Brad Glick, DO, MPH

Is TSW Becoming More Accepted in Dermatology? With Brad P. Glick, DO, MPH

Topical steroid withdrawal (TSW) syndrome is considered by some to be a controversial topic in the 

 world today, but it is becoming more widely discussed among clinicians and patients.

Brad Glick, DO, MPH, a board-certified dermatologist and dermatologic surgeon known for his role at the Glick Skin Institute, spoke with the 

2026 American Academy of Dermatology (AAD) Annual Meeting

 in Denver, Colorado, about this topic and others covered in his session at the conference. He was first asked whether TSW is becoming more accepted as a real condition in the dermatology space.

“[Just] ask the country of Canada…and Great Britain, where there are now specific warnings and package inserts for topical corticosteroids, about TSW,” Glick expressed.

He addressed the growing recognition of TSW, describing the condition as increasingly supported by emerging research and international regulatory acknowledgment around the world. Glick added, despite some remaining skepticism within the dermatology community, that mounting data and patient presentations are contributing to TSW’s broader acceptance as a real condition.

From a clinical standpoint, he described several characteristic features to aid clinicians in their identification of TSW. Such characteristics include diffuse erythema, especially involving the face, as well as more distinctive findings such as the “sleeve sign.” This sign is marked by the sharp demarcation of erythema located on patients’ wrists or ankles, as well as erythema of the lower extremities.

Glick further referenced recent mechanistic insights suggesting a potential role for metabolic pathways, including NADH-related processes, in driving rebound inflammation following chronic or moderate topical corticosteroid use, potentially helping to clarify the pathophysiology underlying TSW.

Additionally, he pointed to the role of patient awareness and social media in amplifying recognition of TSW. Specifically, Glick described a marked increase in inquiries among patients following educational presentations on the subject. Despite acknowledgement of online discourse sometimes overstating various concerns, he emphasized that clinicians are encountering individuals with symptoms aligned with TSW in clinical practice.

 with a broader perspective on therapeutic innovations in dermatology in 2026. Glick pointed to the expansion of non-steroidal topical agents’ availabilities as a notable advancement, adding that such shifts may help patients’ disease control and may diminish their reliance on intermittent corticosteroid use. Later, Glick noted the sustained impact of biologic drugs in the current armamentarium, particularly in psoriasis and atopic dermatitis.

Looking ahead, Glick expressed optimism regarding the development of novel oral medications, and this was described by Glick as especially true for psoriasis. Such developments may complement existing biologic and topical options for patients with dermatologic diseases. Nevertheless, the critical barrier of access was cited by Glick as remaining, with prior authorization requirements being described as a persistent obstacle.

The quotes used in this interview summary were edited for clarity.

Glick has served as an adviser, consultant, speaker, or investigator for Amgen, AbbVie, AstraZeneca, Almirall, Arcutis, Bausch Health/Valeant, Ortho Dermatologics, Boehringer Ingelheim, Bristol-Myers Squibb, Brickell Biotech, Cara, ChemoCentryx, Dermavant, Dermira, Eli Lilly, EPI/Novan, Incyte, Janssen Pharmaceuticals, LEO Pharma, Galderma, Nimbus Lakshmi, Inc, Novartis, Sun Pharma, Pfizer, Sanofi, Regeneron, UCB and the CorEvitas AD, CorEvitas PSO, and PROSE Registries and is a shareholder of Top MD

Lio P. Addressing Doubts About Topical Steroid Withdrawal (TSW), with Peter Lio, MD. HCPLive. June 10, 2025. Accessed December 12, 2025. 

https://www.hcplive.com/view/addressing-doubts-about-topical-steroid-withdrawal-tsw-peter-lio-md

Glick B, et al. S065 What's New in Dermatology. Session presented at: 2026 American Academy of Dermatology Annual Meeting; March 27–31, 2026; Denver, CO.

Videos

In this interview from AAD 2026, Glick speaks about key insights on topical steroid withdrawal (TSW) and on the future of dermatology.

