Topical Steroid Withdrawal: Perspectives of Dutch Healthcare Professionals

Authors

  • Florence Vroman Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
  • Charlotte S. Schimmel Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
  • Lisa P. van der Rijst Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
  • Marlies de Graaf Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
  • Marjolein de Bruin-Weller Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
  • Patrick M.J.H. Kemperman Department of Dermatology, Amsterdam University Medical Center, Amsterdam Medical center, Amsterdam, The Netherlands
  • Dirk Jan Hijnen Department of Dermatology, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
  • Inge M. Haeck Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands

DOI:

https://doi.org/10.2340/actadv.v105.44209

Keywords:

atopic dermatitis, topical corticosteroids, Topical Steroid Withdrawal, Topical Steroid Withdrawal Syndrome

Abstract

Topical steroid withdrawal (TSW) is a highly controversial condition, typically reported following prolonged and/or frequent use of topical corticosteroids. Despite growing public awareness, knowledge of topical steroid withdrawal remains limited. Therefore, this study aimed to explore the perspectives of Dutch healthcare professionals (HCPs) on topical steroid withdrawal. A web-based survey was conducted among 168 Dutch HCPs. The results show that erythema (64.1%) and a burning sensation (60.3%) were the most frequently selected symptoms associated with TSW. The majority of respondents (69.6%) attributed TSW symptoms to atopic dermatitis (AD) flares and/or the adverse effect of topical corticosteroid use. Only a small percentage (12.2%) firmly believed that TSW is a distinct clinical entity, while 17.6% believed that it does not exist. Preferred treatments included using other topical immunomodulators, reinitiating and subsequently tapering topical corticosteroids, and providing non-drug and psychological support. While HCPs felt confident in addressing concerns about topical corticosteroids and topical steroid withdrawal, approximately one-quarter (24.2%) preferred not to treat patients refusing topical corticosteroids. This study highlights variations in perception among HCPs and the need for robust research to establish clear diagnostic criteria and guidelines regarding TSW. Finally, improved awareness and open communication between HCPs and patients are essential when addressing topical steroid withdrawal.

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Author Biographies

Florence Vroman, Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands

Dermatology department

MD

Florence Vroman and Charlotte Schimmel share first authorship

Charlotte S. Schimmel, Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands

Dermatology department

MD

Florence Vroman en Charlotte Schimmel share first authorship

Lisa P. van der Rijst, Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands

Dermatology department

MD

Marlies de Graaf, Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands

Dermatology department

MD, PhD

Marjolein de Bruin-Weller, Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands

Dermatology department

prof., MD, PhD

Patrick M.J.H. Kemperman, Department of Dermatology, Amsterdam University Medical Center, Amsterdam Medical center, Amsterdam, The Netherlands

Dermatology department

MD

Dirk Jan Hijnen, Department of Dermatology, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands

Dermatology department

prof., MD, PhD

Inge M. Haeck, Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands

Dermatology department

MD, PhD

References

Tan S, Phan P, Law JY, Choi E, Chandran NS. Qualitative analysis of topical corticosteroid concerns, topical steroid addiction and withdrawal in dermatological patients. BMJ Open 2022; 12: e060867. DOI: https://doi.org/10.1136/bmjopen-2022-060867

Hwang J, Lio PA. Topical corticosteroid withdrawal (‘steroid addiction’): an update of a systematic review. J Dermatolog Treat 2022; 33: 1293–1298. DOI: https://doi.org/10.1080/09546634.2021.1882659

National Eczema Society BDNG, British Association of Dermatologists. Topical Steroid Withdrawal [Internet]. 2024. Available from: https://eczema.org/information-and-advice/topical-steroid-withdrawal-tsw/

Hajar T, Leshem YA, Hanifin JM, Nedorost ST, Lio PA, Paller AS, et al. A systematic review of topical corticosteroid withdrawal (“steroid addiction”) in patients with atopic dermatitis and other dermatoses. J Am Acad Dermatol 2015; 72: 541–549.e542. DOI: https://doi.org/10.1016/j.jaad.2014.11.024

Barta K, Fonacier LS, Hart M, Lio P, Tullos K, Sheary B, et al. Corticosteroid exposure and cumulative effects in patients with eczema: results from a patient survey. Ann Allergy Asthma Immunol 2023; 130: 93–99.e10. DOI: https://doi.org/10.1016/j.anai.2022.09.031

