The definition of response and inadequate response to topical corticosteroid treatment in atopic dermatitis and related skin inflammatory diseases: A GA2LEN ADCARE statement paper.
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Zuberbier Torsten, Abuzakouk Mohamed, Angelova Fischer Irena, Arruda Luisa Karla, Augustin Matthias, Beck Lisa, Bernstein Jonathan, Bindslev-Jensen Carsten, Bertolín-Colilla Marta, Bangert Christine, Calderón-Llosa Oscar, Canonica Giorgio Walter, Roldan-Castor Mary Anne, Casis-Hao Roxanne J, Cherrez-Ojeda Ivan, Choo Karen Jui Lin, Chularojanamontri Leena, Cork Michael J, Craig Timothy J, Criado Paulo Ricardo, Custovic Adnan, Çetinarslan Tubanur, Çalıcıoğlu Furkan, de Bruin-Weller Marjolein, Douladiris Nikolaos, Ensina Luis Felipe, Erdem Öztürk Yasemin, Ertaş Ragip, Ferrucci Silvia Mariel, Rosário Filho Nelson, Flohr Carsten, Fluhr Joachim, Fomina Daria, Gregoriou Stamatios, Gotua Maia, Giménez-Arnau Ana Maria, Hoetzenecker Wolfram, Jack Carolyn, Criado Roberta Fachini Jardin, Katoh Norito, Katoulis Alexandros, Kökçü Karadağ Şefika İlknur, Larenas-Linnemann Desiree, Lee Haur Yueh, Lima Herminio, Mansour Eli, Mortz Charlotte G, Morelo Rocha Felix Mara, Morris Victor, Moschione Castro Ana, Mota Veloso Bruscky Dayanne, Mukhina Olga, Nguyen Dinh Van, Nosbaum Audrey, Ozceker Deniz, Özkaya Esen, Oztas Kara Rabia, Parisi Claudio A S, Peter Jonny, Puig Luis, Ramon German Dario, Rincón-Pérez Catalina, Sahiner Umit Murat, Schmid-Grendelmeier Peter, Serra-Baldrich Esther, Sevimli Dikicier Bahar, Smith Catherine H, Staubach Petra, Stevanovic Katarina, Su Kucuk Ozlem, Teovska Mitrevska Natasa, Thaci Diamant, Torres Maria Jose, Torres Tiago, Trócoli Zanetti Maria Eduarda, Tuchinda Papapit, Vadasz Zahava, Vakirlis Efstratios, Vieira Duarte Gleison, Virtanen Hannele, Werfel Thomas, Wollenberg Andreas, Worm Margitta, Yew Yik Weng, Pereira Manuel P
Аннотация
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.