Credit: Skin and Cancer Associates and The Center for Cosmetic Enhancement

Advances in topical dermatologic medications are quickly reshaping how clinicians manage chronic inflammatory skin diseases, providing them with new options designed to extend beyond the long-standing reliance on corticosteroids.

In a new interview, Brad Glick, DO, MPH, a board-certified dermatologist and the director of the dermatology residency training program at the Larkin Health System Palm Springs campus in Florida, reflected on this topic in light of data he presented in his recent presentation at the 

American Academy of Dermatology (AAD) Annual Meeting

In this session and in his subsequent Q&A interview with 

’s editorial team, Glick highlighted emerging nonsteroidal therapies and their growing role in clinical practice:

What were some of the topical therapies you elected to discuss in this talk, titled ‘What’s New in Dermatology’?

First of all, it's such an honor to be able to be at the podium at the Academy, and I've had that opportunity the last few years to do so. But one of my favorite sessions at virtually the end of the meeting is this. When my colleague, Dr. Mark Lebwohl, invited me last year to be at the podium to do this very same topic. One of the things he told me was to make sure everything is pretty brand spanking new. So I tried to do that. What did I talk about?...I spoke on steroidal topical therapies, which are really in Vogue now. We still need our topical corticosteroids, but we can use them more effectively, even more now than we did before.

Now we have three topical non steroidal therapies, roflumilast, ruxolitinib, and tapinarof, which was the first one to be approved down to the age of 2 for treating our kiddos with atopic dermatitis. Roflumilast has multiple indications: psoriasis, seborrheic dermatitis, atopic dermatitis. And we have things in our toolbox now that we can use for our recommendations for our patients once or twice a day where they don't have what I like to call that ‘saw-tooth’ pattern that we get with corticosteroids. Someone has a bad rash, we still prescribe topical corticosteroids, but for something that is chronic, what is the solution for them?

When we tell them, ‘Okay, use it for 2 or 3 weeks and then take a break,’ we have to have some substantive substitute for that particular product so that they can continue with their therapy. Otherwise, we run into what I talked about in my lecture, which was not only the common side effects that we're concerned about with the chronic use of topical corticosteroids…and not just atrophy of the skin and broken blood vessels, telangiectasias, and maybe steroid acne and steroid rosacea, particularly when topical steroids are used in the face, but what has become a topic of significant discussion. There've been multiple articles published in this last year…steroid withdrawal syndrome. We have hundreds of thousands of patients that have been using topical steroids for many years, some of them for reasonably moderate periods of time, but many of them have this phenomenon over longer periods of time because that's what they were given, or that's what they found successful, transiently.

But [for some] it then seems to backfire, where they get this rebound type of change, worsening of their rash and profound involvement of their face. It may not always be where the corticosteroid is being utilized. So all that told we've had this need for topical, non-steroidals and I talked a lot about newer ones like delgocitinib, which was recently approved for chronic hand eczema. It will have some other uses. I talk a lot about off-label uses of all of these new non-steroidals, so whether it's tapinarof for things like seborrheic dermatitis, there is some data around that for vitiligo that's in progress.

JAK inhibitors [too] are becoming like the Windex of dermatology. We can use them for almost anything right now, although there are obviously FDA-approved indications, such as those for ruxolitinib 1.5% cream for atopic dermatitis down to the age of two, and also for adolescents and adults for non-segmental vitiligo. But there are off-label uses for these therapeutics as well. Palmoplantar postulosis is being studied with a number of these topical non-steroidals.

The punchline is, for our cutaneous, inflammatory, immune-mediated diseases, we now can shift our therapy to more long-term solutions, because patients can use these therapies for longer periods of time compared to, for instance, higher potency corticosteroids. Hopefully, that was an exciting part of my talk. But there are new things that are coming as well, that are exciting for disease states that have been very difficult to treat. Let's talk about one of them, frontal fibrosing alopecia. We've largely used hydroxychloroquine orally and intralesional corticosteroids, but now we may be able to use some of these topical, for instance, Janus kinase inhibitors, to treat that condition. We also have some therapies that may be coming for treatment.

