Linda Stein Gold, MD: Safety Considerations for Nonsteroidal Topicals for PsO, Atopic Dermatitis

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Linda Stein Gold, MD, explains how the safety considerations of nonsteroidal topicals must be weighed against their significant value in the treatment arsenal.

In the second part of an interview with HCPLive, Stein Gold, vice president of the American Academy of Dermatology and head of the Division of Dermatology at the Henry Ford Health System, discussed the safety concerns for nonsteroidal topical medications and how these newer treatment options fit into a comprehensive treatment plan for patients with psoriasis and atopic dermatitis. These findings were further explained in her lecture “Non-Steroidal Topical Therapies in Psoriasis and Atopic Dermatitis: The Paradigm Shift,” presented at the 2023 Fall Clinical Dermatology Conference.1

In terms of safety considerations, when using the topical Janus kinase (JAK) inhibitor ruxolitinib, Stein Gold said it is suggested to limit application to a body surface area of no more than about 20% due to potential systemic absorption, which is generally manageable considering this coverage. For topical tapinarof, there have been isolated cases of contact dermatitis or folliculitis, which are typically mild to moderate in severity. However, Stein Gold noted some cases of folliculitis can be resolved with continued treatment. Roflumilast, a well-tolerated drug, may cause mild gastrointestinal upset, such as nausea or diarrhea, particularly in patients with larger application areas, although these side effects usually subside within a few weeks.

These nonsteroidal options are valuable additions to the treatment toolkit, applicable to both psoriasis and atopic dermatitis. They can be used in conjunction with other treatments, including topical corticosteroids, systemic agents, oral medications, or biologics.

While the package insert for topical JAK inhibitors recommends against their use with other biologics or JAK inhibitors, real-world experience suggests positive outcomes when combining them with biologic agents.

“I think it is an exciting time for topical therapy,” Stein Gold concluded. “As dermatologists, we utilize topical therapy more than anything else. It is important that we continue to invest in research and development and bring new treatment options to market.”

This transcript was edited for clarity.


  1. Stein Gold L. Non-Steroidal Topical Therapies in Psoriasis and Atopic Dermatitis: The Paradigm Shift. Presented at: Fall Clinical Dermatology 2023 Conference. Las Vegas, NV. October 19 – 22, 2023.