Traditional Steroids vs Emerging Therapies in Atopic Dermatitis

Linda Stein Gold, MD:What I find interesting, and 1 of the things I explain to my patients—in terms of topical steroids, there’s always going to be some need for topical steroids, especially acutely—is that it’s more of a short-term solution to a long-term problem. Ali, Matt gave us a great overview of the topicals. In the past, if we used a nonsteroidal, it had some sting and burning. We’ve come to expect that in terms of our nonsteroidals. Is that something you spend a lot of time explaining to patients? Our newer ones don’t have that, which is great.

Alexandra Golant, MD: Many of our new therapies have been a paradigm shift in terms of how we counsel our patients, what expectations we can tell them to anticipate after starting the therapy. Previously, the trade-off of not using the steroid was that burning and stinking. We would go to great lengths to tell patients, “This will go away. This is not an allergy. Get through it. You can store it in the fridge.” With something like topical ruxolitinib and some of our topicals coming through the pipeline, the local tolerability is excellent. It makes them easy to use. It’s head to toe. You can treat anywhere with 1 medication. We spend so much time with these patients, talking about the systemic nature of disease and how that translates into systemic therapy. From a topical perspective, for that mild or mild-to-moderate patient, we’ve seen a shift from reactive therapy—you flare, we give you a steroid; you flare, we give you a steroid—to a proactive approach. We want to treat during flare-free periods to try to maintain and that clearance that a patient can achieve and that’s directly aided by the availability of well-tolerated, safe nonsteroidal topicals.

Linda Stein Gold, MD: We have to remember that even normal-looking skin is still not normal. It can be difficult when a patient is so itchy and irritated to begin with. You say, “Go ahead and use this cream, but it stings.” To have some options that don’t have the local tolerability problem is wonderful.

Transcript edited for clarity