Topical steroid withdrawal: self-diagnosis, unconscious bias and social media

Guckian, Jonathan, Hughes, Olivia, Nikookam, Yasmin, Nair, Ria, Asif, Aqua, Brown, Jeremy, Bewley, Anthony and Latheef, Faheem 2025. Topical steroid withdrawal: self-diagnosis, unconscious bias and social media. Skin Health and Disease 10.1093/skinhd/vzaf051

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Abstract

Background Consensus amongst dermatologists regarding the phenomenon of topical steroid withdrawal (TSW) is elusive. This may be contrasted with a growing online patient movement, including social media communities. Objectives This study aimed to investigate dermatologist perspectives regarding TSW and to assess attitudes towards self-diagnosis. Methods A two-part online questionnaire was disseminated to UK-based Dermatology Consultants, Registrars and Fellows. Section one presented a clinical scenario and randomized respondents into two groups: one mentioning TSW self-diagnosis, and an otherwise identical control without the self-diagnosis. Questions about the clinical scenario were directed to dermatologists and focused on attitudes regarding patient-predicted behaviours. Section two asked about TSW perceptions and experiences, and thematic analysis of open text responses was undertaken. Results One hundred and three responses were received, including 51 Consultants, 38 Trainee Dermatologists, 10 Dermatology Fellows, 3 Specialty And Specialist (SAS) Dermatology doctors and 1 Post-CCT (Certificate of Completion of Training) Fellow. Thirty-four percent (n = 35/103) of respondents considered TSW to be a distinct clinical entity, 17.5% (n = 18/103) did not and 48.5% (n = 50/103) were unsure. Respondents felt that self-diagnosing TSW patients were less likely to comply with treatment, and more likely to take up time and pose management problems compared with controls. Themes of uncertainty regarding diagnostic veracity and social media misinformation were identified. Conclusions Uncertainty regarding the veracity of a TSW diagnosis and its management is common amongst dermatology healthcare professionals (HCPs). Dermatology HCPs in this study considered that patients who self-diagnosed TSW were more difficult to engage with skin disease management. Dermatologists desire further understanding of and research into the nature and management of TSW.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Psychology
Publisher:	Wiley Open Access
ISSN:	2690-442X
Date of First Compliant Deposit:	1 July 2025
Date of Acceptance:	29 May 2025
Last Modified:	02 Jul 2025 13:53
URI:	https://orca.cardiff.ac.uk/id/eprint/179466

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