A new study challenged previous understandings of topical steroid withdrawal, reporting that 65% of patients could differentiate between symptoms of topical steroid withdrawal and atopic dermatitis occurring simultaneously.
In the observational cross-sectional study, published in Acta Dermato-Venereologica, investigators from six Swedish institutions analyzed the responses from 82 Swedish patients with atopic dermatitis (AD) who reported topical steroid withdrawal (TSW) symptoms. The cohort was predominantly female (95%) and aged 18 to 39 years (74%). Notably, 21% of them continued using topical glucocorticoids (TGC) despite reporting TSW symptoms.
"While the description of clinical signs and symptoms of [AD] and [TSW] seem to overlap, 65% of the participants reported activity of both conditions in parallel, indicating that they could discriminate between them," the study authors wrote.
Among the key findings were:
- Recurring TSW episodes: 60% experienced multiple episodes, with 26% reporting five or more episodes. Recurrence was defined as symptoms resolving after 2 months without TSW-related manifestations.
- Triggers: 93% identified TGCs as their trigger, whereas 33% also identified oral glucocorticoids (OGC); 5% reported OGCs as the sole trigger.
- Self-diagnosis: 84% self-diagnosed their TSW compared with 5% diagnosed by health care providers.
- Symptoms and skin signs: The most commonly reported symptoms were pruritus (96%), sleep disturbance (95%), and burning skin (90%). Frequently reported skin signs included erythema, desquamation, dryness, and oozing. The face, neck, and upper extremities were most often affected.
Text analysis of participant responses revealed that 63% of patients defined TSW as “dependency” on glucocorticoids, followed by “skin symptoms” (23%) and “reactions” (20%).
Health care avoidance was prevalent, with 37 participants avoiding care; 27 feared their condition would not be recognized by medical staff. Among those who received systemic therapy, dupilumab was the most prescribed treatment (n = 11), followed by methotrexate (n = 4) and upadacitinib (n = 3). Additionally, 15% of the patients reported undergoing phototherapy.
The study noted significant quality-of-life impacts, including anxiety, depression, and sleep disruption. Study limitations included potential selection bias as a result of social media recruitment and the inability to confirm AD diagnoses through physical examination.
"As of now, TSW remains an exclusion diagnosis after careful ruling out of established causes for adverse reactions to TGCs," the study authors underscored. "This stance requires that the patients' concerns and beliefs are respected by empathic and open-minded health care providers who uphold an evidence-based approach and offer alternatives to TGCs when possible," they concluded.
Full disclosures can be found in the study.
