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Topical steroid withdrawal (TSW) is a newly recognized condition causing skin issues after stopping potent steroid creams. Many patients experience significant distress and seek unconventional treatments due to a lack of understanding and support from healthcare professionals.

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Area of Science:

  • Dermatology
  • Psychodermatology

Background:

  • Topical steroid withdrawal (TSW) is a poorly defined condition characterized by erythema and burning after discontinuing mid- to high-potency topical corticosteroids.
  • No consensus diagnostic criteria for TSW exist, leading to misinterpretation as underlying condition flares or contact allergy.
  • TSW significantly impacts patients' mental and physical well-being, often accompanied by anxiety and depression.

Purpose of the Study:

  • To characterize TSW symptomatology.
  • To describe clinical experience managing TSW patients.
  • To determine the prevalence of nonconventional treatment seeking in TSW.

Main Methods:

  • Retrospective review of case notes from a multidisciplinary service.
  • Inclusion of patients presenting with TSW between January 2019 and June 2021.

Main Results:

  • Nineteen TSW cases identified (15 female, 4 male), predominantly under 35 years old.
  • Common symptoms include redness, burning pain, skin sensitivity, flaking, insomnia, and severe itching.
  • High prevalence of anxiety and depression noted, with some patients experiencing suicidal ideation.
  • Approximately 50% of patients pursued nonconventional treatments, including international private consultations.
  • Improvements observed with psychodermatology consultations and earlier conventional management.

Conclusions:

  • Patients with TSW often face dismissal from healthcare professionals, leading to reliance on unregulated online information and increased morbidity.
  • Dermatology professionals must recognize TSW and provide supportive, shared decision-making for treatment.
  • Awareness and appropriate management strategies are crucial to mitigate the physical, mental, and social burden of TSW.