Topical Steroid Withdrawal

What is topical steroid withdrawal?

Topical steroid withdrawal is a skin condition that can develop when someone uses potent topical steroids frequently and for a long time. The condition can manifest within days to weeks after you stop using topical steroids, or it can manifest as a worsening rash that requires stronger and more frequent application of topical steroids to control.

One of two main types of rashes may develop with topical steroid withdrawal at the sites of application. One type is red, swollen, scaly and peeling, and the other is defined by red, pus-filled bumps without scaling or peeling. The skin may also be burning, stinging, or itchy, and you may experience facial hot flashes.

Treatments include discontinuing the troublesome medication as well as methods to soothe associated symptoms.

You should go see your primary care doctor to talk about stopping use of the steroid. Your doctor may prescribe a medication like antibiotics, antihistamines, or cool compresses to help heal along with testing the skin with what's called "patch testing."

Topical steroid withdrawal symptoms

Topical steroid withdrawal symptoms usually develop within days to weeks after stopping a topical steroid medication. In general, people who develop topical steroid withdrawal can develop one of two main types of rashes: erythematoedematous ("red and swollen") and papulopustular ("bumpy"). The rashes are usually limited to the areas of skin where topical steroids were applied, and more often affect the face or genital areas because of the thinner skin in these areas.

These two types of rashes, as well as other symptoms seen in topical steroid withdrawal, are described below.

Erythematoedematous rash

People with topical steroid withdrawal who develop the erythematoedematous form of rash will experience the following. This type of rash is seen more commonly in people who used the topical steroid for an underlying skin condition such as atopic dermatitis (eczema) or seborrheic dermatitis.

• Redness and swelling of the skin: This will be at the site of topical steroid application.
• Skin that is scaly or peeling
• Red bumps may or may not be present
• Defined rash border: In some people who develop this type of rash on the face, there may be a sharp cutoff between the red and normal-appearing parts of the skin, with sparing of the nose and ears.

Topical steroid withdrawal causes

Topical steroid withdrawal usually occurs in adults older than 18 years old and has been reported more frequently in women. Most people who use topical steroids as directed do not get topical steroid withdrawal. Risk factors for developing topical steroid withdrawal include using mid- or high-potency steroids, using topical steroids more frequently or for a longer duration than recommended and using topical steroids on the face or groin region.

Using mid- or high-potency topical steroids

Most cases of topical steroid withdrawal have been described in people who use mid- or high-potency topical steroids. Topical steroids can be more potent due to the specific steroid in the medication, the concentration of steroid in the medication, and/or the formulation of the medication. For example, creams and ointments tend to be stronger than lotions and solutions. Examples of mid- and high-potency topical steroids include triamcinolone 0.1 to 0.5% cream or ointment (Kenalog), mometasone 0.1% cream or ointment (Elocon), fluocinonide 0.05% cream or ointment (Lidex), desoximetasone 0.25% cream or ointment (Topicort), or clobetasol 0.05% cream or ointment (Temovate), among others.

Using topical steroids more frequently or for a longer duration than recommended

This may cause topical steroid withdrawal. High-potency topical steroids are typically not to be used more than once daily, and for no longer than three weeks at a time. In some cases, your physician may recommend using a mid- or high-potency topical steroid intermittently, such as twice a week as maintenance therapy. In addition, most physicians will recommend tapering the topical steroid once the skin condition has resolved. Most people who develop topical steroid withdrawal use topical steroids daily and for more than 12 months.

Using topical steroids on the face or groin regions

Using topical steroids on the face or groin regions increases the risk of developing topical steroid withdrawal. This is because the skin on the face and groin regions is thinner and absorbs topical steroids more easily, predisposing the individual to develop topical steroid withdrawal in those areas.

Treatment options and prevention

Treatment for topical steroid withdrawal involves discontinuing the use of topical steroid medications and managing the symptoms of the withdrawal. Specific treatment options include:

Discontinue the use of topical steroid medications

In most cases of topical steroid withdrawal, the first step in treatment is to discontinue the use of topical steroid medications. Some physicians may recommend tapering the topical steroid slowly, due to concern that stopping the topical steroid suddenly may worsen the withdrawal symptoms. However, other physicians may recommend stopping the topical steroid suddenly once withdrawal symptoms develop since some studies show no difference between stopping suddenly and stopping gradually.

Apply ice or cool compresses

Some physicians may recommend applying ice or cool compresses to the skin to alleviate stinging, burning, or itching.

When to seek further consultation

If you develop any symptoms of topical steroid withdrawal after using topical steroids, you should see your physician. He or she can determine if your symptoms such as skin redness, swelling, burning, or itching, are in fact due to topical steroid withdrawal.