Topical Steroid Withdrawal Is a Targetable Excess of Mitochondrial NAD+
Clinical Summary
View sourceWhat was studied
A multimodal pilot compared patients meeting a topical steroid withdrawal (TSW) profile (n=16) with atopic dermatitis (n=10) and healthy controls (n=11), using clinical criteria, skin metabolomics/transcriptomics, cellular and mouse models, and an open-label trial of complex I inhibitors (metformin, berberine).
Key findings
Skin omics in TSW implicated neuroinflammatory pathways tied to complex I–mediated oxidation of NAD+, complex I blockade mitigated glucocorticoid-induced metabolic effects in the implicated cell type, and an open-label trial of metformin/berberine was reported as “successful” (no quantitative outcomes provided).
Study limitations
Small pilot cohorts (TSW n=16; comparators n=10 and n=11), an open-label trial without controls and with unreported outcomes in the abstract, and a complex multimodal design that limits generalizability and causal inference.
Clinical implications
TSW appears mechanistically distinct from atopic dermatitis with a complex I/NAD+ signature; any use of metformin or berberine for TSW should be treated as investigational until controlled trials report outcomes.
Related Questions
Explore related topics and deepen your understanding