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Topical steroid withdrawal, also known as red burning skin and steroid dermatitis, has been reported in people who apply topical steroids for 2 weeks or longer and then discontinue use. [4] [5] [2] [1] Symptoms affect the skin and include redness, a burning sensation, and itchiness, [2] which may then be followed by peeling. [2]
Abrupt termination of the drug commonly causes transient non-specific symptoms such as loss of appetite, upset stomach, vomiting, drowsiness, confusion, headache, fever, joint and muscle pain, peeling skin, and weight loss. [29] [30] These symptoms can be attributed to steroid withdrawal syndrome, adrenal insufficiency, or disease relapse. [29]
Withdrawal syndrome: Withdrawal of topical glucocorticoids after long-term use, particularly on the face or genitals, may bring about different kinds of signs and symptoms including redness of the skin, burning or stinging sensation, itching, pain, and hot flashes on the face. [12]
When topical steroid medication is lost, 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. [40]
Steroid-induced skin atrophy is thinning of the skin as a result of prolonged exposure to topical steroids. In people with psoriasis using topical steroids it occurs in up to 5% of people after a year of use. [5] Intermittent use of topical steroids for atopic dermatitis is safe and does not cause skin thinning. [6] [7] [8]
Adrenal crisis can be triggered by abrupt, and frequently unintentional, steroid withdrawal. The hypothalamic–pituitary–adrenal axis is suppressed by the use of glucocorticoids in rectal preparations, spinal injections, injections into the dermis, injections into the joint, nasal, inhaled, or steroids applied to the skin.
[7] [8] [6] It differs from the similarly named prednisone in having a hydroxyl at the 11th carbon instead of a ketone. Common side effects with short-term use include nausea, difficulty concentrating, insomnia, increased appetite, and fatigue. [5] More severe side effects include psychiatric problems, which may occur in about 5% of people. [9]
Where risks or harms is the reason for withdrawal, this will usually have been prompted by unexpected adverse effects that were not detected during Phase III clinical trials, i.e. they were only made apparent from postmarketing surveillance data collected from the wider community over longer periods of time.