Topical steroid withdrawal reactions: a review of the evidence

Low blood pressure can occur when you stop taking steroids, and, when it becomes severe, it can lead to dizziness and fainting. The most frequently identified symptoms include agitation, anxiety, distractibility, fear, hypomania, indifference, insomnia, irritability, lethargy, labile mood, pressured speech, restlessness, and tearfulness. Abbie suffered from topical steroid withdrawal (TSW), which left her skin raw, oozing and cracked. One TikTok creator shared clips of her skin, which, even four months down the line after stopping using topical steroid treatments, looked raw and painful.

  • It also causes major insomnia and makes you feel cold all the time – like when you’ve got sunstroke.
  • TSW refers to the symptoms that occur when a patient reduces or ceases the use of topical steroids, including painful redness, burning, swelling, itching, flaking, and oozing of the skin.
  • It allows you to gradually reduce your dose over time so as to avoid a sudden shift in your hormone balance.
  • These would include depressive or manic-depressive illness and previous steroid psychosis.

I was off work at the time and immersed myself in how to «fix» myself. There are numerous Instagram accounts of people going through withdrawal and their methods [including specific diets] it works for some – but, for me, it was too easy to become obsessive. I had so much empathy, though, for the other people all over the world going through the same horror as me.

About topical corticosteroids

60% had used potent topical corticosteroids on the face, and 42% had a history of oral corticosteroid use for skin symptoms. Burning pain was reported in 65%; all had widespread areas of red skin; and so-called “elephant wrinkles” or “red sleeve”. Topical steroid withdrawal reactions are usually seen after long-term use of these medicines. They have also been seen after as little as 2 months of continual use in children.

  • The right treatment can provide you with the information and support you need to ease off the medication.
  • ‘Following application instructions are key – using too little can result in long-term use and a prolonged flare because the inflammation is never properly controlled,’ says Dr Vyas.
  • Prednisolone appears in small amounts in breast milk but maternal doses of up to 40mg daily are unlikely to affect the infant.
  • Contact dermatitis causes the skin to become itchy, blistered, dry and cracked.

This redness can extend beyond the area treated with the topical corticosteroid. Redness can be a spectrum of pink, to purple, which may show as darkening of the normal skin tone and can vary depending on the skin tone of the individual. Other signs include burning or stinging, intense itching, peeling of the skin, or oozing open sores. In some patients, the adverse reactions appear to present while the topical corticosteroid is still being used.

Anticoagulant medicines

Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences. Steroid injections are often only given at intervals of at least 6 weeks. There’s generally no reason why someone shouldn’t be able to use a steroid inhaler or steroid spray.

Day 1 of quitting the drug – As the substance leaves your system initial withdrawal symptoms may appear, such as fatigue, soreness, and a strong desire to use the drug (cravings). As soon as the withdrawal symptoms begin to intensify, you might notice less energy and alertness. Also, anxiety, depression, and other psychological symptoms can start to worsen. Please read this information sheet from GOSH alongside the patient information leaflet (PIL) provided by the manufacturer.

These cases may not relate to topical steroid withdrawal reactions and may represent allergic reactions (possibly to multiple topical corticosteroids), patients developing a different skin condition or some form of tolerance. The cases have been reported over a wide time-period, and the majority of reports are from patients. The terms used for reporting are reactions that are already listed in the product information, which impacts how we detect newly emerging safety concerns to medicines. Most of these side effects are already listed individually for topical corticosteroids.

Particular care is required when considering the use of systemic corticosteroids in patients with existing or previous history of severe affective disorders in themselves or in their first degree relatives. These would include depressive or manic-depressive illness and previous steroid psychosis. Although it is best not to take steroids during pregnancy, it is safer than many drugs and the benefit of treatment may outweigh the risks.

Topical corticosteroids can be used safely in children if recommended by a healthcare professional. However, children, especially infants, are particularly susceptible to side effects with corticosteroids. Topical corticosteroids are used for the treatment of inflammatory conditions of the skin, such as eczema and psoriasis. Cravings occur during withdrawal, in addition to other physical and mental effects.

There are several programmes designed to help you break free of steroid addiction and get back on your feet. The best recovery programme for you will depend on different factors, including your level of addiction. However, inpatient steroid addiction is recognised as the most effective form of treatment programme with 24 hour care and other crucial services. The physical and behavioural side effects of using steroids can make it impossible for them to be used secretly.

Following an increasing number of patient enquiries to the US National Eczema Association, Hajar and colleagues sought to review the current evidence regarding addiction and withdrawal of topical steroid withdrawal. Cases without a clear temporal association were excluded, as were case series without a definitive number of cases and reviews of expert opinion. The authors https://myhealthcarezone.com state that when dermatitis first developed, many of the patients self-prescribed over-the-counter 1% hydrocortisone cream or ointment. For those who sought medical consultation, many had been given moderate-strength corticosteroids initially, but in the recent years before publication, potent corticosteroid preparations were commonly prescribed at the outset.