In certain conditions, like cutaneous T-cell lymphoma, and from a topical perspective, we have a certain topical like hypericin gel, which may be beneficial in combination with photodynamic therapy, meaning we use a light source to allow this particular substance, which appears to work just about as well as one of our topical nitrogen mustards. And then this is a fairly uncommon condition, CTCL, cutaneous T cell lymphoma. Nevertheless, the toolbox is not there and is very full. We'll mostly use phototherapy and topical corticosteroids. And of course, for advanced disease, we've had to either use topical retinoids in combination with phototherapy or even systemic retinoids. And so this is a unique and novel agent that's still under study.

Its mechanism of action is to downregulate a lot of these inflammatory changes that are leading to the chronic inflammatory change that we see in CTCL, which leads to the development of these atypical lymphocytes that we see in this particular condition. So stay tuned on that. But hyperson gel, in combination with photodynamic therapy, a light source used with this agent, may have some benefit in the treatment of CTCL, so that's particularly exciting. And actually, there's some thought that maybe even some of the topical Janice kinase inhibitors that I talked about may play some role in the treatment of CTCL, albeit a little bit controversial, and we have to stay tuned there.

Would you go a bit more in depth about JAK inhibitors covered in your talk? Do you feel clinicians are more open to their use now that some of the JAK safety data has been cleared up?

Let's answer question number one first. There's really three reasonable, reasonably accessible topical Janus kinase inhibitors. So let's start with topicals first, and then I'll answer part, part two of the question second, because your question involves the orals and the topicals, which is pertinent. There are 3 topical therapies. Two of them are FDA approved, one that we can get from compounding pharmacies that are primarily used. There are others that are on the horizon. I gave a talk about some of them, providing a list. I mentioned the pan-JAK inhibitor in delgocitinib. It's a pan-JAK inhibitor that's approved for chronic hand eczema first and only, currently approved for adults only. But I can tell you, there was the DELTA-TEEN study that was done. I did talk about it in one slide in my talk…We saw treatment success versus vehicle in the clinical trials for chronic hand eczema, and hopefully it will be approved soon down to the age of 12. That's one to highlight.

The second one, which is the originator topical JAK that was first approved for atopic dermatitis, now approved down to the age of 2, is ruxolitinib 1.5% cream. Use it twice daily. That's also one to highlight, highly effective in the treatment of atopic dermatitis in that age spectrum of 2 years and above. And then finally, for topical tofacitinib…[It] has been evaluated topically for the treatment of various forms of alopecia, including alopecia area and frontal fibrosine alopecia. Our audience will know that the initial discovery for the benefits of JAK inhibitor started with oral tofacitinib, and so many of us have used it for many years in a variety of different settings.

…Question two was that you asked about the risk adverse nature of some of our colleagues where JAK inhibitors are concerned, because the systemic agents of which there are now 3 that are approved for alopecia areata in baricitinib, ritlecitinib, and now deuruxolitinib, and then also our originator products in baricitinib for alopecia areata, but also upadacitinib for atopic dermatitis down to the age of 12, of getting those approvals correctly. Abrocitinib is also approved for adolescents. These are unique therapies, but all of them, and including one of the topical therapies, which is ruxolitinib cream…The point is that I think with more use, yes, we're starting to see a steady uptake of the use of the orals and certainly the topicals. I think that our expert dermatology colleagues feel quite comfortable that these topical therapies, unless someone is swimming in it and using all over their body, 100%.

The quotes used in this Q&A interview summary were edited for clarity.

Glick B, et al. S065 What's New in Dermatology. Session presented at: 2026 American Academy of Dermatology Annual Meeting; March 27–31, 2026; Denver, CO.


Articles

Topical dermatologic management is shifting toward steroid-sparing, longer-horizon strategies for chronic inflammatory disease control. Newer nonsteroidals—roflumilast, ruxolitinib cream, tapinarof, and emerging agents like delgocitinib—aim to reduce reliance on intermittent corticosteroid cycles and mitigate risks such as atrophy, telangiectasias, acne/rosacea, and topical steroid withdrawal. Topical JAK inhibition is expanding across approved indications and off-label exploration, with increasing clinician comfort as safety understanding matures. Pipeline approaches also include novel topical options for difficult diseases, including CTCL.

