Expert Calls for Improved Recognition and Management at RAD 2025 Conference
NASHVILLE, Tenn. – Dermatologists must remain vigilant for topical steroid withdrawal (TSW), a frequently misdiagnosed condition that mimics severe atopic dermatitis (AD) flares, warned Dr. Brad Glick during the 2025 Revolutionizing Atopic Dermatitis (RAD) Conference.
Diagnostic Challenges in TSW
“We need to be on the lookout for topical steroid withdrawal,” said Glick, director of Dermatology Residency at Larkin Health System. “As my colleague Peter Lio always says, it’s sometimes very difficult to differentiate from a really bad AD flare, but you have to take a step back and get a thorough history.”
The practicing dermatologist and Florida International University professor explained TSW typically appears 2-4 weeks after chronic topical corticosteroid use, presenting with distinctive features including widespread erythema, “elephant skin” texture on lower extremities, and the “red sleeve sign” – sharp erythema demarcation at wrists or ankles.
Root Causes and Treatment Shifts
Glick identified “steroid phobia” and inconsistent corticosteroid use as major contributors to TSW development. “Patients either underuse or over-rely on these therapies due to past treatment limitations,” he told Dermatology Times.
He advocated for targeted therapeutic approaches when TSW is suspected, highlighting newer non-steroidal topicals and systemic options including:
- Biologics: dupilumab, tralokinumab, lebrikizumab
- JAK inhibitors: abrocitinib, upadacitinib
These agents may help address the “cytokine storm” driving TSW inflammation.
Future Directions in Dermatology
Glick expressed particular optimism about emerging treatments for hidradenitis suppurativa (HS), calling it “a new frontier in inflammatory skin disease therapeutics.” He noted HS remains significantly underdiagnosed despite growing treatment options.
Value of Specialty Conferences
The dermatologist praised RAD’s focus on nuanced therapeutic decision-making, stating: “While AD diagnosis is typically well understood, tailoring treatments to individual patient profiles is increasingly essential.” He emphasized the conference’s role in addressing complex comorbidities and evolving evidence in dermatologic care.
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