Topical steroid withdrawal: dissecting the controversy.

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.