This Q&A interview from AAD 2026 covers a number of notable tips for clinicians in dermatology regarding topical therapies.

What's New in Topical Dermatology Drugs, With Brad Glick, DO, MPH

The number of innovative approaches to an array of both common and uncommon dermatologic diseases has grown in recent years, and many dermatologists have sought to share clinical pearls related to these approaches with other clinicians in the field.

 in Denver, a session on these topics titled ‘Pearls: Diagnostic and Therapeutic’ was given by several notable speakers, 1 of whom was Brad P. Glick, DO, MPH, a board-certified dermatologist and the director of the dermatology residency training program at the Larkin Health System Palm Springs campus in Florida.

 editorial team about his portion of this session, describing several key insights on treating conditions appearing on patients’ nails, designed to help dermatology clinicians:

 Your portion of this session on diagnostic and therapeutic pearls covers nail disease within dermatology. Why did you feel the topic was important to pursue?

In our training in dermatology, I think one of the areas that doesn't necessarily get a ton of attention. While I didn't necessarily talk about a particular publication, because there are publications on this topic, I don't think nails get a lot of attention on our training. [This is] because there's just so much else going on. We have to learn about the basement membrane zone, then we apply that clinically to blistering diseases and immune mediated skin diseases. So we learn about how it treats psoriasis and eczema and lichen planus and this multitude of over 3000 diseases that we take care of in dermatology that I think probably the nails get a little neglected.

Deborah Lin, who is a resident University of Miami under the tutelage of Dr. Brian Morris, and her residency program director, a couple of years ago, published a really nice paper just vetting this, [noting] that even in programs where they have nail knowledge…our dermatology residents coming out of training and, if there's an area where they maybe feel a little bit uncomfortable, it's with nails. [This is] not only with assessment, but also with just how to do a biopsy, where to look, how to assess. So I think that was one of the main reasons why I like to provide tips.

Most of my tips are literature based, whether this relates to various topics like, let's say, the impact of biologic therapies and systemic therapies on nail diseases, whether it relates to the technique of doing an intra-lesional injection, and what that actually means. Where you're doing the injection depends largely on how you assess the nail. So those were the primary reasons, because I think we need more in our residency training programs.

Would you highlight some of the biggest takeaways that you mentioned within the session?

I think that one of the things that I talked about was the use of systemic small molecules and biologic therapies in the treatment of psoriatic disease, specifically psoriasis. You know, one of the things I highlighted is that when we're evaluating patients who have psoriatic disease, we really need to look at, first and foremost, as confirmed by some of the recent international psoriasis Council and AAD guidelines, high impact areas. The nails are critically important. So I think, as I tell my residents, if someone's there for psoriasis and their shoes and socks are still on, they need to take them off. They always need to look at all 20 nail units, because patients with nail psoriasis are three to four times more likely to develop psoriatic arthritis compared to those that really don't have nail changes associated with their psoriasis. 

I think that's important, because in addition to seeing that, we also need to be screening our patients for psoriatic arthritis. Of course, we do a test called the PEST test, which is the psoriasis epidemiology screening tool, and it's all intertwined. One of the things I talked about is not only assessing the nails in the setting of an immune mediated skin disease like psoriasis…but also, there is significant impact by a number of our biologic therapies on psoriatic nail disease. So I think a we need to hone in on that assess accordingly, not just look at it from the standpoint of making the nails look or feel better, because a lot of times we don't ask, and a lot of our patients with nail changes in psoriatic disease.

