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

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 ( 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.