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Related Experiment Video

Updated: Apr 3, 2026

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Topical steroid withdrawal: dissecting the controversy.

Ian A Myles1, Grace Ratley1

  • 1Laboratory of Clinical Immunology and Microbiology (LCIM), Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States.

Frontiers in Medicine
|April 2, 2026
PubMed
Summary

Topical steroid withdrawal (TSW) is increasingly recognized, yet its distinction from underlying skin conditions is debated. This review clarifies TSW origins, addresses skepticism, and guides providers in diagnosis and patient care.

Keywords:
Eczemaatopic dermatitiscorticosteroidssteroidtopical steroid withdrawal (TSW)

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Area of Science:

  • Dermatology
  • Clinical Medicine

Background:

  • Topical steroid withdrawal (TSW) is gaining recognition, with established clinical features and treatment options.
  • Regulatory agencies have updated topical corticosteroids (TCS) warning labels to include TSW.
  • The distinct nature of TSW versus underlying dermopathies remains a point of debate.

Purpose of the Study:

  • To elucidate the origins and current status of the controversy surrounding TSW.
  • To aid healthcare providers in understanding and recognizing TSW.
  • To differentiate TSW from other dermatological conditions with similar symptoms.

Main Methods:

  • Narrative review of the medical literature.
  • Analysis of historical claims and counterclaims regarding TSW.
  • Examination of arguments used to deny TSW's distinctness.

Main Results:

  • Identified three primary errors in TSW denial: overlooking its syndromic nature, devaluing patient-reported symptoms, and circular logic in diagnostic criteria.
  • Highlighted knowledge gaps in TSW research.
  • Provided updated insights into the TSW controversy.

Conclusions:

  • Providers should recognize TSW as distinct from underlying dermopathies.
  • Accurate diagnosis allows for better patient counseling on TCS risks and trauma-informed care.
  • Further research is needed to address existing knowledge gaps.