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: supportive care including ice and cool compresses, psychological support, systemic doxycycline, tetracycline, or erythromycin, antihistamines, and calcineurin inhibitors.
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.
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However whether this should be tapered or abrupt has not been determined. Japanese reports suggest there is minimal difference in the outcome, so recommend immediate cessation. A tapering course of oral steroids is helpful, as the addiction appears to relate only to the use of topical corticosteroids. Supportive measures such as cold compresses and psychological support are often recommended. Prevention or treatment of secondary infection may require oral antibiotics.
Prevention is best, with patients and doctors being alert to the risk and avoiding prolonged frequent and prolonged use of moderate to high potency topical corticosteroids.
The higher the potency, the longer the period of application ie more than one year , and the more frequent the application more than once daily , the more likely that topical corticosteroid withdrawal may occur. Concerns about the risk of topical corticosteroid withdrawal should not prevent appropriate management of atopic dermatitis with topical corticosteroids, as far more people respond to appropriate topical corticosteroid use than develop a withdrawal rash.
It can take weeks to years to return to its original condition. See smartphone apps to check your skin. DermNet NZ does not provide an online consultation service. If you have any concerns with your skin or its treatment, see a dermatologist for advice. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.
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The best foods to eat for healthy skin. Are you protected against flu? Join the discussion on the forums. There are ways to help prevent it, and to make sure TSW is recognized, respected and treated appropriately. Topical corticosteroids TCS have been used in treating eczema for more than 50 years and remain among the most effective, inexpensive and widely used drugs in dermatology, with no current, affordable alternative offering the same efficacy.
They work directly with the body to reduce inflammation, and are closely related to corticosteroids made daily by the adrenal glands. According to treatment guidelines developed in Europe, Asia and the United States, topical steroids remain the mainstay of treatment for adults and children with eczema, even in severe cases in which they may be used in combination with systemic therapies. Most people with eczema use topical steroids to help manage their symptoms without experiencing adverse events.
But for some, TSW can arise as a complication of topical steroid use, even leading to symptoms significantly worse than their original skin condition. While topical steroids can be effective in improving inflammation in the skin of patients with eczema, research has confirmed the need for avoiding daily long-term use of topical steroids.
For patients needing longer-term management, incorporating non-steroidal therapies and using topical steroids only intermittently such as twice per week , will likely prevent most cases of TSW.
She emphasizes that a basic need remains for the eczema community: to know that TSW exists and is a possibility, to try to prevent it and to know its early warning signs. I had to vacuum his sheets daily. An analysis of numerous medical journal articles and studies related to TSW found that TSW recovery does often take more than three months.
Anecdotally, sufferers sharing experiences online often recount years of struggle. It would be good for some research to be done to show how we can improve the clinical state and the underlying immunologic processes.
But in his own practice, Dr. Lio looks for three major things to distinguish between TSW and severe eczema. While TSW may be more common than we yet know, it seems to be preventable in at least the majority of cases.
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