Initial Consensus for the Management of Topical Steroid Withdrawal: A Delphi Study

<u><b><i></i></b></u> <u><b><i>Background:</i></b></u> Topical steroid withdrawal (TSW) is a poorly defined condition thought to be related to prolonged use of topical corticosteroids. Currently, management guidelines for TSW do not exist. <u><b><i>Objective:</i></b></u> This study aimed to form expert consensus and initial management guidelines using the modified Delphi consensus approach. <u><b><i>Methods:</i></b></u> Our expert panel of 21 physicians and patient advocates assessed 72 pharmacologic and supportive management strategies for consensus over 2 survey rounds. Outcomes achieving ≥70% agreement or disagreement were defined as meeting endpoint consensus. <u><b><i>Results:</i></b></u> Final expert consensus included 12 outcomes, primarily focused on cessation of topical and systemic corticosteroids and psychosocial support. Additionally, our panel met consensus for dupilumab as a first-line systemic treatment. <u><b><i>Conclusions:</i></b></u> Here, we present initial guidelines for the management and treatment of TSW until further therapies can be investigated for future evidence-based care.