A groundbreaking study by researchers at the National Institutes of Health (NIH) has unveiled a critical distinction between dermatitis caused by topical steroid withdrawal (TSW) and eczema. The research highlights that TSW stems from an overabundance of nicotinamide adenine dinucleotide (NAD+), a form of vitamin B3, which is found in elevated levels in individuals experiencing TSW. Scientists from NIH’s National Institute of Allergy and Infectious Diseases (NIAID) have identified potential treatments involving drugs that could reduce NAD+ levels, paving the way for clinical trials. This discovery, published recently in the Journal of Investigative Dermatology, may revolutionize the diagnosis and treatment of this poorly understood condition.

In an effort to gain deeper insights into TSW, researchers conducted a comprehensive evaluation of a prior survey encompassing 1,889 adults exhibiting symptoms resembling eczema. By segmenting participants based on self-reported TSW, they uncovered distinct characteristics unique to this condition. A pilot study involving 16 individuals with TSW symptoms, 10 with eczema but no TSW, and 11 without any skin conditions further corroborated these findings. Elevated NAD+ levels were detected in both blood serum and skin samples of those with TSW, whereas levels remained normal in others.

To explore potential treatment avenues, scientists employed cultured skin cells and a mouse model to simulate TSW-like conditions. Their investigations revealed that NAD+ production was triggered by the use of topical steroids, leading to inflammation. Intriguingly, inhibiting the formation of NAD+ through mitochondrial complex I blockade showed promise in alleviating TSW symptoms. In a subsequent pilot study assessing the efficacy of metformin and berberine—drugs known to block mitochondrial complex I—most participants reported significant improvements in their symptoms after three to five months of treatment.

Beyond identifying effective treatments, the study also established provisional criteria for healthcare providers to diagnose TSW more accurately. These guidelines aim to assist practitioners in distinguishing TSW from eczema, enabling targeted interventions for affected patients. While the findings represent a major step forward, further research is essential to confirm whether all TSW cases involve excess NAD+ and to explore additional defining features of the condition.

This pioneering research not only enhances our understanding of TSW but also opens new doors for developing safe and efficacious treatments. By providing healthcare professionals with clearer diagnostic parameters, the study promises to improve patient outcomes and foster a deeper comprehension of the implications of prolonged topical steroid use.