Dr. Eichenfield Urges Caution for Steroid-Phobia at Maui Derm
In addition to the various clinical skin conditions that pediatric patients present with, dermatologists now must understand how to deal with steroid-phobia, according to Lawrence Eichenfield, MD.
Dr. Eichenfield discussed patient perspectives on topical corticosteroids during his segment of “Atopic Dermatitis and Pruritus: Current Concepts and Therapeutics for 2025” at the Maui Derm Hawaii 2025 meeting in Maui, Hawaii.
“In our practice, we see a different kind of steroid-phobia because there is a projection on pediatric patients that their atopic dermatitis is due to topical corticosteroids,” Dr. Eichenfield said.
He recommended that dermatologists watch “Skin on Fire,” a YouTube video about topical steroid withdrawal syndrome.
“Just to get a sense of the messaging that people are getting and finding that puts a really negative perspective on pretty much any topical corticosteroid and sort of imputes that eczema is due to topical corticosteroid use,” Dr. Eichenfield said.
While he said topical steroid withdrawal is a real phenomenon, Dr. Eichenfield added that avoiding these treatment options altogether would not be in the patient’s best interest.
“I still consider topical steroids to be the hammers in my practice,” he said. “But then I have screwdrivers, plyers, and the analogy of our nonsteroids.”
A network meta-analysis of topical anti-inflammatory treatments for eczema was published in the Cochrane Database of Systematic Reviews in 2024,1 but Dr. Eichenfield said that was “limited” because it covered medications studies over decades in differing populations, severities, and variable outcomes measures.
“My assessment is that the paper is not especially helpful,” he said.
Instead, Dr. Eichenfield suggested searching PubMed for the latest research on specific therapeutic treatments for specific conditions.
“They keep coming out and informing us, so there is an incredible database,” he said.
- Lax SJ, et al. Topical anti-inflammatory treatments for eczema: network meta-analysis. Cochrane Database Syst Rev. 2024;8(8):CD015064. doi: 10.1002/14651858.CD015064.pub2.
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