Topical steroid withdrawal

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC

Topical steroid withdrawal
Synonyms	Red skin syndrome, steroid dermatitis, steroid addiction
Pronounce	N/A
Specialty	Dermatology
Symptoms	Redness, burning sensation, itching, peeling skin, swelling
Complications	N/A
Onset	After discontinuation of topical corticosteroids
Duration	Weeks to months
Types	N/A
Causes	Prolonged use of topical corticosteroids
Risks	Long-term use of potent topical steroids, sudden cessation
Diagnosis	Clinical evaluation, history of steroid use
Differential diagnosis	Atopic dermatitis, contact dermatitis, psoriasis
Prevention	N/A
Treatment	Supportive care, moisturizers, antihistamines, pain management
Medication	N/A
Prognosis	Generally good with time, but can be prolonged
Frequency	Unknown, but considered rare
Deaths	N/A

Red (burning) Skin Syndrome - Typical Pattern of Lower Arms & Hands

Topical steroid withdrawal (TSW), also known as red skin syndrome or steroid dermatitis is a condition that can occur after the discontinuation of topical corticosteroids. These medications are commonly used to treat eczema and other inflammatory skin conditions. TSW is characterized by a range of symptoms including redness, burning, and peeling of the skin.

Symptoms

The symptoms of topical steroid withdrawal can vary but often include:

• Intense erythema (redness)
• Burning or stinging sensation
• Peeling or shedding of the skin
• Swelling
• Itching
• Oozing or crusting

These symptoms typically appear days to weeks after stopping the use of topical steroids and can last for weeks to months.

Causes

Topical steroid withdrawal occurs when the skin becomes dependent on corticosteroids. Prolonged use of these medications can lead to tachyphylaxis, where the skin becomes less responsive to the treatment, requiring higher doses for the same effect. When the steroids are stopped, the skin can react with a rebound effect, leading to the symptoms of TSW.

Diagnosis

Diagnosis of TSW is primarily clinical, based on the history of topical steroid use and the appearance of symptoms after discontinuation. There are no specific tests for TSW, but a dermatologist may rule out other conditions that could cause similar symptoms.

Treatment

The primary treatment for TSW is the cessation of topical steroids. Supportive care may include:

• Moisturizers to soothe the skin
• Cool compresses to reduce burning
• Antihistamines to control itching
• Pain relief medications

In some cases, systemic treatments such as immunosuppressants may be considered.

Prognosis

The prognosis for individuals with TSW varies. While the condition can be distressing and uncomfortable, most people eventually recover with time. The duration of symptoms can range from a few months to over a year, depending on the severity of the withdrawal and the duration of prior steroid use.

See also

• Eczema
• Corticosteroid
• Dermatitis