Derm Dispatch: Unpacking Topical Steroid Withdrawal

In a recent episode of Derm Dispatch, host Renata Block, DMSc, MMS, PA-C, interviewed David Seiter, FNP-C, a nurse practitioner practicing in Arizona, on the emerging and often controversial topic of topical steroid withdrawal (TSW). The discussion highlighted the current landscape of knowledge, patient experiences, and the need for further research in this area.

Topical corticosteroids remain a cornerstone therapy in the management of eczema and other inflammatory skin diseases. For decades, these agents have provided effective symptom control, reduced inflammation, and improved patient quality of life. However, increasing patient narratives, particularly amplified on social media platforms like TikTok, have raised concerns about the phenomenon of TSW, also known as topical steroid addiction or red skin syndrome.

During the interview, Seiter emphasized the lack of an official diagnostic code for TSW, underscoring the challenge clinicians face when evaluating patients who attribute their symptoms to withdrawal. Many individuals describe burning, erythema, and rebound flares after discontinuing prolonged topical steroid use. While some case reports and patient-led advocacy groups support the existence of this entity, large-scale controlled studies remain limited. Consequently, dermatology professionals are navigating a delicate balance between acknowledging patient-reported experiences and adhering to evidence-based practice.

Seiter noted that patient trust plays a pivotal role in managing this clinical uncertainty. With over one billion views of the hashtag #TSW on TikTok, it is clear that public awareness and anxiety are increasing. He advocated for open communication, patient education on proper topical steroid use, and shared decision-making when alternative therapies are considered. He also highlighted that misuse, overuse, or abrupt cessation of potent corticosteroids may contribute to adverse outcomes, but the precise pathophysiology of TSW remains under investigation.

Block and Seiter both stressed the importance of ongoing research and collaboration between clinicians and patients. As biologics and non-steroidal topical agents become more widely available, new therapeutic avenues may reduce reliance on corticosteroids and potentially mitigate concerns related to withdrawal.

In conclusion, TSW represents an evolving conversation within dermatology. While definitive diagnostic criteria are lacking, the growing number of patient reports underscores the need for rigorous scientific study. Until clearer guidance emerges, clinicians are encouraged to approach the topic with empathy, transparency, and a commitment to evidence-based care.