Topical Steroid Withdrawal: An Emerging Challenge in the Treatment of Atopic Dermatitis

Topical corticosteroids (TCS) have been a cornerstone in managing atopic dermatitis (AD) since their introduction in 1952. Though there are well-documented adverse effects attributed to their use, the existence of some complications of TCS use, including topical steroid withdrawal (TSW) syndrome, characterised by TCS dependence and skin disease worsening after TCS discontinuation, are more controversial within the dermatology community. There is no consensus on diagnostic criteria for TSW or clarity on its prevalence, natural history and management. Media reports are common and TSW overdiagnosis may lead to steroid phobia, poor adherence to TCS therapy, and unnecessary, increased, and protracted AD flares. This paper reviews the historical context, clinical presentations, challenges in diagnosis and the ongoing debate regarding TSW, with a focus on the implications for patient management and the potential consequences of steroid phobia on treatment adherence.