Advancing Understanding of Topical Steroid Withdrawal in Dermatology

At the 2025 Revolutionizing Atopic Dermatitis (RAD) Conference held in Nashville, Tennessee, Dr. Brad Glick, DO, MPH, provided an in-depth review of topical steroid withdrawal (TSW), emphasizing its clinical signs and the importance of thorough patient histories for accurate diagnosis. Dr. Glick, a practicing dermatologist at Glick Skin Institute and clinical assistant professor at the FIU Herbert Wertheim College of Medicine, stated, "We need to be on the lookout for topical steroid withdrawal. As my colleague Peter Lio always says, it's sometimes very difficult to differentiate it from a really bad flare of atopic dermatitis, but you have to take a step back. You have to get a really good history. You have to talk about whether patients are following the instructions with the use of topical corticosteroids." He highlighted the challenges in diagnosing TSW, which often mimics severe atopic dermatitis flares.

TSW typically manifests two to four weeks after prolonged use of topical corticosteroids, though symptoms can appear sooner. Key clinical signs include widespread erythema and the “red sleeve sign,” characterized by a sharp demarcation of erythema at the wrists or ankles. Dr. Glick noted the absence of formal diagnostic criteria and the frequent overlap with atopic dermatitis, underscoring the necessity for a comprehensive clinical history.

A significant factor contributing to TSW is the phenomenon of “steroid phobia,” where patients either underuse or over-rely on corticosteroids due to past negative treatment experiences. This inconsistency in usage is critical, as it complicates the management of patients experiencing TSW. Dr. Glick urged clinicians to adopt more targeted therapeutic approaches, particularly when TSW is suspected. He pointed out the efficacy of newer non-steroidal topicals and systemic therapies, including biologics such as dupilumab, tralokinumab, and lebrikizumab, as well as JAK inhibitors like abrocitinib and upadacitinib, which can effectively mitigate the inflammatory responses typical in TSW.

In looking to the future of dermatology, Dr. Glick expressed optimism regarding ongoing research in hidradenitis suppurativa, labeling it a new frontier in the treatment of inflammatory skin diseases. He acknowledged that while atopic dermatitis is generally well understood, the tailored therapeutic discussions at conferences like RAD are increasingly essential for managing complex patient profiles.

The RAD conference not only serves as a platform for discussing emerging evidence and therapeutic algorithms but also emphasizes the importance of addressing multifactorial disease states and associated comorbidities. This multifaceted approach is vital for enhancing clinician confidence and improving patient outcomes.

In summary, the discourse at RAD 2025 highlighted the necessity for heightened awareness of TSW, improved diagnostic strategies, and the exploration of innovative treatment pathways. The evolving landscape of dermatological research, particularly in inflammatory conditions, promises new opportunities for patient care and therapeutic precision.

**References:** 1. Dasilva D, Glick B, Lio P. Understanding topical steroid withdrawal (TSW) in patients with atopic dermatitis (AD). Presented at: 2025 Revolutionizing Atopic Dermatitis; June 6-7, 2025; Nashville, TN. 2. Mohta A, Sathe NC. Topical steroid withdrawal (red skin syndrome). In: StatPearls. StatPearls Publishing; 2025. Accessed June 8, 2025. [Link](https://www.ncbi.nlm.nih.gov/books/NBK603718/).