From the Guidelines
There is currently no established correlation between Nicotinamide adenine dinucleotide (NAD) levels and topical steroid withdrawal (TSW). The scientific literature does not provide sufficient evidence to suggest that NAD supplementation or monitoring would be beneficial for individuals experiencing TSW symptoms 1. Topical steroid withdrawal, also known as red skin syndrome, occurs when someone stops using topical corticosteroids after prolonged use, resulting in symptoms like redness, burning, stinging, and flaking of the skin. While NAD plays important roles in cellular metabolism, energy production, and DNA repair, its specific relationship to the skin inflammation and dysfunction seen in TSW has not been well-studied.
The pathophysiology of TSW is thought to involve rebound vasodilation, immune system dysregulation, and skin barrier dysfunction following steroid discontinuation, rather than NAD depletion. Key risk factors for TSW include prolonged, inappropriate use of potent topical steroids on the face or in intertriginous areas, which would be inadvisable in any case 1. Current management of TSW focuses on supportive care, time for natural skin healing, moisture control, infection prevention, and symptom management. If you're experiencing TSW symptoms, consulting with a dermatologist who understands this condition would be more beneficial than pursuing NAD-focused interventions at this time.
Some key considerations in TSW management include:
- Avoiding further use of topical corticosteroids
- Implementing gentle skin care routines
- Using non-steroidal topical treatments for symptom relief
- Monitoring for potential complications such as infection. Given the lack of evidence linking NAD levels to TSW, the most effective approach to managing TSW symptoms is to follow established dermatological guidelines and consult with a healthcare professional 1.
From the Research
Correlation between NAD and Topical Steroid Withdrawal
- There is no direct evidence in the provided studies to suggest a correlation between Nicotinamide adenine dinucleotide (NAD) levels and topical steroid withdrawal.
- The studies focus on the clinical presentation, risk factors, and management of topical steroid withdrawal syndrome, but do not mention NAD levels as a factor 2, 3, 4, 5, 6.
- Topical steroid withdrawal syndrome is described as a distinct clinical adverse effect of topical corticosteroid misuse, characterized by symptoms such as burning, stinging, erythema, and edema 4.
- The studies highlight the importance of awareness and education among healthcare providers and patients about topical steroid withdrawal syndrome to facilitate prevention, diagnosis, and management 2, 3, 5, 6.
Key Findings on Topical Steroid Withdrawal
- Topical steroid withdrawal syndrome can occur after prolonged use of high-potency topical corticosteroids, particularly on the face and genital area 2, 4.
- The syndrome can be divided into papulopustular and erythematoedematous subtypes, with the latter presenting with more burning and edema 4.
- Patient-reported characteristics of topical steroid withdrawal in atopic dermatitis include erythema, desquamation, dryness, and oozing, as well as pruritus, sleep disturbance, and signs of anxiety and depression 5.
- Recurring episodes of manifestations attributed to topical steroid withdrawal are common, and self-reported manifestations can be similar to those of atopic dermatitis but appear to be distinguishable for patients 5.