's General Hospital (IE), Centre International de Recherche en Infectiologie (FR), IRCCS Humanitas Research Hospital (IT), Hochgebirgsklinik Davos (CH), Instituto de Investigación Biomédica de Málaga (ES), Universidad del Ejército y Fuerza Aérea (MX), Institut de Recerca Sant Pau (ES), Imperial College London (GB), Universidade Federal do Paraná (BR), University of Rochester (US), University of Cincinnati (US), Istanbul University (TR), Freie Universität Berlin (DE), Medical University of Vienna (AT), Charité - Universitätsmedizin Berlin (DE), Ludwig-Maximilians-Universität München (DE), Universidade Federal do Estado do Rio de Janeiro (BR), International Balkan University (MK), University of Sheffield (GB), University of Cincinnati Medical Center (US), University of Lübeck (DE), McMaster University (CA)
Amgen, Eli Lilly and Company, Pfizer, Sanofi, L'Oreal USA, Regeneron Pharmaceuticals, Les Laboratories Pierre Fabre, BioCryst, Boehringer Ingelheim Japan, Galderma, LEO Pharma, Canadian Institutes of Health Research
Good health and well-being
Openalex Percentile: Top 26%
Dermatology and Skin Diseases
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