The debate over topical steroid withdrawal (TSW) took center stage at the BAD 2026 Annual Meeting, where experts urged clinicians to listen to patients even amid scientific uncertainty. TSW — marked by red, burning, peeling skin after stopping topical steroids — lacks agreed diagnostic criteria but was recognized by the UK's MHRA in 2021. Experts say compassion and honest communication are key while research catches up.
At the British Association of Dermatologists (BAD) 2026 Annual Meeting in Manchester, experts tackled one of dermatology's most contentious debates: is topical steroid withdrawal (TSW) a distinct clinical condition or just a flare of underlying eczema? The consensus? That question shouldn't stop clinicians from treating patients with empathy and honesty.
TSW — characterized by red, itchy, burning skin that can peel, crack, and blister — can emerge days to weeks after stopping topical steroids, sometimes spreading beyond the original treatment area. The UK's MHRA recognized TSW in 2021 and mandated warning language in all topical steroid patient leaflets. Still, no agreed definition or diagnostic criteria exist, leaving both patients and clinicians in a grey zone.
Experts proposed a spectrum-based terminology ranging from "controlled eczema" to "recovered TSW," and called for high-quality research. Non-steroidal alternatives like ruxolitinib and delgocitinib may offer future options, while dupilumab has already helped some severe cases.
Key Takeaways:
Why it matters: With patient concern about topical steroids growing and social media filling the information void, clinicians who listen, communicate honestly, and stay open to evolving evidence can meaningfully improve outcomes — and trust.
