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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.
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.
Purpose Of Review:
Topical corticosteroids (TCS) have long been a mainstay in treating pediatric atopic dermatitis (AD). Topical steroid withdrawal syndrome (TSWS) has garnered increasing public attention, driven largely by social media discourse. This review aims to provide guidance for clinicians to effectively address concerns about pediatric TSWS in order to optimally manage AD in children.
Recent Findings:
An examination of the literature reveals several misconceptions surrounding TSWS. Research highlights the importance of standardized diagnostic criteria, caution with high- or inappropriate potency TCS, particularly in sensitive areas, and the need for provider-patient communication to improve therapeutic alliance.
Summary:
TSWS is gaining recognition, and the lack of consensus on diagnostic standards and similarities with AD flares can result in misdiagnosis. This review highlights practical, evidence-based clinical approaches to discuss TSWS with patients/parents. Strategies to prevent adverse effects from TCS include appropriate potency selection and duration of treatment, utilizing gradual tapering protocols with proactive maintenance therapy, and addition of nonsteroidal anti-inflammatory therapies. Moreover, fostering an open, empathetic doctor-patient relationship can reduce unwarranted phobia around corticosteroids and ensure that TCS continue to be used optimally to treat AD and other inflammatory skin conditions. Thorough clinical guidance is essential to address patient/parent concerns about TSWS while working together toward an effective treatment plan for skin disease.
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