- Clinical Technology
- Adult Immunization
- Hepatology
- Pediatric Immunization
- Screening
- Psychiatry
- Allergy
- Women's Health
- Cardiology
- Pediatrics
- Dermatology
- Endocrinology
- Pain Management
- Gastroenterology
- Infectious Disease
- Obesity Medicine
- Rheumatology
- Nephrology
- Neurology
- Pulmonology
On Topical Steroid Withdrawal Syndrome, We Need Bigger Studies, More Clinical Trials: Brad Glick, DO, MPH
The literature on topical steroid withdrawal syndrome is scant, Glick says; we're learning more about it, but we need more research to help our patients.
Topical corticosteroid withdrawal (TSW) syndrome is a cutaneous eruption seen after long-term use (at lest 3 months) of the medications that is followed by sudden cessation, typically of mid- to high-potency formulations. It is described in the literature as "a form of tachyphylaxis and rebound vasodilation with skin barrier dysfunction."1 The most common symptoms are intense burning, pruritis, and erythema.2,3
At Revolutionizing Atopic Dermatitis 2025, held in Nashville June 6-7, Brad Glick, DO, MPH, was 1 of 3 experts for the presentation titled, Understanding Topical Steroid Withdrawal (TSW) in Patients with Atopic Dermatitis (AD).4 Glick spoke with Patient Care© after the presentation and noted the early stage of investigation into the reaction, emphasizing the importance of much wider and deeper research. He also pointed to some progress in the area. In the UK, package inserts for topical steroids "actually include an alert for topical steroid withdrawal or topical steroid withdrawal syndrome," he said. "They outline a variety of features for both clinicians and patients to be on the lookout for."
Even in the absence of established diagnostic criteria, Glick said, there are several features that are becoming recognized as consistent across individuals having the experience.
In the video above, Glick talks more about what dermatologists are learning about the syndrome and while also calling for greater scientific focus.
Brad Glick, DO, MPH, is a practicing dermatologist at the Glick Skin Institute, in Wellington, FL, director, dermatology residency at Larkin Health System Palm Springs Campus, and clinical assistant professor of dermatology at FIU Herbert Wertheim College of Medicine, in Miami, FL.
The following transcript has been lightly edited for clarity and flow.
Patient Care: How would you describe the general knowledge of topical steroid withdrawal syndrome among health care professionals?
Brad Glick, DO, MPH: Well, I would point out that there's very little literature on this condition. In fact, I’ll acknowledge my colleague again, Dr. Peter Lio—he’s perhaps written more on this than almost anyone in our area of dermatology, starting with a really exceptional systematic review published in 2015.
I think the biggest thing right now, in my humble view, is that there are a lot of people walking around with this after using topical corticosteroids for many years. They’re not responding to standard therapies, whether in the primary care setting or even in the clinics of our dermatology partners, and I think they’re frustrated. There are blogs, there are social media correspondents, there are so-called experts in this area who appear to elucidate what this condition really is.
So it’s getting a lot of attention. And I think we both know that social media is very loud these days—and in some respects, important—because it is providing messages that we need to synthesize and perhaps use to go in a different direction.
Let me point out one example of where the concern about overuse of steroids, or the so-called steroid addiction, is getting some needed attention. In the UK, their package inserts for topical corticosteroids actually include an alert for topical steroid withdrawal or topical steroid withdrawal syndrome. They outline a variety of features for both clinicians and patients to be on the lookout for. That’s what’s different right now—it’s getting more attention. Perhaps that attention will reach a point where a consensus group will get together and create diagnostic criteria.
I have to mention one other thing, too. There’s a little bit more science about the pathophysiology now. We're beginning to understand that there may be more going on in the background—certain receptors, particularly glucocorticoid receptors, appear to be downregulated or inhibited by excessive corticosteroid use. This can lead to an imbalance between vasoconstriction and vasodilation, which helps explain why the skin is so red.
And there’s more science coming behind it, too. But many of the studies assessing topical steroid withdrawal have been very small. So, as we like to say, we need bigger studies and more clinical trials.