Tan SY, Chandran NS, Choi EC. Steroid phobia: is there a basis? A review of topical steroid safety, addiction and withdrawal. Clin Drug Investig 2021; 41: 835–842. DOI: https://doi.org/10.1007/s40261-021-01072-z

Marshall HF, Leung DYM, Lack G, Sindher S, Ciaccio CE, Chan S, et al. Topical steroid withdrawal and atopic dermatitis. Ann Allergy Asthma Immunol 2024; 132: 423–425. DOI: https://doi.org/10.1016/j.anai.2023.12.022

Bowe S, Masterson S, Murray G, Haugh I. Topical steroid withdrawal through the lens of social media. Clin Exp Dermatol 2022; 47: 1554–1557. DOI: https://doi.org/10.1111/ced.15194

Haddad F, Abou Shahla W, Saade D. Investigating topical steroid withdrawal videos on TikTok: cross-sectional analysis of the top 100 videos. JMIR Form Res 2024; 8: e48389. DOI: https://doi.org/10.2196/48389

ITSAN. What is TSW Syndrome? Available from: https://www.itsan.org/what-is-tsw-syndrome/

Howells L, Broome H, Burleigh A, Hammond H, Ismail F, Proctor A, et al. Topical corticosteroid withdrawal syndrome: the patient community call for high-quality research, clear definitions and diagnostic criteria. Br J Dermatol 2023; 188: 288–289. DOI: https://doi.org/10.1093/bjd/ljac067

Barlow R, Proctor A, Moss C. Topical steroid withdrawal: a survey of UK dermatologists’ attitudes. Clin Exp Dermatol 2024; 49: 607–611. DOI: https://doi.org/10.1093/ced/llae045

Guckian J, Hughes O, Nikookam Y, Nair R, Brown J, Bewley A, et al. Dermatologist perspectives on topical steroid withdrawal: distrust, disinformation and distance? Br J Dermatol 2023; 188: iv164–iv165. DOI: https://doi.org/10.1093/bjd/ljad113.355

Alsterholm M, Af Klinteberg M, Vrang S, Sigurdardottir G, Sandström Falk M, Shayesteh A. Topical steroid withdrawal in atopic dermatitis: patient-reported characterization from a Swedish social media questionnaire. Acta Derm Venereol 2025; 105: adv40187. DOI: https://doi.org/10.2340/actadv.v105.40187

Brookes TS, Barlow R, Mohandas P, Bewley A. Topical steroid withdrawal: an emerging clinical problem. Clin Exp Dermatol 2023; 48: 1007–1011. DOI: https://doi.org/10.1093/ced/llad161

Sheary B, Harris MF. Cessation of long-term topical steroids in adult atopic dermatitis: a prospective cohort study. Dermatitis 2020; 31: 316–320. DOI: https://doi.org/10.1097/DER.0000000000000602

Ghosh A, Sengupta S, Coondoo A, Jana AK. Topical corticosteroid addiction and phobia. Indian J Dermatol 2014; 59: 465–468. DOI: https://doi.org/10.4103/0019-5154.139876

Feschuk AM, Pratt ME. Topical steroid withdrawal syndrome in a mother and son: a case report. SAGE Open Med Case Rep 2023; 11: 2050313x231164268. DOI: https://doi.org/10.1177/2050313X231164268

Shobnam N, Ratley G, Saksena S, Yadav M, Chaudhary PP, Sun AA, et al. Topical steroid withdrawal is a targetable excess of mitochondrial NAD. J Invest Dermatol 2025, Feb 10 [Online ahead of print] DOI: https://doi.org/10.1101/2024.04.17.24305846

Cotter C, Burton T, Proctor A, Moss C, Flohr C. Topical steroid withdrawal syndrome: time to bridge the gap. Br J Dermatol 2022; 187: 780–781. DOI: https://doi.org/10.1111/bjd.21770

Additional Files

Published

2025-08-12

How to Cite

Vroman, F., Schimmel, C. S., van der Rijst, L. P., de Graaf, M., de Bruin-Weller, M., Kemperman, P. M., … Haeck, I. M. (2025). Topical Steroid Withdrawal: Perspectives of Dutch Healthcare Professionals. Acta Dermato-Venereologica, 105, adv44209. https://doi.org/10.2340/actadv.v105.44209

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