Topical steroid withdrawal diagnostic criteria defined by NIH researchers

Friday, March 14, 2025

Criteria may help guide treatment of dermatitis

Researchers at the National Institutes of Health (NIH) have determined that dermatitis resulting from topical steroid withdrawal (TSW) is distinct from eczema and is caused by an excess of an essential chemical compound in the body. Scientists from NIH’s National Institute of Allergy and Infectious Diseases (NIAID) identified treatments that could be studied in clinical trials for the condition based on their potential to lower levels of the chemical compound — called nicotinamide adenine dinucleotide (NAD⁺), a form of vitamin B3. The findings were published today in the Journal of Investigative Dermatology.

Dermatitis is characterized by inflammation, itching, or burning sensations on the skin, and can result from various conditions including TSW and eczema. Eczema, also known as atopic dermatitis, is a common cause of dermatitis and affects 10 to 30% of children and 2 to 10% of adults each year in the United States. Topical steroids — specifically glucocorticoids or topical corticosteroids — have long been used as a first-line treatment for dermatitis caused by eczema because the drugs are safe, effective, easy to apply, and considered well-tolerated.

Some people experience dermatitis after using topical steroids for prolonged periods of time and then stopping — a condition called TSW. Diagnosing and treating this condition is difficult because TSW is not well understood. Symptoms include skin redness, burning sensations, skin heat (thermal dysregulation), itching and peeling, which can even occur on parts of the body where topical steroids were not applied. As TSW and eczema have similar symptoms, it has been difficult to distinguish the two disorders.

*Hand and wrist of a participant in the pilot study before (left) and after (right) treatment of topical steroid withdrawal symptoms with berberine, a mitochondrial complex I-blocking drug.*