Balancing Steroid and Non-Steroid Treatments

At the 2025 Masters of Pediatric Dermatology conference, Peter Lio, MD, clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine, addressed common misconceptions regarding topical steroids and the expanding range of non-steroidal alternatives for dermatologic conditions.

A prevalent concern among both patients and clinicians is the belief that steroids are inherently harmful. Lio emphasized that while caution is necessary, these medications remain an essential component of dermatologic care. "I think one of the biggest misconceptions is that steroids are the enemy, and we feel pretty confident in saying that they are not," he explained. "They can be used safely. They are very, very accessible for patients. They're very reliable. They help almost everybody." However, he stressed the importance of responsible usage, advising practitioners to "use them sparingly and in a targeted fashion."

Lio outlined a practical approach: employing steroids initially to control flare-ups, then transitioning to non-steroidal therapies for maintenance. "We use our topical steroids for a burst to get things better, because almost nothing works that quickly," he noted. "But then once we're better, we put those away and switch to non-steroidal options." This strategy minimizes potential adverse effects while ensuring sustained skin health.

The expanding arsenal of non-steroidal treatments has revolutionized dermatologic therapy. Options range from simple skincare regimens to advanced pharmacologic agents. Lio highlighted various alternatives, including topical Janus kinase (JAK) inhibitors, phosphodiesterase-4 (PDE4) inhibitors, and aryl hydrocarbon receptor modulators. "We are so lucky. We have a whole bunch of new non-steroidal topical options that are fantastic," he stated. Among these, ruxolitinib, a JAK inhibitor, and roflumilast, a PDE4 inhibitor, have demonstrated promising results in clinical practice. Additionally, tapinarof, an aryl hydrocarbon receptor modulator, offers another effective once-daily option.

Patient preferences play a crucial role in treatment selection. "I have some patients who love one and don't like another," Lio noted. "I have some patients who kind of like the one they've been using and don't want to change, and other people who are up for trying something new all the time." The availability of diverse treatments allows for personalized care tailored to individual needs.

While topical steroids remain an indispensable tool in dermatology, a growing selection of non-steroidal alternatives enables safer, long-term disease management. Thoughtful prescribing and patient-centered approaches ensure optimal therapeutic outcomes.