Advanced Topical Nonsteroidal Therapies for Atopic Dermatitis: Consensus Statements from an Expert Panel
March 2026 | Volume 25 | Issue 3 | 9806 | Copyright © March 2026
Published online February 27, 2026
April W. Armstrong MD MPHa, Yvonne Nong MDa, Christopher G. Bunick MD PhDb, Raj Chovatiya MD PhDc,d, Adelaide A. Hebert MDe, Leon Kircik MDf,g, Jiade Yu MDh, Mark G. Lebwohl MDf
aDivision of Dermatology, University of California, Los Angeles, CA
bDepartment of Dermatology, Yale School of Medicine, New Haven, CT
cDepartment of Dermatology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL
dCenter for Medical Dermatology and Immunology Research, Chicago, IL
eUT Health McGovern School of Medicine and Children's Memorial Hermann Hospital, Houston, TX
fDepartment of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
gDepartment of Dermatology, Indiana University School of Medicine, Indianapolis, IN
hDepartment of Dermatology, Virginia Commonwealth School of Medicine, Richmond, VA
Abstract
Background: Advanced topical nonsteroidal therapies are expanding options for atopic dermatitis (AD) by providing targeted anti-inflammatory control without many limitations of long-term topical corticosteroids. As these agents become more available, practical guidance is needed on their use as first-line therapy, proactive maintenance, combination regimens, safety, and long-term management.
Objective: To develop expert consensus statements defining the clinical role of advanced topical nonsteroidal therapies in AD.
Methods: A seven-dermatologist expert panel used a structured Delphi process informed by a literature review. Statements were drafted, iteratively refined, and voted on across multiple rounds. Evidence quality and strength of recommendations were assessed using the Strength of Recommendation Taxonomy (SORT). Consensus was predefined as ≥75% agreement.
Results: The panel reached unanimous consensus on seven statements regarding advanced topical nonsteroidal therapies, including topical ruxolitinib, tapinarof, roflumilast, crisaborole, tacrolimus, pimecrolimus, and delgocitinib. These therapies were considered effective in reducing AD signs and symptoms, including pruritus, and appropriate as first-line agents for many patients. Their use was associated with longer disease control, fewer relapses, and reduced cumulative topical corticosteroid exposure. The panel agreed that these therapies improve patient-reported outcomes, including quality of life and sleep, and can be safely incorporated into combination regimens with other topical or systemic treatments. They demonstrated favorable safety and tolerability profiles without the need for baseline or ongoing laboratory monitoring. Compared with topical corticosteroids, nonsteroidal therapies were preferred for long-term management to avoid steroid-associated adverse effects, with simplified dosing and suitability for sensitive and high-impact sites supporting adherence.
Conclusion: Advanced topical nonsteroidal therapies represent an important evolution in AD management and are appropriate first-line options across disease severities, supporting sustained disease control and improved quality of life.
INTRODUCTION
Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease that imposes a substantial burden through persistent itch, sleep disturbance, and impaired quality of life. Despite major advances in systemic therapy, topical treatment remains central to AD management across disease severities, serving as first-line therapy for mild disease and as adjunctive treatment for residual activity in patients receiving systemic agents. Because AD often involves sensitive anatomic sites and requires consistent and/or long-term treatment, the safety and durability of topical therapies are critical considerations in routine practice.
The long-term use of topical corticosteroids (TCS) is limited by cutaneous and systemic risks, as well as by adherence challenges. Steroid-sparing options such as topical calcineurin inhibitors (TCI) have addressed some of these limitations, though their clinical effect may be modest for certain patients. More recently, advanced topical nonsteroidal therapies, including topical Janus kinase (JAK) inhibitors, aryl hydrocarbon receptor agonists, and phosphodiesterase-4 (PDE4) inhibitors, have expanded the therapeutic landscape (Table 1).
