Initial Consensus for the Management of Topical Steroid Withdrawal: A Delphi Study

Abstract

Abstract: Background: Topical steroid withdrawal (TSW) is a poorly defined condition thought to be related to prolonged use of topical corticosteroids. Currently, management guidelines for TSW do not exist.

Objective: This study aimed to form expert consensus and initial management guidelines using the modified Delphi consensus approach.

Methods: Our expert panel of 21 physicians and patient advocates assessed 72 pharmacologic and supportive management strategies for consensus over 2 survey rounds. Outcomes achieving ≥70% agreement or disagreement were defined as meeting endpoint consensus.

Results: Final expert consensus included 12 outcomes, primarily focused on cessation of topical and systemic corticosteroids and psychosocial support. Additionally, our panel met consensus for dupilumab as a first-line systemic treatment.

Conclusions: Here, we present initial guidelines for the management and treatment of TSW until further therapies can be investigated for future evidence-based care.

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References

Ahuja

, Lio

. Pediatric topical steroid withdrawal syndrome: What is known, what is unknown. Pediatr Dermatol. 2025; 42(4):899–900; doi: 10.1111/pde.15799

Shobnam

, Saksena

, Ratley

, et al.; NIAID Centralized Sequencing Program. Topical steroid withdrawal is a targetable excess of mitochondrial NAD+. medRxiv. 2024:2024.04.17.24305846; doi: 10.1101/2024.04.17.24305846

Marshall

, Leung

DYM

, Lack

, et al. Topical steroid withdrawal and atopic dermatitis. Ann Allergy Asthma Immunol. 2024; 132(4):423–425; doi: 10.1016/j.anai.2023.12.022

Barlow

, Proctor

, Moss

. Topical steroid withdrawal: A survey of UK dermatologists’ attitudes. Clin Exp Dermatol. 2024; 49(6):607–611; doi: 10.1093/ced/llae045

Topical Steroid Withdrawal (Red Skin Syndrome). StatPearls—NCBI Bookshelf; 2024. Available from: https://www-ncbi-nlm-nih-gov.online.uchc.edu/books/NBK603718/

Ahuja

, Lio

. Topical steroid withdrawal syndrome: A retrospective chart review in a specialty center. Journal of Integrative Dermatology. 2023. Available from: https://www.jintegrativederm.org/article/73769-topical-steroid-withdrawal-syndrome-a-retrospective-chart-review-in-a-specialty-center

Sheary

. Steroid withdrawal effects following long-term topical corticosteroid use. Dermatitis. 2018; 29(4):213–218; doi: 10.1097/DER.0000000000000387

Wojtara

, Rajeev

, Shukla

, et al. An analysis of literature on topical steroid withdrawal in dermatology. Qeios. 2023; doi: 10.32388/IBZM9G

Hajar

, Leshem

, Hanifin

, et al.; (the National Eczema Association Task Force). A systematic review of topical corticosteroid withdrawal (“steroid addiction”) in patients with atopic dermatitis and other dermatoses. J Am Acad Dermatol. 2015; 72(3):541–549.e2; doi: 10.1016/j.jaad.2014.11.024

10.

Sheary

, Harris

. Cessation of long-term topical steroids in adult atopic dermatitis: A Prospective Cohort Study. Dermatitis. 2020; 31(5):316–320; doi: 10.1097/DER.0000000000000602

11.

Brookes

, Barlow

, Mohandas

, et al. Topical steroid withdrawal: An emerging clinical problem. Clin Exp Dermatol. 2023; 48(9):1007–1011; doi: 10.1093/ced/llad161

12.

Lahiri

. A Treatise on Topical Corticosteroids in Dermatology. Springer; 2018.

13.

Arnold

, Treister

, Lio

. Dupilumab in the management of topical corticosteroid withdrawal in atopic dermatitis: A retrospective case series. JAAD Case Rep. 2018; 4(9):860–862; doi: 10.1016/j.jdcr.2018.06.012

14.

Rahaghi

, Baughman

, Saketkoo

, et al. Delphi consensus recommendations for a treatment algorithm in pulmonary sarcoidosis. Eur Respir Rev. 2020; 29(155):190146. Available from: https://err.ersjournals.com/content/29/155/190146.short

15.

Sforzini

, Worrell

, Kose

, et al. A Delphi-method-based consensus guideline for definition of treatment-resistant depression for clinical trials. Mol Psychiatry. 2024. Available from: https://www-nature-com.online.uchc.edu/articles/s41380-021-01381-x

16.

Puig

, Choon

, Gottlieb

, et al. Generalized pustular psoriasis: A global Delphi consensus on clinical course, diagnosis, treatment goals and disease management. Acad Dermatol Venereol. 2023; 37(4):737–752; doi: 10.1111/jdv.18851

17.

Suehs

, Menzies-Gow

, Price

, et al.; Oral Corticosteroids Tapering Delphi Expert Panel. Expert consensus on the tapering of oral corticosteroids for the treatment of asthma. A Delphi Study. Am J Respir Crit Care Med. 2021; 203(7):871–881.

18.

Dammann

, Abla

, Al-Shahi Salman

, et al. Surgical treatment of brainstem cavernous malformations: An international Delphi consensus. J Neurosurg. 2022; 136(5):1220–1230.

19.

Bhaskar

, Bell

, Boivin

, et al. Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: Results of a modified Delphi process. J Cannabis Res. 2021; 3(1):22–12; doi: 10.1186/s42238-021-00073-1

20.

Tejwani

, Chang

, Tran

, et al.; coreASTHMA panel. A multistakeholder Delphi consensus core outcome set for clinical trials in moderate-to-severe asthma (coreASTHMA). Ann Allergy Asthma Immunol. 2021; 127(1):116–122.e7; doi: 10.1016/j.anai.2021.03.022

21.

Fukaya

. Improvement of atopic dermatitis after discontinuation of topical corticosteroid treatment. Arch Dermatol. 2000; 136(5):679–680; doi: 10.1001/archderm.136.5.679

22.

Fukaya

, Sato

, et al. Topical steroid addiction in atopic dermatitis. Drug Healthc Patient Saf. 2014; 6:131–138; doi: 10.2147/DHPS.S6920

23.

Mansouri

, Taheri

, Mansoori

. Rebound of atopic dermatitis as a complication of using systemic glucocorticoids; a myth or a fact? J Dermatolog Treat. 2019; 30(4):365; doi: 10.1080/09546634.2018.1524822

24.

Forte

WCN

, Sumita

, Rodrigues

, et al. Rebound phenomenon to systemic corticosteroid in atopic dermatitis. Allergol Immunopathol (Madr). 2005; 33(6):307–311; doi: 10.1016/s0301-0546(05)73248-1

25.

Drucker

, Eyerich

, de Bruin-Weller

, et al. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement. Br J Dermatol. 2018; 178(3):768–775; doi: 10.1111/bjd.15928

26.

Kwatra

, Kambala

, Dong

. Neuropathic pruritus. J Allergy Clin Immunol. 2023; 152(1):36–38; doi: 10.1016/j.jaci.2023.04.006

27.

Shea

, Grinich

, Simpson

. Topical steroid withdrawal treated with ruxolitinib cream. JAAD Case Rep. 2024; 48:5–7; doi: 10.1016/j.jdcr.2024.03.011

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