Advancing Topical Stewardship and Expanding Nonsteroidal Options

Peter Lio, MD, a board-certified dermatologist and clinical assistant professor of dermatology and pediatrics at Northwestern Feinberg University School of Medicine in Chicago, Illinois, presented at the 2025 Elevate-Derm Fall Conference to discuss topical corticosteroid stewardship and adverse effects to be aware of. He also discussed the latest advancements in pediatric dermatology, including expanded age indications in pediatric patients down to 2 years in the latest atopic dermatitis topicals.

Lio emphasized a pragmatic, stewardship-driven approach to topical corticosteroids while outlining an increasingly robust nonsteroidal therapeutic landscape—particularly meaningful for pediatric populations. He noted that corticosteroids remain foundational first-line agents, but their long-term safety considerations require intermittent use and close follow-up. Effective stewardship, he explained, hinges on maintaining therapeutic benefit while avoiding chronic, unsupervised exposure that can lead to complications, including topical steroid withdrawal (TSW).

Regarding TSW, Lio mentioned a rising anxiety among patients and caregivers, a concern he addresses proactively through careful monitoring and early course-correction. He reassures families that vigilant oversight, appropriate potency selection, and timely tapering remain central to preventing overuse. This clinician-led vigilance, he said, helps minimize risk while preserving the efficacy of corticosteroids when indicated.

The second major theme of his discussion centered on the rapid evolution of nonsteroidal topical therapies. Agents such as tapinarof, ruxolitinib, and roflumilast—now approved down to age 2—offer comparable or, in select cases, superior risk–benefit profiles relative to corticosteroids, particularly regarding tolerability and suitability for sensitive anatomic sites or chronic management. Lio highlighted early-age studies underway, including investigations of topical roflumilast down to 3 months of age, which hold potential to expand safe treatment options for infants.

Finally, he emphasized a holistic management approach that integrates inflammation control with comprehensive skin-barrier support, appropriate OTC product selection, stress-reducing strategies, and lifestyle optimization. This multidimensional framework, he noted, can reduce reliance on corticosteroids, improve long-term skin stability, and support recovery in patients with existing TSW.