The various challenging and uncomfortable side-effects of topical corticosteroid creams are well documented, but how does the body react if they’re withdrawn? In this article we look at what steroids are, how they affect the skin, and how the body reacts when you stop using them.

What are topical steroids?

Topical corticosteroid creams are made from synthetic hormones, and are generally prescribed to reduce itchiness and inflammation of the skin. They’re widely used as a treatment for different kinds of eczema (including childhood eczema) alongside emollient moisturising creams.

Topical steroid creams come in different varieties and different potencies, and the right type should be prescribed for appropriate areas of the body. That’s because the skin absorbs more steroids when it’s thinnest, and less when it’s thick; the skin of the face and genital area absorbs much more than the skin on the arms, legs or palms, for example.

As well as the part of the body that’s to be treated, doctors will also take into consideration the age of their patient (little children and the elderly both absorb more steroids), the health of their skin (cracked or raw skin absorbs more than intact skin); how big an area of skin needs to be treated; and whether the skin is going to be covered or not (occlusion by wraps, clothes or bandages means more is absorbed).

Topical steroids are meant to be used as a short-term treatment to help severe symptoms, not as a long-term management strategy.

How do steroids work?

Topical steroids work by dampening down the body’s natural inflammatory response to a trigger. The trigger could be something like dust mite debris, washing powder, perfume, cat hair, pollen, fabric, etc. In a person with eczema, a trigger like perfume or detergent can cause an overreaction of the immune system, with the body going into full-blown and unnecessary inflammatory response and causing the skin to get hot, swollen, itchy and sore.

The idea of using topical steroids is to calm down this debilitating reaction by constricting the blood vessels and reducing inflammation.

Symptoms of topical steroid addiction

It’s not clear why some people react badly to the creams, and others can continue using them for short term relief of severe eczema symptoms without issues, but for those who are badly affected, it’s as if their body has become addicted to the creams and can’t react ‘normally’ any more.

How can you tell that your body has become dependent on topical steroids? It’s usually because the creams are not working as they should, and your skin is getting worse, not better.

• Your doctor is having to prescribe more and more potent steroids in order to have the same effect on your eczema
• You experience a rebound flare, where your skin gets much worse after you’ve finished a course of steroid creams
• You experience new symptoms that are different from the eczema the cream is treating
• Your skin becomes more sensitive to allergens

Topical steroid withdrawal syndrome

Unfortunately, if you stop using topical steroid creams after experiencing these problems your skin is unlikely to recover immediately. There’s usually a period of withdrawal and healing, as your body readjusts to life without steroids. It’s this process that’s known as topical steroid withdrawal.

Symptoms of topical withdrawal syndrome include:

• ‘Red skin” as if burnt - tone and colour will depend on your skin colour, so the ‘red’ in the term can be misleading. ‘Red sleeves’ which end abruptly at the wrists are especially characteristic of TSWS.
• Very dry and easily-irritated skin
• Extremely flaky skin
• Oozing skin
• Swollen areas
• Feeling very much too cold or too hot
• Extremely sensitive skin
• Intense, ‘bone-deep’ itch
• ‘Zingers’ or nerve pain
• Enlarged lymph nodes
• ‘Elephant skin’: baggy or wrinkly skin
• Hair loss
• Depression, anxiety, exhaustion, insomnia, lack of appetite

The process of recovery from the damaging effects of topical steroids can be severe and slow; it’s important to remember that not everyone prescribed steroid creams experiences topical steroid addiction, and that everyone’s recovery is different. For most people, time and support is crucial to getting through the difficult readjustment period.

You can find more information on Topical Steroid Withdrawal on our Info Hub, including Top 8 Tops for Keeping Calm During Topical Steroid Withdrawal by guest writer Eden Brown.

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Balmonds Skin Salvation
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