Topical steroid withdrawal (TSW) is a condition that occurs when the body reacts to the sudden stop, or significant reduction of long-term topical steroid use, usually on the skin. They’re a group of side effects some people get when they use too much of these medicines, stay on them for too long, or stop taking them too quickly. It is quite an unfortunate situation to be in, many people who experience these side effects, develop issues like social isolation, and depression.
Topical steroids, also known as corticosteroids, are commonly prescribed creams, ointments, or lotions to treat various skin conditions like eczema, psoriasis, and dermatitis. They provide relief from inflammation, itching and swelling.
However, when it’s used for extended periods, the skin becomes dependent on these steroids to function properly. Therefore, stopping or reducing the use of topical steroids abruptly, can lead to withdrawal symptoms.
Symptoms of topical steroid withdrawal
- Horrendous itching
- Sleeplessness
- Pouring oozes that end up soaking clothes within minutes
- Thin skin/ thickened skin
- Extreme dryness/ skin shedding
- Extreme redness and inflammation often worse than the original condition
- Suicidal thoughts due to emotional distress, depression or anxiety
- Shaking/ no thermal regulation
- No appetite
- Long periods of isolation
- Nerve Pain
The symptoms usually worsen right after you stop taking steroids. First, the skin turns red, then it becomes itchy. However, the skin eventually clears up, but the symptoms may reoccur, and can last anywhere from a couple of months to many years.
Treatment and management of topical steroid
The recovery from topical steroid withdrawal requires patience, because the process takes a long while and can be uncomfortable. However, some measures you can take to reduce the intensity and aid your recovery process are:
- Phototherapy (light therapy)
- Walking, yoga
- Taking long, cool showers and every night
- Ibuprofen and antihistamines
- Reducing moisturizer when not needed
- Avoiding irritants and allergens
- Wear comfortable clothing
- Reduce alcohol consumption
- Low inflammation diet
- Traditional Chinese medicine
- Gradual tapering (reducing steroid use gradually)
- Moisturizing to soothe dry skin
- Avoid vigorous physical activity
- Seek emotional support from family, friends, or support groups
In addition, medical professionals may recommend alternative treatments, such as:
- Phototherapy (light therapy)
- Oral medications for itching or inflammation
- Non-steroidal creams or ointments
That said, it is very important to consult with a doctor or dermatologist for guidance on managing topical steroid withdrawal. So, they can create a specially-made treatment plan.
Phases of TSW
Topical steroid withdrawal can be divided into three phases.
1 . Initial phase (0-2 weeks): Symptoms begin within days or weeks after the person has stopped using topical steroids. The symptoms are usually intense redness, and itching.
2 . Peak phase (2 to 6 weeks): Here the symptoms worsen, which leads to increased inflammation, and discomfort.
3 . Recovery phase ( 6 to 24 weeks or longer): At this point, the symptoms gradually subside as the skin adjusts to life without topical steroids.
Prevention of topical steroid withdrawal
It is possible to reduce the risk of experiencing the ugly side effects of topical steroids.
1 . Use them only as prescribed
2 . Limit usage duration and potency, because withdrawal can be prevented by not using topical steroids as frequently. However, applying less TCS than prescribed may result in treatment failure. Which may then require an even longer course, and greater amounts of potentially stronger steroid- thus actually increasing your risk of TSW.
3 . Gradually taper off steroids when stopping.
4 . Monitor your skin for signs or dependency or withdraw.
5 . Try other treatments for skin conditions.
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