Findings on Topical Steroid Withdrawal Versus Eczema, with Ian Myles, MD, MPH

New findings by a team of scientists from the National Institutes of Health’s National Institute of Allergy and Infectious Diseases (NIAID) Laboratory of Clinical Immunology and Microbiology indicate that dermatitis due to topical steroid withdrawal (TSW) is distinct from atopic dermatitis, and they suggest that it is the result of an excess of an essential chemical compound.1

This team of investigators had evaluated a prior survey involving 1,889 adults subjects with symptoms that were determined to be comparable to atopic dermatitis, or eczema. One such investigator was Ian Myles, MD, MPH, from the Epithelial Therapeutics Unit in NIAID’s Laboratory of Clinical Immunology and Microbiology, who spoke with HCPLive about these new data and their significance.

“The biggest [finding] is that, unlike regular atopic dermatitis, there's a mitochondrial defect in patients with topical steroid withdrawal and up-regulation of 1 of the components of the electron transport chain,” Myles said. “It basically gets revved up for reasons we do not understand, and it will not turn off for those patients. So with this overactivity, it starts producing too much niacin in the skin, which I think most of us are familiar with, from causing flushing when it used to be used for cholesterol. Then for the body to recycle niacin, it has to break down tryptophan, and so in the breaking down of tryptophan and the overactivity of niacin, those 2 things combined, we think would explain all of the symptoms that are distinct from regular eczema.”.

Myles noted that among those in the field of dermatology, many have this condition due to TSW and not eczema.

“I think what this helps is to identify who is it that you think is TSW, as it is a distinct entity and should be respected as such,” Myles said. “We did do pilot studies with interventions with metformin, and then ‘herbal metformin’ which is Berberine. They're promising. The end number is small, but I think the important thing is to establish it as a real diagnosis and give some people basic outlines of how you would go about separating who in your clinic has TSW versus who in your clinic probably has severe eczema.”

For additional information on these findings, view the full interview with Myles posted above this summary.

The quotes contained in this summary were edited for clarity. Allergy & Asthma Network received funding from Sanofi, Regeneron, Genentech, Pfizer, and Novartis for unbranded disease awareness and education; however, such funding was noted as not relevant to this research.

Interested in dermatology? Learn more about the annual Revolutionizing Atopic Dermatitis (RAD) Conference, hosted by HCPLive Dermatology Times, and our CE/CME partner Physicians’ Education Resource.

References

1. Shobnam N, Ratley G, Myles I, et al. Topical Steroid Withdrawal Is a Targetable Excess of Mitochondrial NAD+, Journal of Investigative Dermatology, 2025, ISSN 0022-202X, https://doi.org/10.1016/j.jid.2024.11.026.