PS58 Management approaches and assessment of treatment response in patients with topical steroid withdrawal

Abstract

Topical steroid withdrawal (TSW) is a poorly understood condition that follows discontinuation of prolonged topical corticosteroids. Its relapsing–remitting course and erythematic presentation overlap with atopic dermatitis (AD), leading to controversy regarding its validity. There is no formal diagnostic or management framework. We aimed to evaluate real-world treatment outcomes and psychological burden in patients presenting with self-diagnosed TSW at a tertiary dermatology centre. Patients seen with TSW at a psychodermatology centre between January and April 2025 were included. Baseline characteristics; treatments [including conventional systemics, biologics and Janus kinase (JAK) inhibitors]; changes in Eczema Area and Severity Index (EASI) and Dermatology Life Quality Index (DLQI) scores; and psychiatric impact were extracted from electronic records. Fifteen patients were included (mean age 29.5 years, SD 7); 67% were female and 87% had prior AD. Most followed the local pathway of initial conventional systemics (60%). Overall, 40% progressed to advanced treatments, and 47% required more than one therapy. Ciclosporin was the most common first-line agent (60%) and had the highest response rate (33%), although long-term use was limited. Methotrexate (27%) showed poor efficacy. One-third of patients received biologics: dupilumab (20%) and lebrikizumab (7%) were effective with variable durability, while tralokinumab (20%) showed no significant benefit. JAK inhibitors – abrocitinib (7%) and upadacitinib (7%) – demonstrated promising responses in refractory cases. Psychological comorbidities were frequent (53%), including suicidal ideation in 13%. Overall, 67% achieved lasting changes, with mean (SD) absolute EASI improving from 21 (8) to 8 (5) and DLQI from 23 (6) to 7 (5). Although TSW may represent a distinct clinical entity, it remains unclear whether this cohort truly had TSW, as diagnoses were often self-reported and influenced by social media. Furthermore, most patients had underlying AD. Regardless, management should be multidisciplinary, combining effective cutaneous therapy and psychodermatology. Further studies are needed to better characterize this controversial condition and to define optimal management strategies.