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Initial Consensus for the Management of Topical Steroid Withdrawal: A Delphi Study
Sarah Kamsiah Zemlok1,2, Mykayla Sandler2,3, JiaDe Yu2
1From the University of Connecticut School of Medicine, Farmington, Connecticut, USA.
Dermatitis : Contact, Atopic, Occupational, Drug
|October 15, 2025
Summary
Topical steroid withdrawal (TSW) management guidelines are lacking. Experts reached consensus on cessation of topical/systemic steroids, psychosocial support, and dupilumab as a first-line treatment for TSW.
Area of Science:
- Dermatology
- Clinical Practice Guidelines
Background:
- Topical steroid withdrawal (TSW) is an emerging condition linked to prolonged topical corticosteroid use.
- Current management guidelines for TSW are absent, necessitating expert consensus for clinical direction.
Purpose of the Study:
- To establish initial expert consensus and management guidelines for topical steroid withdrawal (TSW).
- To utilize the modified Delphi consensus approach for developing evidence-based recommendations.
Main Methods:
- A panel of 21 physicians and patient advocates evaluated 72 management strategies.
- Two survey rounds were conducted to achieve consensus (≥70% agreement/disagreement).
Main Results:
- Twelve key outcomes reached expert consensus, emphasizing corticosteroid cessation and psychosocial support.
- Dupilumab was identified as a consensus-based first-line systemic therapy for TSW.
Conclusions:
- Initial management guidelines for TSW have been established through expert consensus.
- These guidelines provide a framework for TSW treatment pending further research and evidence-based therapies.
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