Abstract Background Topical steroid withdrawal syndrome (TSW) is an adverse event following discontinuation of topical corticosteroids (TCS) and is of growing interest among patients and dermatologists. The absence of well-defined diagnostic criteria and limited insights into the pathomechanisms make diagnosis and future research challenging. Objective To propose preliminary diagnostic criteria for TSW with the erythemato-edematous subtype applicable for adult and pediatric populations using a Delphi consensus approach informed by a thorough literature review that summarizes the signs, symptoms, and histology of TSW. Methods Eleven clinicians experienced in diagnosing and treating suspected TSW in both children and adults participated in a three-round modified Delphi process. Two rounds of surveys were conducted, with items ranked using a 5-point Likert scale. A predefined consensus threshold of ≥75% was established for any one feature to be deemed important. The third round involved a live video conference where the panel reached a consensus on essential diagnostic criteria. Results The panel identified 18 critical diagnostic items, encompassing elements from the patient's clinical history, signs, and symptoms. This includes history of escalating TCS requirement; morphology and distribution differing from primary condition; regional or generalized spontaneous neuropathic pain; and severe burning sensation of the skin. Conclusions Differentiating TSW from conditions such as severe atopic dermatitis (AD) remains challenging. By emphasizing the common signs and symptoms of TSW, we aim to encourage discussions among healthcare professionals and progress towards the development of a reliable diagnostic tool.
Hsu et al. (2025) studied this question.