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Pediatric topical steroid withdrawal syndrome: facts, misconceptions and communicating with patients and families

Kathleen L Miao1, Hsi Yen2,3, Minnelly Luu2,3

  • 1Keck School of Medicine, University of Southern California.

Current Opinion in Pediatrics
|June 16, 2025
PubMed

Insights

Topical steroid withdrawal syndrome (TSWS) is a growing concern in pediatric atopic dermatitis (AD) management. This review offers clinicians evidence-based guidance to address patient fears and optimize topical corticosteroid (TCS) use for better skin health.

Area of Science:

  • Dermatology
  • Pediatrics
  • Pharmacology

Background:

  • Topical corticosteroids (TCS) are standard for pediatric atopic dermatitis (AD).
  • Topical steroid withdrawal syndrome (TSWS) is increasingly discussed online, causing patient concern.
  • Misconceptions about TSWS can complicate AD management.

Purpose of the Study:

  • Provide clinicians with guidance on addressing pediatric TSWS concerns.
  • Optimize the use of TCS in managing AD in children.
  • Improve the doctor-patient relationship regarding corticosteroid therapy.

Main Methods:

  • Literature review examining current understanding of TSWS.
  • Analysis of research on diagnostic criteria and TCS use.
  • Synthesis of evidence-based clinical strategies.

Main Results:

  • Several misconceptions surround TSWS.
  • Standardized diagnostic criteria for TSWS are lacking.
  • Careful selection of TCS potency and duration is crucial.
  • Effective provider-patient communication is vital for therapeutic alliance.

Conclusions:

  • TSWS recognition is rising, but diagnostic consensus is absent.
  • Misdiagnosis can occur due to similarities with AD flares.
  • Practical strategies include appropriate TCS selection, tapering, and non-steroidal therapies.
  • Open communication and empathetic relationships reduce corticosteroid phobia and ensure optimal treatment for AD.
Abstract

Keywords:
atopic dermatitispatient educationpediatrictopical corticosteroidstopical steroid withdrawal

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