TCS and TCIs: Benefits, Risks, and Real-World Uses for Atopic Dermatitis

EP: 1.Recognizing and Diagnosing Atopic Dermatitis With Confidence

EP: 2.A Practical Guide to Atopic Dermatitis Differential Diagnosis

EP: 3.Quantifying Atopic Dermatitis in Practice: Evaluating Patient Disease Severity

EP: 4.Soothing the Skin: Wellness Practices for Atopic Dermatitis Management

EP: 5.The Topical Toolbox: A Review of Atopic Dermatitis Treatment Options

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EP: 6.TCS and TCIs: Benefits, Risks, and Real-World Uses for Atopic Dermatitis

EP: 7.Beyond Steroids: Clinical Trial Results on the Next Generation Agents for Atopic Dermatitis

EP: 8.Tailoring Treatment: Personalizing Topical Therapy for Patients With Atopic Dermatitis

EP: 9.Stronger Together: Collaborating with Dermatologists for Better Outcome

EP: 10.Real Cases, Key Takeaways: Applying Atopic Dermatitis Insights in Clinical Practice

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When patients with atopic dermatitis fail to respond to first-line topical corticosteroids, dermatologists have several strategic options available. Survey data reveals that practitioners commonly escalate to higher-potency corticosteroids, transition to PDE4 inhibitors, or consider JAK inhibitors and aryl hydrocarbon receptor agonists. However, only 7% of respondents felt comfortable advancing to systemic therapy, while 25% preferred dermatology referrals for complex cases.

Topical corticosteroids remain the cornerstone of atopic dermatitis treatment, classified from Class I (highest potency like clobetasol) to Class VII (lowest potency like hydrocortisone). Effective steroid management requires selecting appropriate potencies for different body areas—avoiding ultra-potent steroids on sensitive areas like the face and eyelids. The recommended approach involves using high-potency options like clobetasol or betamethasone for severe areas, medium-potency steroids like triamcinolone 0.1% for moderate involvement, and low-potency options like desonide for sensitive regions.

Long-term topical corticosteroid use presents significant safety concerns, including skin atrophy, stretch marks, acne eruptions, telangiectasias, and HPA axis suppression occurring within two weeks of potent steroid use. Real-world studies demonstrate that patients frequently overuse topical steroids—with 90% using them for up to one month across multiple body areas, averaging 15 years of continuous use. This overuse pattern contributes to steroid phobia among patients and the emergence of topical steroid withdrawal syndrome, necessitating expertise in non-steroidal alternatives.