Topical corticosteroids can treat inflammatory skin conditions, such as eczema. In rare cases, an individual may experience withdrawal symptoms after they stop using a topical corticosteroid. This is known as topical steroid withdrawal (TSW).
Topical corticosteroids for eczema come in a range of strengths. Mild versions are available over the counter (OTC), and more potent versions are available via prescription.
Eczema is a chronic inflammatory skin condition. The most common type of eczema is atopic dermatitis. The condition can range from mild to severe, with people typically experiencing flare-ups, in which the symptoms can intensify for days or weeks.
Other symptoms of eczema include:
- dry skin
- skin discoloration and inflammation
- thick, hard, scaly patches of skin
- rashes that may start weeping
- swollen skin
In lighter skin, eczema patches may appear red, while in darker skin, eczema patches may appear gray, purple, or dark brown.
Topical steroids are anti-inflammatory formulations that come in several different forms, such as:
People can apply topical steroids directly to the skin. They are the most common medication for the treatment of eczema.
Topical steroids are effective as a treatment for eczema because they can suppress the overactive immune system and reduce inflammation.
They range in strength from mild to ultra-high potency. Different strengths of topical products may include the same active ingredients in different concentrations.
Lower concentrations and amounts of topical steroids pose less risk of side effects when the body absorbs the steroid.
If a person’s eczema affects large areas of their skin, a doctor
- fluocinolone acetonide
- clobetasone butyrate
- triamcinolone acetonide
Strong topical steroids may be more effective for treating eczema in areas where a person’s skin is thicker, such as the palms and soles. A doctor
- mometasone furoate
- betamethasone dipropionate
- diflorasone diacetate
A doctor may prescribe very high potency topical steroids for people whose eczema did not respond to high strength treatment.
- clobetasol propionate
- halobetasol propionate
Some people may experience TSW within days or weeks of stopping treatment. This may lead to symptoms that are worse than those of their original skin condition.
People who experience TSW often have skin that has returned to its natural state without eczema before they stop treatment. Symptoms that may develop after ending treatment can include:
- scaly, dry skin
- thick, hardened skin
- skin sensitivity
- excessive sweating
- burning and stinging
Other symptoms may include:
Researchers do not know what causes TSW. More research and data are necessary to determine the causes, the number of people who develop TSW, and how much topical steroid a person would need to use to develop the condition.
Researchers have found that people who use topical steroids over a long period of time, and those who use moderate to high strength topical steroids daily, are at higher risk of developing TSW. These people are also
Researchers have not developed a standard treatment for TSW. A doctor will typically advise a person to stop using the steroid medication and let their skin heal over time. The effectiveness of this strategy can vary among individuals.
A doctor may prescribe a course of oral steroids to help with TSW. They will gradually reduce the strength of these drugs throughout treatment.
A person who experiences any symptoms of TSW should contact their doctor to rule out other causes and seek treatment. They should not stop taking or change how they use any medication their doctor has prescribed without discussing it with them first.
Someone with severe eczema symptoms may also contact a doctor to discuss treatment, as OTC treatments may not be effective. Eczema treatment can reduce the severity of symptoms, but there is no cure.
People who are experiencing pain or discomfort that interferes with their day-to-day life or sleep schedule should speak with a doctor.
Below are some of the most common questions about TSW and eczema.
How common is topical steroid withdrawal in people with eczema?
How long does topical steroid withdrawal last?
People can experience TSW for different amounts of time. The withdrawal symptoms may last from days to years, and a person’s skin may take from weeks to years to return to its usual state.
Does topical steroid withdrawal go away?
Yes, TSW can go away if a person stops using topical steroids completely and permanently. However, a person should not stop using topical steroids without consulting a doctor.
Topical steroids are a common treatment for eczema. They range in strength and are available in various forms, including creams, lotions, gels, and ointments. Mild topical steroids are available OTC, and a doctor can prescribe higher potency treatments.
People who use moderate to high strength topical steroids daily, or use topical steroids over a long period of time, are at greater risk of developing TSW. Symptoms may include itching, burning, lesions, and insomnia.
Researchers do not know what the exact causes of TSW are. People are at lower risk of developing TSW when they use low concentration topical steroids over a short time period.