Topical Steroid Withdrawal Syndrome: What Dermatologists Need to Know About Diagnosis and Management

With topical steroid withdrawal (TSW) syndrome generating clinical and public attention, dermatologists are increasingly on the front lines of navigating patient concerns, limited diagnostic criteria, and a landscape cluttered with social media misinformation, said Maria-Angeliki Gkini, MD, a consultant dermatologist at Bart's Health in London and honorary senior lecturer at Queen Mary University. Gkini addressed the topic at the 34th Annual Meeting of the Association for Psychocutaneous Medicine of North America (APMNA), held March 26 in Denver ahead of the 2026 American Academy of Dermatology Annual Meeting.¹

"It's in the news, it's on social media, on TikTok, on Instagram," Gkini told Dermatology Times. "Many, many patients are coming to us and they're saying, ‘Look, doctor, I believe I have TSW.’"

The Diagnostic Challenge

Despite growing recognition, TSW remains difficult to define in the clinic, explained Gkini, , who has a special interest in inflammatory conditions and psychodermatology. Although emerging research suggests it may be a distinct entity from conditions like atopic dermatitis, robust data and standardized diagnostic criteria are still lacking, she added. TSW is currently considered a diagnosis of exclusion. A recent Delphi consensus paper has begun to outline some diagnostic criteria, she said.²

What concerns Gkini is how patients are received when they raise the possibility of TSW with their clinicians. "The majority of these patients, they are dismissed by their physicians saying that this condition does not exist," she said in an interview with Dermatology Times. That dismissal, she emphasized, carries real consequences.

Navigating TSW Management

When patients feel dismissed, they turn elsewhere for answers, which often means social media where misinformation about TSW is prevalent. "It's our responsibility, us physicians, to support our patients, to provide the right information and to offer to them a tailored management plan," she told Dermatology Times.

That management plan, she explained, may include conventional systemic therapies, light therapy, biologics, or small molecules, often combined with interventions that address mental health and overall well-being. Her message was direct: engaging patients, rather than dismissing them, keeps them in the care of qualified clinicians and out of unreliable information ecosystems.

A Psychodermatology Approach

Gkini's clinic at Bart's Health runs a dedicated psychodermatology service where a dermatologist and psychiatrist see patients together, which she noted was particularly effective for this population. A psychodermatology approach allows clinicians to address both the psychosocial comorbidities and quality of life and mental well-being issues that arise with TSW.

She acknowledged that not all clinics have this structure, and that stigma around psychiatry can complicate referrals to psychiatric clinicians. "Often patients feel, ‘You know, I don't have any mental health condition, why I should be referred to a psychiatrist,’" she reported. Her recommendation is for dermatologists to proactively explain the rationale by framing psychiatric support not as a suggestion that symptoms are imagined, but as an evidence-informed component of comprehensive TSW care.

The payoff for acknowledging TSW, she noted, is immediate clinical engagement. "When we as physicians and psychiatrists also, but also dermatologists, acknowledge that TSW exists, you can see that the patients get immediately engaged," Gkini said.

Ultimately, more research is needed and expected, she told Dermatology Times. "I think this is going to be a hot topic for the next few years until we get all the answers that we want."

References
1. Gkini MA. Topical Steroid Withdrawal: where are we now? Presented at the 34th Annual Meeting of the Association for Psychoneurocutaneous Medicine of North America (APMNA); March 26, 2026; Denver, Colorado.

2. Hsu C, Guo L, Adams D, Davis D, Eichenfield L, Hsu Friedman O, Harris S, Serrao R, Sheary B, Shi V, Sidbury R, Simpson E, Yu J, Lio P. Topical steroid withdrawal syndrome: developing diagnostic criteria through a modified Delphi method. Br J Dermatol. 2026;194(4):768-778. doi: 10.1093/bjd/ljaf518.