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Topical steroid withdrawal syndrome: developing diagnostic criteria through a modified Delphi method.
Cynhia Hsu1,2, Lily Guo1,3, Derrick Adams4
1Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, IL, USA.
The British Journal of Dermatology
|December 11, 2025
Summary
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.
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.
