The Ultimate Guide to Topical Steroid Withdrawal

Topical Steroid Withdrawal

Table of Contents
    Add a header to begin generating the table of contents

    What is Topical Steroid Withdrawal?

    Topical steroid withdrawal (TSW) is a dermatological condition characterized by a constellation of symptoms that arise upon discontinuation of prolonged and potent topical steroid use. While topical steroids are commonly prescribed to manage various inflammatory skin conditions such as eczema, psoriasis, and dermatitis, their extended usage can lead to dependency and subsequent withdrawal reactions upon cessation. TSW manifests with a myriad of distressing symptoms, including severe itching, burning sensation, redness, swelling, and flaking of the skin, often significantly impacting the quality of life of affected individuals. Although the concept of TSW has been recognized for decades, awareness of this condition has increased notably in recent years, prompting further research and advocacy efforts to better understand and address its complexities. As awareness grows, so does the need for accurate diagnosis, appropriate management strategies, and support for those navigating the challenging journey of topical steroid withdrawal.

    Symptoms of Topical Steroid Withdrawal

    • Worsening of rash/dermatitis and increased redness including in areas where topical steroids were never applied
    • Severe burning/stinging sensation of the skin
    • Skin is red, dry and crinkles easily - underlying blood vessels may become visible
    • Skin depigmentation or dark hyperpigmentation.
    • Visible stretch marks on the skin (aka. atrophic striae)
    • Skin swelling
    • Pimple-like bumps (papules), nodules and pustules
    • Extensive wrinkling of skin (premature skin ageing) - “elephant skin”.
    • Loss/thinning of hair and/or loss of eyebrows
    • Cracked skin
    • Frequent skin infections
    • Increased and persistent itch
    • ·“Red sleeve” sign – palms and soles spared
    • ·“Headlight” sign – redness of the lower part of the face but not the nose or the area around the mouth

    Systemic Symptoms of Topical Steroid Withdrawal

    • Sleep disturbances and insomnia
    • Body temperature dysregulation and excessive sweating
    • Depression and anxiety
    • Elevations of IgE levels
    • Th2 dominant immune response
    • HPA Axis suppression & increased susceptibility to stress
    • Lymphadenopathy
    • Zaps of stabbing, squeezing, cold or prickly pain known as zingers
    • Visual changes and light sensitivity
    Woman with red inflamed skin due to topical steroid withdrawal

    What Causes Topical Steroid Withdrawal?

    Topical steroid withdrawal is most commonly caused by prolonged use of moderate to high strength topical corticosteroids. Major risk factors for the development of topical steroid withdrawal include:

    •  Topical corticosteroid use on the face
    • History of atopy/eczema/dermatitis
    • Oral corticosteroid use
    • Female gender (79%)
    • Adults over the age of 18
    • Topical corticosteroid of medium or high potency
    • Topical corticosteroid treatment duration of 6 months or more

    If you suspect that you are experiencing Topical Steroid Withdrawal it's essential to consult a qualified healthcare provider for an accurate diagnosis and personalized treatment plan. They can evaluate your symptoms, medical history, and lifestyle to determine the underlying cause of your dermatitis and recommend appropriate interventions.

    4 Healing Phases of Topical Steroid Withdrawal

    Phase 1: Inflammation

    At the beginning of every flare is inflammation: when the skin appears very red, usually feels warm to touch and is sometimes accompanied with swelling and a general feeling of malaise. If you are beginning withdrawal, this is part of the withdrawal process. If you are experiencing this having already withdrawn for a period of time, it is possible that you are experiencing a flare up from a trigger.

    Phase 2: Oozing, crusting & scab formation

    If you have used Class 3 steroids and above, you are likely to experience oozing.

    Ooze, also called exudate, is made of cellular protein in skin cells. When platelets in the ooze are exposed to air, they begin to break apart and form fibrin, which resembles tiny threads. These threads form a web-like mesh that hardens as it dries, forming crust, a clot or a scab. Crusting and scabbing helps 1) prevent any further bleeding and 2) protects the wound so that new skin can be formed underneath.

    Phase 3: Proliferation

    Proliferation is observed as flaking. Lots and lots of flaking. Unfortunately, the dry and flaky stage of TSW is unavoidable, and in fact very necessary.

    For the skin to heal up and close all wounds, skin flakes are continuously formed in layers to cover the wound. Keratinocytes are migrated to the wound site and begin proliferating to rebuild the base membrane of the skin. Growth factors are secreted to help this process. As more and more layers are formed, the top most layers are pushed to the surface and eventually flake off. The process will continue until all skin cells are completely healthy.

    At a less severe stage, flakes reduce in size and eventually the skin becomes simply rough to touch.

    Phase 4: Remodeling

    Remodelling happens when wounds begin to contract and collagen synthesis happens to strengthen the skin tissue. The skin pulls inwards of wounds, tightening and closing them up. This action can be observed as thin lines along the skins surface around a wound.

    In this stage, the skin is also working on restoring its elasticity via collagen synthesis - collagen type III is being replaced by collagen type I which has a different tensile strength and elasticity. You may see thin lines forming on the skin. This is usually more easily observed at the joint areas e.g. inner elbows, neck, back of knees.

    Phases of Topical Steroid Withdrawal Healing

    Treatments at Connected for Topical Steroid Withdrawal

    website images
    Naturopathic Medicine
    Woman speaking to a female therapist
    Psychotherapy
    Customized Skincare
    Gentle Skincare (Corneotherapy)
    LED Light Therapy
    Red Light Therapy

    Frequently Asked Questions

    Scroll to Top