What is Topical Steroid Withdrawal Syndrome and how do I prevent it?Topical steroids are also called topical corticosteroids, glucocorticosteroids, and cortisone. They come in many different preparations including creams, ointments, oils, gels, and lotions. RSS topical steroid cream withdrawal symptoms characterized by red, itchy, burning skin that can appear after ceasing topical steroid treatments, or even between treatments. In RSS, topical steroids are effective for a period of time to treat the skin condition. As time passes, however, applying topical steroids results in less and less clearing. The original problem escalates as it spreads to other areas of the body. RSS is an iatrogenic condition, which means it is a condition caused inadvertently by a medical treatment.
Coping w/ Red Skin Syndrome and Topical Steroid Withdrawal
J Am Acad Dermatol. The following is the NEA Education Announcement on the use of topical corticosteroids based on this publication. Topical corticosteroids, or topical steroids, have been used in treating eczema and atopic dermatitis for more than 50 years and remain among the most effective and widely used drugs in dermatology. They work directly with the natural system in the body to reduce inflammation, and are closely related to corticosteroids made daily by the adrenal glands.
In the United States, topical corticosteroids are classified by potency levels from 1 highest to 7 lowest. Topical steroids are well absorbed through thin skin areas such as face, neck, and groin and more poorly through thick skin such as that found on the hands and feet. Occluding the skin with compresses, wet wraps, or bandages for example, may increase the absorption of topical corticosteroids. Children may be more susceptible to increased topical corticosteroid absorption from equivalent doses due to their larger skin surface-to-body mass ratios.
According to treatment guidelines recently developed in Europe, Asia, and the United States, topical corticosteroid remain the mainstay of treatment for adults and children with atopic dermatitis, even in severe cases in which they may be used in combination with systemic therapies.
Topical corticosteroids are recommended when patients have failed to respond to a consistent eczema skin care regimen, including the regular use of moisturizers emollients , appropriate anti-bacterial measures, and trying to eliminate any possible allergens that may be contributing to the underlying problem.
Your provider should strive to help create a safe and effective long-term treatment plan that does not include daily use of topical corticosteroids, especially on more sensitive areas. Close follow up and careful monitoring with good communication will help ensure this. According to the report, topical corticosteroid withdrawal syndrome generally occurs after inappropriate, prolonged frequent use of high-potency topical corticosteroids. Concern for this side effect should not prevent the appropriate management of patients with chronic inflammatory skin disease.
As with all medications, steroids are associated with some risk. However, the potential benefits with use of topical steroids far outweigh the risks of side effects, including steroid withdrawal syndrome see below , when used appropriately. It can result from prolonged, frequent, and inappropriate use of moderate to high potency topical corticosteroids, especially on the face and genital area, but is not limited to these criteria.
In reviewing the studies that were used for the systematic review, it is thought that adult women who blush easily are a population particularly at risk. Very few cases have been reported in children, but no large-scale studies have attempted to quantify the incidence.
Thus, continued vigilance and adherence to a safe, long-term treatment plan developed in conjunction with your dermatology provider is advised. Burning, stinging, and bright red skin are the typical features of topical steroid overuse and withdrawal.
The signs and symptoms occur within days to weeks after TCS discontinuation. In general, TCS withdrawal can be divided into two distinct subtypes: Clinical features differ between the two types, but there is some overlap of some signs and symptoms. The majority of erythematoedematous type was found in patients with an underlying eczema-like skin condition like atopic or seborrheic dermatitis.
Patients with this type of withdrawal experience swelling, redness, burning, and skin sensitivity usually within weeks of stopping the steroid. The papulopustular variant was more often associated with use of topical corticosteroids for cosmetic purposes or for an acne or acne-like disorder. It can be differentiated from the erythematoedematous type by the presence of papules pimple-like bumps , nodules deeper bumps , pustules, redness, and—less frequently— swelling, burning, and stinging.
Based on systematic review of research to date, both types primarily affect the face of adult females and are mostly associated with inappropriately using mid- to high-potency topical corticosteroids daily for more than 12 months. Consult your healthcare provider. Your doctor will most likely rule out other conditions such as allergic contact dermatitis, a skin infection or, most importantly, a true eczema flare.
Confusing the signs and symptoms of eczema for steroid withdrawal could lead to unnecessary under-treatment of the eczema. Once a diagnosis of steroid addiction or overuse is made, the goal should be to discontinue the inappropriate use of topical steroids and provide supportive care.
Consideration might be given to some of the treatment options discussed in the literature: Natural and alternative treatments can sometimes be used in addition to or rather than conventional treatments. However, they also may have associated risks. Discuss any natural or alternative treatments with your doctor so that, together, you can devise the safest, most effective personalized treatment plan.
For many patients, topical corticosteroids are a safe, very effective therapy for eczema treatment. If TCS therapy is no longer effective for your condition, stopping topical corticosteroids should be done with the knowledge and supervision of a caring physician.
There are many side effects that are reported with the inappropriate use of topical corticosteroids. When used with the proper dosage, frequency, and duration, along with close monitoring by a physician, topical corticosteroids have a very low risk of causing systemic problems or thinning the skin. Embarrassment from eczema can cause social isolation and impacts the daily life activities of childhood such as clothing choices, holidays, interaction with friends, owning pets, swimming, and the ability to play sports or go to school.
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