Topical corticosteroids are medical products that are designed to treat skin disorders such as eczema, contact dermatitis and psoriasis. Such treatments usually come in the form of creams, ointments or gels, or mousses or shampoos if for the scalp. They contain a type of steroid, which is produced naturally by the body and can also be made artificially.
What is TSW?
The medication works by suppressing the immune response in the skin, reducing inflammation and the associated symptoms such as itchiness, redness, and dry cracked skin. Topical steroid withdrawal (TSW) has been reported as skin redness and burning that is worse than the original condition.
The condition is not fully understood because it is thought to be relatively rare, but it is possibly caused by a rebound reaction when the topical corticosteroid treatment is suddenly stopped. As the skin readjusts after the removal of steroids, the symptoms of the original condition can become more intense.
This is likely to be worse after prolonged use when a dependency has built up. Symptoms may include red skin that resembles sunburn; an intense itching or burning sensation; swelling or puffiness of the skin; and dryness or flaking. As the skin heals, it may ooze clear fluid and form crusts.
Besides the physical symptoms, TSW may cause significant psychological and emotional distress, causing self-consciousness and triggering or worsening anxiety and depression.
What causes TSW?
TSW is primarily caused when the use of topical corticosteroids is stopped after a prolonged period of time, especially when the discontinuation is abrupt. The frequency of application and the potency of the steroid treatment are also thought to be factors. The nature and severity of the underlying skin condition may also be a contributing factor.
How can TSW be treated?
When using topical steroids, always follow the prescribing advice carefully, and consult a doctor or pharmacist before discontinuing use. Keep the skin well hydrated with gentle moisturisers to reduce the risk of dry, flaky skin. If skin becomes inflamed with itchy or burning sensations, apply a cold compress to cool the area and provide relief.
An emerging treatment for TSW is cold atmospheric plasma (CAP). It is designed to promote the natural healing of the skin by speeding up the production of new skin cells, meaning that the weak and damaged skin is repaired faster. The treatment is available at cosmetic skin clinics, and it may require a course of several applications for best results.
The 2021 safety review
The Medicines and Healthcare products Regulatory Agency (MHRA) and the Commission on Human Medicines (CHM) published a review of the safety evidence for topical corticosteroids in 2021, after reports of a withdrawal reaction following prolonged use of the products.
The key message from the review is that topical steroids are safe and effective treatments for skin disorders when used correctly. This includes using them for short periods, or with breaks in treatment over longer periods of time.