They're uncomfortable, they have mechanical issues. It impacts their quality of life, but moreover, they may be one of those 30% of individuals who actually may either have or move on to develop psoriatic arthritis. I think rapid assessment is important, and realizing that we have specific biologic therapies that hadn't been studied directly for nail diseases, including tumor necrosis factor inhibitors, which are older therapies now they're mostly biosimilars…There are other post hoc analyses from our more modern day IL-17 and IL-23 inhibitors that demonstrate not only improvement in nail disease, but perhaps we are either pre-treating or treating their active psoriatic arthritis. That was really one very important area of discussion that I discussed in my my presentations on nail tips and tricks.

One of the things I also did for the audience was spend maybe 15 of my 30 minutes just going over nail terminology and different nail findings, because they are either common signs of normal health or aging, or they may be visible markers for systemic disease. I talked a lot about nail signs in general, not specific references to literature, although I did that in my remaining time, because there are some key journal articles that have been published just in the last year that I think are critical for us in our assessments for patients with nail diseases. I did talk a lot about nail terminology and nail signs of systemic disease. One other thing that I also talked about that I thought was important, because there are some new, if you will, data or information on how we assess certain nail signs of systemic disease, and one of them is the yellow nail syndrome.

Yellow nail syndrome is not particularly common, but on the other hand, it is a potential skin sign of systemic disease, where all 20 nails take on a yellow or sometimes a yellowish green color. And one of the hallmarks the presentation of patients who have yellow nail syndrome are complete absence of their cuticles. It's very, very unique presentation. And there's a wide differential diagnosis. It can look like fungus…But what's important about this particular condition is that it involves all 20 nails. Typically, the patients will present with a yellow discoloration, or yellow green discoloration of their nails. It's important to recognize this because it may be a nail sign of systemic problem, like cardiovascular disease, pulmonary disease, and more important malignancies such as bronchogenic carcinoma.

Glick had no relevant disclosures to highlight for this session.

Glick B, et al. S005 Pearls: Diagnostic and Therapeutic. Session presented at: 2026 American Academy of Dermatology Annual Meeting; March 27–31, 2026; Denver, CO.

Lee DK, Lipner SR. Optimal diagnosis and management of common nail disorders. Ann Med. 2022 Dec;54(1):694-712. doi: 10.1080/07853890.2022.2044511. PMID: 35238267; PMCID: PMC8896184.

Nail pathology remains underemphasized in dermatology training despite its diagnostic value and procedural complexity. Focused assessment of all 20 nail units is essential in psoriasis, given nail involvement’s association with increased psoriatic arthritis risk and meaningful quality-of-life impairment. Contemporary systemic agents, including IL-17 and IL-23 inhibitors, show post hoc benefits for nail disease and may address concomitant joint activity. Standardized nail terminology and pattern recognition can distinguish aging-related changes from systemic markers. Yellow nail syndrome, characterized by diffuse discoloration and absent cuticles, warrants evaluation for cardiopulmonary disease and malignancy.

This Q&A interview at AAD 2026 highlights a number of notable tips for clinicians in dermatology from the ‘Pearls: Diagnostic and Therapeutic’ talk.

Key Diagnostic and Therapeutic Pearls in Dermatology, With Brad P. Glick, DO, MPH

2025 Revolutionizing Atopic Dermatitis (RAD) Conference

 in Nashville, Tennessee, Brad Glick, DO, MPH, spoke in a Q&A interview with the 

 editorial team about his conference talk titled ‘Understanding Topical Steroid Withdrawal (TSW) in Patients with Atopic Dermatitis (AD) - Spotlight Symposium.’

Glick, who is known for his role as a board-certified dermatologist and as the director of the dermatology residency training program at the Larkin Health System Palm Springs campus in Florida, touched on several important comments about topical steroid withdrawal, also known as TSW. The following is a description of his discussion:

Would you share some of the specifics of your topical steroid withdrawal presentation?

 Let's talk about topical steroid withdrawal syndrome. First of all, what is it? Well, it's a profound inflammatory process affecting the skin that appears to happen about 2 to 4 weeks after somewhat chronic use of topical corticosteroids. That's the typical patient, but we've seen it happen in shorter periods of time. The patients can present with widespread, patchy redness, sometimes full redness.

