Topical Steroids are a common prescription in modern society, with corticosteroids being commonly prescribed for eczema. These are prescribed to newborns ranging through to adults with dosages being increased over time. Due to this the incidence of Topical Steroid Withdrawal (TSW) is rising within the population as those who have relied on these topical treatments are stopping use and experiencing subsequent debilitating whole body withdrawal symptoms. This condition is not completely accepted within the dermatology field making it difficult for those relying on conventional medicine to adequately support this withdrawal.
What is Topical Steroid Withdrawal?
TWS, also known as ‘red skin syndrome’ due to the full body redness and inflammation that can occur systemically, refers to a group of symptoms that occur approximately 1-2 weeks after ceasing long term topical steroid use with symptoms in some continuing for years.
Symptoms can include(2):
Burning skin
Extreme skin flaking, peeling or shedding
Swelling
Oozing
Insomnia
Body temperature dysregulation
Hair loss
Fatigue
Increased susceptibility to bacterial, viral and fungal infections
Subsequent depression, anxiety and cortisol issues.
A 2018 analysis found that 56% of TSW patients were female, 60% had used topical steroids directly on their face, 40% internally. From this data symptoms most prevalent were burning pain in 65% of the group studied, 100% experiencing whole body red skin flaring and extensive wrinkling of the skin in 56% due to the lack of skin integrity and thinner skin post long-term use(1).
Topical steroids commonly prescribed in Australia that are potent when used long term include products such as: Elocon, Sigmacort, Halog Ointment, Lidex Cream and Florone Ointment. The commonly accepted symptoms of short term steroid use include epidermal thinning, skin atrophy, delayed wound healing, permanent stretch marks, easy bruising and blood vessel dilation.
How to support coming off Topical Steroids
When ceasing topical steroid use after a short term period the likelihood of Topical Steroid Withdrawal is lower, however can still occur. The longer-term the usage the more likely systemic withdrawal symptoms are to occur. At the same time supporting the driving health factors that led to the reason for topical steroid use in the first place, 90% of use is for eczema, and resolving the eczema from the root cause further assists in the process of ceasing steroid use.
Essential Fatty Acids (Fish Oil)
As topical steroid application can lead to changes in the epidermal barrier repairing and replenishing this barrier through the use of Essential Fatty’s acids is the number 1 priority to assist with a stronger skin cell barrier which leads to less reactivity, decreased inflammation and restoration of the thinner skin experienced. Omega’s have been studied in a 3g EPA dosage to have beneficial effects on eczema healing as well making these essential in treating the original use of topical steroid use alongside the withdrawals symptoms. Essential fatty acids can be found in foods such as: fatty fish, salmon, mackerel, chia seeds, flax seed oil and walnuts. High therapeutic dosages through supplementation to support TSW are crucial in combination with the dietary changes.
Zinc
Zinc is a micronutrient that is essential to human health, in terms of skin health zinc plays a main role in the wound healing process and skin cell repair(3), supporting a reduction in inflammation, oxidative stress and scar formation. Zinc dosing is important to be correlated based on patients serum zinc/copper levels to ensure optimising dosage and high dosing where appropriate.
Herbal Support
Adrenal support post topical steroid use is important due to the effects steroid use can have surpressing the hypothalamic-pituitary axis(6). This suppression can exacerbate insomnia, stress response, energy levels and hormonal distribution. Working alongside a naturopath to use the correct herbs to support the adrenals and manage stress with an individualised formula creates a better space for healing.
Anti-Inflammatory Diet
As the withdrawal process is quite inflammation driven as most chronic conditions are(5) dietary changes will always make the biggest difference in supporting the immune system to be less reactive, decrease systemic inflammation and decrease the likelihood of food triggers worsening and prolonging healing time. An anti-inflammatory diet is dependant on the individual but is richer in fruits, vegetables, omega-3 foods, healthy fats and lean protein. Minimising or strictly avoiding the intake of diary, sugar and gluten.
Creating a support network
Due to the nature of Topical Steroid Withdrawal the creation of a support network during harder times is essential for mental health, keeping up daily tasks and ensuring a wholesome and healthy diet is maintained. The lack of a timeline in when the symptoms will end can be extremely difficult to deal with making this even more so important.
Further online support websites such as ITSAN(4) and Topical Steroid Withdrawal Facebooks groups can be of great assistance in reassuring you are not alone and that there is an end in sight.
Working with a team of professionals (naturopathy, psychology, an experienced TSW dermatologist and a supportive GP) to assist with your topical steroid withdrawal journey is imperative. A naturopath is invaluable to make your post-steroid use journey smoother in term of skin repair, nutritional factors, improving stress response, decreasing insomnia symptoms and improving overall healing time.
References:
Sheary B. Steroid Withdrawal Effects Following Long-term Topical Corticosteroid Use. Dermatitis. 2018 Jul/Aug;29(4):213-218. doi: 10.1097/DER.0000000000000387. PMID: 29923852. https://pubmed.ncbi.nlm.nih.gov/29923852/
Coondoo A, Phiske M, Verma S, Lahiri K. Side-effects of topical steroids: A long overdue revisit. Indian Dermatol Online J. 2014 Oct;5(4):416-25. doi: 10.4103/2229-5178.142483. PMID: 25396122; PMCID: PMC4228634. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4228634/
Lin PH, Sermersheim M, Li H, Lee PHU, Steinberg SM, Ma J. Zinc in Wound Healing Modulation. Nutrients. 2017 Dec 24;10(1):16. doi: 10.3390/nu10010016. PMID: 29295546; PMCID: PMC5793244. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793244/
https://www.itsan.org
Sears B. Anti-inflammatory Diets. J Am Coll Nutr. 2015;34 Suppl 1:14-21. doi: 10.1080/07315724.2015.1080105. PMID: 26400429. https://pubmed.ncbi.nlm.nih.gov/26400429/
Yasir M, Goyal A, Sonthalia S. Corticosteroid Adverse Effects. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. https://www.ncbi.nlm.nih.gov/books/NBK531462/
Comments