Understanding Topical Steroid Withdrawal: Symptoms and Treatment

Understanding Topical Steroid Withdrawal: Symptoms and Treatment

Women with topical steroid withdrawal looking in mirror

What is Topical Steroid Withdrawal?

Topical steroid withdrawal (TSW) is a phenomenon that occurs when individuals stop using topical steroid medications after prolonged or excessive use. These medications, also known as corticosteroids, are commonly prescribed to treat a variety of skin conditions, such as eczema, psoriasis, and dermatitis.

TSW is characterized by a range of symptoms that typically occur in the weeks and months following discontinuation of topical steroids. These symptoms can include redness, itching, burning, swelling, and flaking of the skin. In severe cases, individuals may experience widespread and severe rashes that can significantly impact their quality of life.

What Causes Topical Steroid withdrawal?

The exact cause of TSW is not yet fully understood. However, it is believed to be related to the body's natural response to corticosteroids. Prolonged or excessive use of these medications can cause the body to become dependent on them, leading to a range of symptoms when they are discontinued.

What are the symptoms of Topical Steroid Withdrawal?

  • Sleep disturbances and insomnia
  • Body temperature dysregulation and excessive sweating
  • Rebound flares of severe itching, redness, burning and scaling even on areas where the steroid was never applied
  • “Elephant wrinkles” – reduced skin elasticity
  • “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
  • Skin oozing and exudates
  • Depression
  • Elevation in blood nitric oxide levels causing vasodilation
  • Elevations in IgE levels
    • Steroids cause a rise in IgE levels. When used for a long time, the body becomes more reactive to antigens. Although it isn’t clearly understood why, when people go through Topical Steroid Withdrawal, their IgE levels sky-rocket into the tens of thousands.
      • Th1 cells defend against intracellular pathogens such as virus and certain bacteria by directing cell-mediated immunity. A Th1 dominant response is implicated in organ-specific autoimmune disease and some delayed-type hypersensitivity reactions.
      • Th2 cells direct humoral immunity (antibody-mediated) fighting extracellular pathogens, and initiating allergic reactions. A Th2 dominant immune response is associated with allergy and atopic disease and systemic autoimmune disease.
  • Th2-dominant immune response
  • Sensitivity to previously tolerated skincare products
  • HPA Axis
    • Topical steroids suppress the hypothalamic-pituitary-adrenal (HPA) axis (secondary adrenocortical insufficiency)
    • The impact of acute or chronic stress on immune function has been the subject of many scientific studies. Research indicates stress may cause increased susceptibility or progression of allergy / atopy. It is thought that stress hormones promote the dysregulation of cytokine production that is associated with Th2- dominant immune disorders. Adaptogenic herbs such as ginseng, rhodiola and cordyceps may prove helpful in individuals with allergies exacerbated by stress.

What Happens When Topical Steroid withdrawal is not treated or managed?

If topical steroid withdrawal (TSW) is not properly diagnosed and treated, the symptoms can persist for an extended period and may even worsen over time. In severe cases, TSW can lead to infection, permanent scarring, and a significant impact on an individual's quality of life.

Without treatment, individuals may experience intense and persistent itching, which can lead to excoriation (skin damage due to scratching) and increased susceptibility to skin infections. The affected skin may become red, inflamed, and sensitive to the touch. Over time, the skin may become thickened, scaly, and discoloured, and may also develop painful cracks and fissures.

Topical Steroid Withdrawal can also have a significant impact on an individual's mental health and well-being, leading to anxiety, depression, and social isolation due to the visible and often uncomfortable nature of the symptoms.

In summary, if TSW is not treated, it can lead to long-term skin damage, pain, and a negative impact on an individual's mental health and quality of life. Therefore, it is essential to seek medical attention from a qualified healthcare provider like a Naturopathic Doctor or Dermatologist to receive a proper diagnosis and develop an effective treatment plan to manage Topical Steroid Withdrawal symptoms.

How is Topical Steroid Withdrawal Managed?

Topical Steroid Withdrawal can be a challenging condition to manage, and it can take months or even years for symptoms to resolve completely. Treatment options for TSW vary depending on the severity of symptoms, but may include topical and oral medications, as well as lifestyle changes to reduce inflammation and promote healing.

We highly recommend working with a TSW literate Naturopathic Doctor to create a plan that addresses both the associated symptoms and the underlying imbalances experienced in Topical Steroid Withdrawal.

That being said, here are some natural remedies that may help alleviate TSW symptoms:

  1. Moisturizing: Keeping the skin well-hydrated can help reduce itching, redness, and irritation. Use natural, fragrance-free moisturizers like coconut oil, shea butter, or aloe vera gel to soothe and hydrate the affected areas.
  2. Oatmeal baths: Adding colloidal oatmeal to a lukewarm bath can help reduce inflammation, soothe itching, and improve skin barrier function.
  3. Calendula: Calendula has anti-inflammatory and antimicrobial properties, and it may help reduce redness, itching, and swelling. Use calendula cream or apply a calendula-infused oil to the affected area.
  4. Chamomile: Chamomile is known for its soothing properties and can help reduce inflammation and itching. Make a chamomile tea and apply it to the affected area or use chamomile cream or oil.
  5. Diet: A diet rich in anti-inflammatory foods like fruits, vegetables, and omega-3 fatty acids may help reduce inflammation and promote healing.

While these natural remedies may provide some relief for mild symptoms, they should not be used as a substitute for medical treatment. It is essential to seek medical attention from a qualified healthcare professional like a Naturopathic Doctor for proper diagnosis and treatment of Topical Steroid Withdrawal.

Medical Disclaimer:

The information presented in this blog post is for educational purposes and should not be interpreted as medical advice. If you are seeking medical advice, treatment or a diagnosis, consult with a medical professional such as one suggested on this website. Connected Health & Skin Ltd and the author of this page are not liable for the associated risks of using or acting upon the information contained in this article.

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