Mapping Online Discourse on Topical Steroid Withdrawal: Accuracy, Safety, and Supporting Evidence

Introduction Topical steroid withdrawal (TSW) refers to a collection of adverse effects related to the cessation of topical corticosteroid use, especially with prolonged use or higher potency formulations. While TSW lacks official recognition and standardized diagnostic criteria, the topic has gained significant attention online. This study analyzes social media discussions surrounding TSW to gain an improved understanding of patient perspectives and assesses the accuracy and safety of the online discourse. Methods TSW-related content was retrieved from social media platforms Instagram and TikTok. Educational content and content specifically created by physicians were rated in accuracy, safety, and agreement by dermatology residents. From Reddit, TSW-related posts in the Subreddit r/eczema were extracted and then analyzed with a sentiment analysis tool. Results The majority of online discourse consisted of users sharing their personal experiences. Educational content consistently fell below the midpoint for accuracy, safety, and agreement on Instagram and TikTok, whereas physician-generated content averaged 4.25 out of 5 in all three categories. Online users discussed non-conventional treatments, including cold atmospheric plasma therapy and no moisture therapy, that present with limited evidence in the management of TSW. Dermatologist-generated content discussed the potential use of dupilumab, which has been utilized in case studies for the treatment of TSW. Conclusion The presence of unregulated and potentially harmful treatment advice in current discourse can pose risks to patient well-being. Establishing standardized diagnostic criteria, prioritizing research into TSW management, and increasing dermatologist involvement online are crucial steps in improving patient care and safety in the context of TSW.