Guckian Jonathan, Hughes Olivia, Nikookam Yasmin, Nair Ria, Asif Aqua, Brown Jeremy, Bewley Anthony, Latheef Faheem
University of Leeds Institute for Medical Education, University of Leeds, Leeds, UK.
School of Psychology, Cardiff University, Cardiff, Wales, UK.
Skin Health Dis. 2025 Jul 1;5(4):281-288. doi: 10.1093/skinhd/vzaf051. eCollection 2025 Aug.
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.
This study aimed to investigate dermatologist perspectives regarding TSW and to assess attitudes towards self-diagnosis.
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.
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 ( = 35/103) of respondents considered TSW to be a distinct clinical entity, 17.5% ( = 18/103) did not and 48.5% ( = 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.
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.
皮肤科医生对于外用糖皮质激素撤药（TSW）现象尚未达成共识。这与在线患者群体的不断壮大形成了对比，其中包括社交媒体社区。
本研究旨在调查皮肤科医生对TSW的看法，并评估他们对自我诊断的态度。
向英国的皮肤科顾问、住院医师和研究员发放了一份分为两部分的在线问卷。第一部分呈现了一个临床病例，并将受访者随机分为两组：一组提及TSW自我诊断，另一组为不提及自我诊断的相同对照病例。针对该临床病例向皮肤科医生提出的问题聚焦于对患者预测行为的态度。第二部分询问了对TSW的看法和经历，并对开放式文本回复进行了主题分析。
共收到103份回复，其中包括51名顾问、38名皮肤科住院医师、10名皮肤科研究员、3名专科和专家（SAS）皮肤科医生以及1名完成培训后（CCT）研究员。34%（=35/103）的受访者认为TSW是一种独特的临床实体，17.5%（=18/103）的受访者不这么认为，48.5%（=50/103）的受访者不确定。与对照组相比，受访者认为自我诊断为TSW的患者不太可能遵医嘱治疗，更可能占用时间并带来管理问题。研究发现了诊断准确性的不确定性和社交媒体错误信息等主题。
皮肤科医疗专业人员（HCPs）对TSW诊断的准确性及其管理普遍存在不确定性。本研究中的皮肤科HCPs认为，自我诊断为TSW的患者更难参与皮肤病管理。皮肤科医生希望进一步了解和研究TSW的本质及管理方法。