But there are also some characteristic signs of the condition, such as what we call elephant tight skin, which we'll see on the lower parts of the thighs or near the knees, or just below the knees. The skin is very crinkly, much like elephant skin, and it's associated with some pretty significant redness. The hallmark sign is called the red sleeve sign. You know, many of our colleagues may not see this or know this, because there's no specific diagnostic criterion for TSW.

The red sleeve sign is basically redness that occurs most commonly on an upper extremity, but it can be the lower extremity, and there is a distinct sharp cut off right at that wrist area, or the ankle area, which is where it gets its name, the ‘sleeve sign,’ or the so called ‘red sleeve sign.’ So those are some of the characteristics of TSW.

What are some of the most important takeaways from your session regarding TSW that you hope attendees walk away with a greater awareness of?

I think it's really important, topical steroid withdrawal or ‘Red Skin Syndrome.’ There are different names for it, but I think we need to be on the lookout for it. As my colleague Peter Lio always says, it's sometimes very difficult to differentiate it from a really bad flare of atopic dermatitis, but you have to take a step back. You have to get a really good history. You have to talk about whether patients are following the instructions with the use of topical corticosteroids, because that's one of our biggest problems.

You know, we call this steroidophobia, or steroid-phobia, where sometimes we have created the scenario, as those who are providing the medication for the patient, where we urge not to overuse it. Sometimes patients may use it too little, but in this case, the patients are typically pushing through and using steroids rather chronically. Sometimes it's because in the past, that's all we had in our toolbox, of course.

Now, one of the solutions to this problem, once we recognize it, is to take advantage and utilize some of these newer, non-steroidal therapies that we have now. Actually, some of these great systemic agents that we have to treat conditions like atopic dermatitis, biologic agents like dupilumab, nemolizumab, tralokinumab, lebrikizumab, and the 2 JAK inhibitors, abrocitinib and upadacitinib. What we think, because there's no specific criteria for TSW, is that patients should respond quite well to this so-called cytokine storm that we see in these patients.

Outside of atopic dermatitis, what other therapeutic research are you looking forward to in other areas of dermatology?

 I mean, the sky's the limit. I think right now, the hot button for me is more and more therapies for hidradenitis suppurativa. I think that we've got psoriasis down pretty well…And that's probably true because we have such effective therapies. I think we've seen a very nice wave for atopic dermatitis as well, in both systemic therapies and topical therapies. But I think for HS, it is very underdiagnosed, and there are patients floating out there who are still not receiving the care that they should be. But the tide is turning. We've got new therapeutics in the toolbox. We've got a lot of research going on, so I'm excited in that particular area

What would you say is the value of RAD as a disease-specific meeting?

 Atopic dermatitis, up to about 7 or 8 years ago, was a disease for which we had not much. Now we do. But now that we have tools in the toolbox, we have to be able to convey those very critical messages about not even so much, how we carefully diagnose a condition like atopic dermatitis, which I think for dermatologists and our advanced practitioner dermatology colleagues, we've got that down. But now, [we have to focus on] how do we use these therapeutics and which therapies for which patients.

I think a meeting like RAD, focusing on atopic dermatitis and related disease states, is critical for all of our understanding, not only of how patients present clinically, but how we hone in on the proper therapeutic interventions for people who are suffering with this condition.

For any additional information on TSW and related topics in the atopic dermatitis space, view the 

latest coverage of the RAD 2025 conference

The quotes used in this summary article were edited for clarity.

Topical steroid withdrawal (TSW) is a significant inflammatory skin condition occurring after chronic use of topical corticosteroids, characterized by symptoms like the "red sleeve sign." Differentiating TSW from severe atopic dermatitis flares requires thorough patient history and understanding of corticosteroid use. The emergence of non-steroidal therapies, including biologics and JAK inhibitors, offers promising treatment alternatives. The RAD conference emphasizes the importance of understanding and utilizing new therapeutic options for atopic dermatitis and related conditions, highlighting ongoing research in areas like hidradenitis suppurativa.

In this Q&A discussion, Glick highlights several important points about topical steroid withdrawal and atopic dermatitis.