People often use topical corticosteroids to treat skin inflammation or irritation. A person applies these directly to the skin as a cream, ointment, gel, lotion, or other preparation.

Topical corticosteroids can range in strength from mild, which are generally available over the counter, to very potent, which are available via prescription.

Rarely, a person can experience an adverse reaction after they stop using a topical corticosteroid. Healthcare professionals refer to this as topical steroid withdrawal.

This article explores what topical steroids are and the symptoms of topical steroid withdrawal. It also discusses the causes, treatment, and prevention of topical steroid withdrawal. Finally, it answers some common questions about topical steroid withdrawal.

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Topical steroids are anti-inflammatory preparations. They may come in a variety of forms, such as:

  • creams
  • gels
  • ointments
  • foams
  • lotions
  • tapes
  • sprays

A person may apply topical steroids to the skin to help control inflammatory skin conditions, such as eczema, psoriasis, and acne. Topical steroids are also known as topical corticosteroids, cortisone, and glucocorticosteroids.

People use topical steroids more than any other treatment for eczema.

Topical steroids have various properties. They may be:

  • anti-inflammatory: reducing inflammation
  • antiproliferative: preventing or slowing the growth and spread of cells
  • immunosuppressive: suppressing the actions of the immune system to prevent it from attacking healthy cells
  • vasoconstrictive: constricting blood vessels to slow or block blood flow

Corticosteroids absorb into thin areas of the skin, such as the eyelids, more easily than thicker areas, such as the soles of the feet.

Topical steroids come in different strengths. The same active ingredient may be included at different concentrations in topical products of different strengths.

Mild

The higher the concentration and amount of a topical steroid, the more the body will absorb. If the body absorbs too much of the steroid, a person may experience adverse effects.

For this reason, a doctor may prescribe a mild strength topical steroid if a person’s skin condition, such as eczema, affects a large area of their body. Although the person will require a large amount of topical steroid, the concentration should not be too high.

A person may also use a milder topical steroid in small amounts for mild symptoms, including itching and redness.

Types include:

  • hydrocortisone
  • fluocinolone acetonide
  • desonide

Learn more about hydrocortisone for acne here.

Moderate

A person may use medium to high potency topical steroids to treat areas that are closed off, such as the armpits, and areas where the skin is thin, such as the eyelids.

Types include:

High

High potency steroids may better treat conditions that occur on areas where skin is thicker, such as the soles of the feet and palms. A doctor may also prescribe them for severe inflammatory skin conditions, such as psoriasis, severe eczema, and contact dermatitis.

Types include:

  • betamethasone dipropionate
  • diflorasone diacetate
  • mometasone furoate

Ultra-high

If a high potency steroid is not producing satisfactory results, a doctor may prescribe a topical steroid with an even greater strength.

Types include:

  • halobetasol propionate
  • clobetasol propionate
  • flurandrenolide

The symptoms of topical steroid withdrawal appear after a person discontinues use of their steroid medication.

Prior to the onset of these symptoms, a person’s skin will have typically returned to a state that is normal for them — although they may still have patches of skin that are resistant to treatment. Once they stop using the topical steroids, they may experience symptoms that include:

  • thickened skin
  • swelling and lesions
  • burning
  • stinging
  • itching
  • redness and flushing in the areas previously treated with steroids, which may spread to untreated areas
  • dry, scaly skin
  • skin sensitivity

Excessive sweating and itchy hives may indicate that the skin is recovering.

Symptoms may also include:

Healthcare professionals do not know exactly what causes topical steroid withdrawal, as there is a lack of research and data available. They do not know how many people have the condition, what amount of topical steroid usage causes it, or what percentage of people who use topical steroids develop it.

However, they do know that topical steroid withdrawal occurs most often in people who use topical steroids over a long period or at medium to high potencies every day, especially on the face or genital area.

More research is necessary for doctors to establish an optimal treatment plan for topical steroid withdrawal. A typical approach is for a person to continue not using topical steroids and allow time for the skin to heal. However, each person’s skin may react differently to this method, and the time frame for recovery will vary.

Some research suggests that the eczema medication dupilumab may help with topical steroid withdrawal. However, further research is necessary to determine whether this is true and how effective it may be. It is also important to note that the Food and Drug Administration (FDA) does not approve of using dupilumab in this way.

A doctor may prescribe a gradually lessening course of oral steroids. A person may also benefit from supportive measures, such as cold compresses to ease discomfort and psychological support to help with any mental and emotional symptoms.

A person should try to avoid prolonged, frequent use of topical steroids — especially moderate to high potency treatments — unless a doctor advises them differently. Risks of topical steroid withdrawal increase when:

  • using higher potency topical steroids
  • applying topical steroids frequently, such as more often than once per day
  • applying topical steroids for a prolonged period

People should not avoid using topical steroids as a treatment for eczema unless a doctor advises them to. Most people respond well to the treatment, and withdrawal is rare. A doctor or dermatologist can help a person find the correct treatment for their condition.

Below are some of the most common questions and answers about topical steroid withdrawal.

How long does topical steroid withdrawal last?

The length of time withdrawal lasts will vary among individuals. It could be between days and months, and it can take weeks to years for the skin to return to its natural state.

Does topical steroid withdrawal go away?

Yes, the withdrawal symptoms recede if a person stops using topical steroids permanently. However, the time it takes for withdrawal symptoms to clear up varies.

Do steroid creams thin skin permanently?

No, skin that has thinned from topical steroid use can repair if a person stops using the steroids. However, a person may develop permanent stretch marks in some areas if they use topical steroids for a prolonged length of time.

People use topical steroids to treat inflammatory skin conditions — most often eczema. Topical steroids come in different forms and range from mild to highly potent in strength. A person can get mild topical steroids over the counter, and a doctor may prescribe stronger treatments.

In rare cases, a person may experience withdrawal after they stop using topical steroids. Symptoms may include pain, itching, redness, lesions, oozing, and insomnia.

Healthcare professionals do not know how many people experience topical steroid withdrawal or exactly why it occurs. A person may prevent withdrawal by avoiding using topical steroids frequently, in high potency doses, or over a long period of time.