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Topical steroids or emollients: does order matter?

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Abstract

Topical corticosteroids, topical steroid-sparing agents, and emollients are all used to treat atopic dermatitis. However, there are no formal guidelines dictating the order and timing in which these topical modalities should be applied. Additionally, the order of application may change drug absorption, efficacy, and distribution. This is especially important for patients with atopic dermatitis. These patients have a dysfunctional skin barrier, which can lead to greater systemic absorption of drugs. Moreover, children already have an increased rate of systemic absorption due to a higher ratio of body surface area to body weight. Thus, the order of application of topical regimens is of the utmost importance in pediatric dermatology. This manuscript presents an updated review of the literature with a focus on guiding clinicians toward the best practices from the available resources.

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Data availability

The data that support the findings of this study are available on request from the corresponding author: ahujak@evms.edu.

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No funding sources were secured for this study.

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Authors and Affiliations

  1. Eastern Virginia Medical School, Kripa Raj Ahuja, 825 Fairfax Avenue, Norfolk, VA, 23507, USA

    Kripa Ahuja

  2. Department of Dermatology, Northwestern University, Chicago, IL, USA

    Peter A. Lio

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  1. Kripa Ahuja
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KA and PL both contributed to the writing, conceptualization, and review of the manuscript.

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Correspondence to Kripa Ahuja.

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Competing interests

Dr. Lio reports research grants/funding from AbbVie, AOBiome, and Regeneron/Sanofi Genzyme; is on the speaker's bureau for AbbVie, Eli Lilly, Galderma, Hyphens, Incyte, LEO Pharma, L'Oreal, MyOR Diagnostics, ParentMD, Pfizer, and Regeneron/Sanofi Genzyme; and reports consulting/advisory boards for AbbVie, Almirall, Amyris, AOBiome, Arbonne, ASLAN Pharmaceuticals, Burt’s Bees, Castle Biosciences, Codex Labs, Concerto Biosciences (stock options), Dermavant, Eli Lilly, Exeltis, Galderma, IntraDerm, Johnson & Johnson, LEO Pharma, L'Oreal, Menlo Therapeutics, Micreos (stock options), Pfizer, Pierre-Fabre, Regeneron/Sanofi Genzyme, Theraplex, and Unilever. In addition, Dr. Lio has a patent pending for a Theraplex product with royalties paid, and is a Board member and Scientific Advisory Committee Member of the National Eczema Association.

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Ahuja, K., Lio, P.A. Topical steroids or emollients: does order matter?. Arch Dermatol Res 316, 104 (2024). https://doi.org/10.1007/s00403-024-02837-0

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