What is Topical Steroid Withdrawal?
Key takeaways:
Topical steroid withdrawal (TSW) is a rare condition that can develop after you stop using a topical steroid medication.
Treatment for TSW is different for everyone. And if you develop it, there’s no specific timeline for how long symptoms are expected to last.
If you’re using a topical steroid medication, speak with your healthcare provider about how to safely stop using it. They may recommend slowly stopping it over time, especially if you’ve been using it consistently for a while.
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Have you ever applied a cream or ointment to your skin to treat a rash, or perhaps even a skin condition like eczema? If you’ve used a steroid cream or ointment and developed a painful rash after stopping it, you’re not alone.
This reaction to topical steroid medications isn’t common. But when it happens, it can be a painful experience. It’s called topical steroid withdrawal (TSW). This is also called red skin syndrome.
TSW is a reaction that can happen when your body is used to receiving a steroid medication, but it’s suddenly stopped. This can result in a cluster of painful symptoms. And in some cases, it can cause difficulty moving around due to having especially sensitive skin.
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Below, we’ll talk about TSW — what causes it, how to treat it, and how to avoid it in the future.
What are topical steroids?
Topical corticosteroids (steroids) are medications that treat many skin conditions. They can help with more minor skin conditions, such as mild, itchy rashes. But they’re also often used to treat chronic skin conditions, such as eczema, contact dermatitis, and psoriasis. They can lower redness, swelling, and pain caused by these conditions.
Most people use topical steroids for about 1 to 2 weeks for minor or temporary skin conditions. But if you have a chronic skin condition, you may be told to use them for longer periods of time.
What topical steroid medications are commonly available?
Several topical steroids are available at different strengths. As a result, some are available over-the-counter (OTC), and others are only available with a prescription. While this is not a complete list, some of the more common topical steroids available include:
Topical steroids also come in various forms, which include:
Creams
Lotions
Ointments
Gels
Mousses
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What is topical steroid withdrawal?
TSW is a reaction that can happen after you stop using a topical steroid medication. It can also happen when you’re switching from one steroid medication to another.
But why does it happen? Your skin can learn to depend on a topical steroid. When you try to stop using it, your skin can become irritated because it doesn’t have access to the medication. These reactions can pop up days or weeks after you stop applying it to your skin.
Thankfully, it’s very rare. And you don’t need to be too concerned about it if you’re only using a topical steroid off-and-on or for a short period of time. It’s more likely to happen if you’ve used a topical steroid consistently for a few months or more.
What are the symptoms of topical steroid withdrawal?
Specific symptoms vary for everyone, but people tend to get many at the same time. The most common symptoms are inflammation (swelling), irritation, and skin rashes after you stop using the medication.
The symptoms can appear on your arms, torso, or below the waist. There are also situations where severe cases appear on the face. Other symptoms may include:
Skin redness on your arms and legs
Itchy skin
Burning skin
Swelling of skin
Flaking of skin
Sensitivity to water, clothing, movement, and temperature
Feeling tired
Insomnia
How is topical steroid withdrawal treated?
Treatment for TSW will vary depending on how severe your symptoms are. A healthcare provider can choose a treatment option for you that depends on your medication, medical history, and other case-by-case factors. The goal of treatment is to have a quick recovery from TSW symptoms.
Again, this is a rare condition. There’s no widely accepted treatment guideline for it. But the following treatment options may be considered by your healthcare provider:
Restarting the medication that you were taking, but then slowly tapering off
Using dupilumab (Dupixent) injections, which is a medication that treats several hard-to-treat skin conditions
Using cold compresses
Using skin moisturizers
How long does topical steroid withdrawal last?
Unfortunately, there's no set time frame for how long symptoms last. Some people only have symptoms for a few weeks, and others can have them for years.
The condition often resolves on its own, but the sooner treatment is started, the quicker the symptoms will go away. Your healthcare provider can tell you more about how long your symptoms might last for.
When the time comes, how can I stop using topical steroid medication safely?
To avoid TSW, it’s recommended to taper off your medication. Tapering means slowly stopping the use of the medication over time. You should avoid abruptly stopping the medication.
There are multiple ways to taper off a medication. Your healthcare provider will guide you on how to do so. For instance, they may lower your dose, reduce how often you’re using the medication, or both.
The bottom line
In rare cases, topical steroids can put you at risk of developing TSW. It’s a rare side effect of using topical steroids, but it can also be a serious side effect that needs immediate treatment. There are various ways that a healthcare provider can treat symptoms of TSW, but each person will be treated based on their specific needs.
If you think you’re experiencing TSW, talk to your healthcare provider. They can guide you on proper medication use and how to treat your symptoms.
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References
Ballard, A. (2021). TSW: What the eczema community needs to know, now. National Eczema Association.
Eichenfield, L. F., et al. (2014). Guidelines of care for the management of atopic dermatitis: Section 2. Management and treatment of atopic dermatitis with topical therapies. Journal of the American Academy of Dermatology.
Fukaya, M., et al. (2014). Topical steroid addiction in atopic dermatitis. Drug, Healthcare and Patient Safety.
Gabros, S., et al. (2021). Topical corticosteroids. StatPearls.
Ghosh, A., et al. (2014). Topical corticosteroid addiction and phobia. Indian Journal of Dermatology.
International Topical Steroid Awareness Network. (n.d.). What is TSW syndrome?
Litchman, G., et al. (2022). Contact dermatitis. StatPearls.
National Psoriasis Foundation. (2022). Potency chart.
Sheary, B. (2018). Steroid withdrawal effects following long-term topical corticosteroids use. Dermatitis.
