Practicing Topical Steroid Stewardship and Timely Follow-Up

The conversation turns toward a more critical view of topical corticosteroid (TCS) stewardship in psoriasis care. With increasing evidence of long-term risks—not only cutaneous (eg, skin atrophy) but also systemic effects such as insulin resistance, hypothalamic-pituitary-adrenal axis suppression, and even bone health concerns—clinicians are being urged to reconsider prolonged or indiscriminate TCS use. Although steroids still play a valuable role, the consensus is that patients should be transitioned off them sooner, especially now that nonsteroidal options with comparable efficacy are more accessible.

The speakers also stress the importance of choosing what’s right for the patient, not just what’s easy. Historically, TCSs have been the go-to because of convenience and formulary access. But with improved access programs for newer agents such as roflumilast, physicians can now build office workflows that make prescribing safer alternatives more feasible. By prioritizing long-term patient outcomes over short-term prescribing ease, clinicians can reduce treatment-related risks and improve care quality. Transparent communication also plays a central role, as patients are told up front that the first-line option may or may not work but that second-line therapies are available and likely more effective if needed.

This proactive, expectation-setting strategy also enhances follow-up adherence and trust. Patients are more likely to return and stick with therapy if they feel supported and informed. Clinicians typically schedule follow-ups within 4 to 6 weeks, adjusting based on disease severity and patient anxiety. These check-ins are often short, especially if the clinician has documented a backup plan at the initial visit. The message is clear: Early, honest conversations and a structured treatment pathway—paired with a reduced reliance on long-term TCSs—create better experiences for both patients and providers while ultimately improving disease management outcomes.