Possible Treatment of Topical Steroid Withdrawal with Methylene Blue Case Report: Implications for Mitochondrial Pathology.

Introduction: Recent observations have demonstrated that topical steroid withdrawal (TSW) is an induced, but targetable, defect in mitochondrial complex I function that warrants further investigation. Case Presentation: An 8-year-old girl with atopic dermatitis (AD) was treated with topical corticosteroids (TCSs), including high-potency agents. Her initial symptoms were limited to the chest and back. After approximately 3 months of treatment with escalating potency, the perceived lack of TCS efficacy prompted her parents to discontinue TCS while maintaining emollients. Four weeks later, the patient developed new symptoms consistent with TSW involving the face, neck, and legs. The family attempted alternative-medical treatments including turmeric, vitamin D3, and more without clinical response, before observing symptomatic relief with a self-initiated, low dose of methylene blue (MB). Conclusion: Although the merits of the case are anecdotal, existing literature suggests that TSW is associated with mitochondrial complex I dysfunction, which could explain the observed clinical benefit. Given that both TSW and AD have natural temporal variations, we cannot extrapolate conclusively based on a single report. However, at minimum, providers should be aware of the TSW patient community's consideration of MB as an alternative therapy, especially given the lack of data on long-term safety.