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Observational Study
. 2025 Jan 3:105:adv40187.
doi: 10.2340/actadv.v105.40187.

Topical Steroid Withdrawal in Atopic Dermatitis: Patient-reported Characterization from a Swedish Social Media Questionnaire

Mikael Alsterholm  1 , Maja Af Klinteberg  2 , Sophie Vrang  3 , Gunnthorunn Sigurdardottir  4 , MariHelen Sandström Falk  5 , Alexander Shayesteh  2
Affiliations
Observational Study

Topical Steroid Withdrawal in Atopic Dermatitis: Patient-reported Characterization from a Swedish Social Media Questionnaire

Mikael Alsterholm et al. Acta Derm Venereol. .

Abstract

Topical steroid withdrawal (TSW) is described as an adverse reaction to topical glucocorticoids (TGCs). A pathophysiological mechanism has not been identified. There are no diagnostic criteria. The aim was to describe patient-reported characteristics of TSW in atopic dermatitis (AD). An observational cross-sectional study was performed by posting a questionnaire for participants, aged ≥18 years, reporting both AD and TSW, in a Swedish TSW-themed Facebook group during 4 weeks in 2023. The questionnaire was accessed by 98 participants, with 82 completing it. Most were female (95%), 18-39 years old (74%), self-diagnosed with TSW (84%), and reported current symptoms of AD and TSW. They defined TSW as dependency on TGCs and adverse reactions to their use. Erythema, desquamation, dryness, and oozing affecting the face, neck, and upper extremities were the most reported signs. Pruritus, sleep disturbance, and signs of anxiety and depression were the most reported symptoms. Recurring episodes of manifestations attributed to TSW were reported by 60%. The personal trigger factor was believed to be TGCs by 93%, and 33% also identified oral glucocorticoids. TGCs were currently used by 21%. Self-reported manifestations of TSW are similar to those of AD but appeared to be distinguishable for the participants and caused considerable morbidity.

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Conflict of interest statement

MA has received speaker honoraria and/or been on advisory boards for AbbVie, Almirall, Eli-Lilly, Essity, LEO Pharma, Pfizer, and Sanofi-Genzyme, and is/has been an investigator for AbbVie, LEO Pharma, and Sanofi-Genzyme. MaK has no conflict of interest to declare. SV has received speaker honoraria and been a consultant for Sanofi-Genzyme and has received speaker honoraria, which were paid to the patient organization Atopikerna, the Swedish Asthma and Allergy Association, from AbbVie, LEO Pharma, and Sanofi-Genzyme. GS has received speaker honoraria and/or been on advisory boards for AbbVie, Almirall, Eli-Lilly, and LEO Pharma. MHSF has received speaker honoraria and/or been on advisory boards for Almirall, Astellas, AstraZeneca, AbbVie, Celgene, Galderma, LEO Pharma, Lilly, MEDA, Novartis, Sanofi-Genzyme, and Wyeth. AS has received speaker honoraria and/or consulting fees from AbbVie, Allergan, Almirall, LEO Pharma, Novartis, and Pfizer. Payments were made to AS’s institution. AS is/has been an investigator for AbbVie and LEO Pharma.

Figures

Fig. 1
Fig. 1
Main characteristics of self-reported topical steroid withdrawal in participants (n=82) with atopic dermatitis. aCategory “Other” distributed over topical calcineurin inhibitor (n = 5), other glucocorticoid preparations (n = 3), Janus kinase inhibitor (n = 1), pregnancy (n = 1), and unspecified (n = 1). bAn episode was defined as being resolved after 2 months without symptoms. cParticipants rated applicability to their life from 0 (does not describe my situation at all) to 10 (describes my situation perfectly) on a visual analogue scale. Box-and-whisker plot. The upper quartile equalled the maximum score for all items. TSW: topical steroid withdrawal; VAS: visual analogue scale.
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References

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