Topical steroid addiction

Topical steroid addiction (TSA) has been reported in long-term users of topical steroids (users who applied topical steroids to their skin over a period of weeks, months, or years).[1][2] TSA is characterised by uncontrollable, spreading dermatitis and worsening skin inflammation which requires a stronger topical steroid to get the same result as the first prescription. When topical steroid medication is stopped, the skin experiences redness, burning, itching, hot skin, swelling, and/or oozing for a length of time. This is also called 'red skin syndrome' or 'topical steroid withdrawal'(TSW). After the withdrawal period is over the atopic dermatitis can cease or is less severe than it was before.[3]

Mechanism of action

Historically it was believed that cortisol is only produced by the adrenal glands. Recent research has shown that keratinocytes in human skin also produce cortisol. [4] It is believed that prolonged and continuous exposure to topical steroids interferes with the body's ability to regulate cortisol production.

Topical Steroid Withdrawal

Observations

Withdrawal symptoms, manifested by angry erythema and burning, are long-lasting and severe. Most of the patients experience burning and itching, symptoms often increase in warm weather, with exercise, or increased ambient heat. A few patients are worse during winter months. The pattern of corticosteroid withdrawal is usually quite characteristic.[5]Seven to ten days after topical corticosteroids are stopped, an initial flare of erythema occur at the site of the original dermatitis, accompanied by local spread and marked burning. This flare lasts anywhere from 7 to 14 days and culminated with exfoliation. The pattern of flare and quiescence repeats itself but each time with flares of shorter duration and more prolonged quiescent periods. Edema, burning, and erythema decrease with each episode of flare.

Symptoms

"Eventually my skin started to split, and it started to ooze and crack off. There was so much blood, so much pain, and my hair started to fall out. I was just in pure misery. I could not sleep, I could barely eat."[6] - Canadian Woman

Red skin syndrome, or topical steroid addiction, is a little-known side-effect. It’s a burning red rash that leaves patients looking like burns victims. Over the next one and a half years, he suffered shocking withdrawal symptoms including full body eczema, excessive skin peeling, constant shivering, severe swelling, oozing skin, body hair loss, insomnia, constipation and blurred vision. “The first 10 days were horrific. Then it seemed to settle down a little bit. I could start going to the bathroom and I slowly kept sleeping an hour at a time,” Mr Killeen said.[7] - Australian Man

When the creams became ineffective two years ago, the Londoner stopped treatment altogether, causing her body to develop Red Skin Syndrome, a condition where skin reddens and peels constantly because of topical steroid withdrawal. "My whole body felt so tender that I could barely wear clothing, I was in constant pain and had this horrid burn sensation."[8] - UK Woman

Duration

The duration of acute topical corticosteroid withdrawal and time to peak is variable from days to months, before eventually the skin becomes ‘normal’. It can take weeks to years to return to its original condition.[9]

References

  1. ↑ Nnoruka, Edith; Daramola, Olaniyi; Ike, Samuel (2007). "Misuse and abuse of topical steroids: implications.". Expert Review of Dermatology 2 (1): 31–40. doi:10.1586/17469872.2.1.31. Retrieved 2014-12-18.
  2. ↑ Sanjay, Rathi; D'Souza, Paschal (2012). "Rational and ethical use of topical corticosteroids based on safety and efficacy.". Indian Journal of Dermatology 57 (4): 251–259. doi:10.4103/0019-5154.97655.
  3. ↑ Fukaya, M; Sato, K; Sato, M; Kimata, H; Fujisawa, S; Dozono, H; Yoshizawa, J; Minaguchi, S (2014). "Topical steroid addiction in atopic dermatitis.". Drug, healthcare and patient safety 6: 131–8. doi:10.2147/dhps.s69201. PMID 25378953.
  4. ↑ Cirillo, N; Prime, S (2011). "Keratinocytes synthesize and activate cortisol.". Journal of cellular biochemistry 6: 131–8. PMID 21344493.
  5. ↑ Rapaport, Marvin; Lebwohl, Mark (May 22, 2003). "Corticosteroid addiction and withdrawal in the atopic: the red burning skin syndrome". Clinics in Dermatology 21 (3): 201–214. doi:10.1016/S0738-081X(02)00365-6.
  6. ↑ Lucia, Francesca. "B.C. Woman Whose Skin Fell Off Warns About Steroid Cream Addiction". The Huffington Post B.C. Retrieved May 15, 2015.
  7. ↑ Conte, Peter. "The hidden dangers of topical steroids". news.com.au. Retrieved July 3, 2015.
  8. ↑ Koman, Tess. "This 28-Year-Old Woman's Skin Molts 4 Times a Day". Cosmopolitan. Retrieved 12 March 2016.
  9. ↑ Oakley, M.D., Amanda. "Topical corticosteroid withdrawal". DermNet NZ. DermNet New Zealand Trust.
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