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Topical steroid withdrawal syndrome: developing diagnostic criteria through a modified Delphi method.

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Topical steroid withdrawal syndrome (TSW) is a growing concern. This study proposes preliminary diagnostic criteria for TSW, focusing on key signs and symptoms to aid healthcare professionals in diagnosis.

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Area of Science:

  • Dermatology
  • Clinical Medicine

Background:

  • Topical steroid withdrawal syndrome (TSW) is an adverse event linked to topical corticosteroid (TCS) discontinuation.
  • Lack of defined diagnostic criteria and understanding of TSW pathomechanisms hinder diagnosis and research.

Purpose of the Study:

  • To establish preliminary diagnostic criteria for the erythemato-edematous subtype of TSW.
  • To develop criteria applicable to both adult and pediatric populations.
  • To utilize a Delphi consensus approach informed by literature review.

Main Methods:

  • A modified Delphi process involving eleven experienced clinicians.
  • Two survey rounds using a 5-point Likert scale with a ≥75% consensus threshold.
  • A final live video conference to finalize essential diagnostic criteria.

Main Results:

  • Identification of 18 critical diagnostic items for TSW.
  • Included history of escalating TCS use, distinct morphology/distribution, neuropathic pain, and severe burning sensations.
  • Criteria encompass clinical history, signs, and symptoms.

Conclusions:

  • Differentiating TSW from conditions like severe atopic dermatitis (AD) remains difficult.
  • Proposed criteria emphasize common TSW signs and symptoms.
  • Aims to foster professional discussion and advance reliable diagnostic tool development.