Topical Steroid Addiction: Causes, Symptoms, and Treatment

• Steroid addiction is a real and serious problem. Topical steroids are commonly used to treat a variety of skin conditions. 

• However, when used improperly, they can lead to addiction and other serious side effects. If you or someone you know is using topical steroids, it’s important to be aware of the risks.

Causes and Symptoms of steroid cream withdrawal

    1. Causes 

• Topical corticosteroids are a two-edged sword, with the very qualities that made it a helpful therapeutic drug becoming the source of its widespread overuse. 

• Kligman and Frosh initially detailed the condition that gave rise to the name "steroid addiction." 

• The term "topical corticosteroid addiction/dependency" refers to cutaneous and psychological dependence that leads to rebound symptoms and psychological distress when the medication is discontinued. This psychological feature distinguishes this illness from other induced cutaneous reactions.

    2. Topical steroid withdrawal symptoms

• If you have been using steroid cream for an extended period, you may experience withdrawal symptoms when you stop using it. Withdrawal symptoms can include itching, redness, swelling, and burning. 

• These symptoms are usually mild and go away on their own within a few days. 

• However, other signs may necessitate the use of specific drugs.

        Topical steroid withdrawal on the face

• Topical steroid withdrawal on the face is common in situations of chronic atopic dermatitis or seborrheic dermatitis. There is a history of long-term use of Topical Steroids to treat a rash that grows increasingly resistant.

• To control this "resistant rash," the patient increases the intensity or the frequency of steroids. A vicious cycle follows, with the patient becoming progressively dependent on the TC. The face is also the most prevalent location of TC overuse by the general public, who use it as a fairness cream, anti-acne cream, and beauty cream. Initially, normal skin begins to develop pustules, acneform lesions, and erythematous papules.

• When topical steroids are stopped, these lesions tend to flare up. The patient has broad face erythema, papules, pustules, dryness, and telangiectasia. 

• Photosensitivity is seen in the majority of instances.   The rebound phenomena might also involve an area larger than the area of corticosteroid use. 

Treatment

    1. Stop topical corticosteroids application

• The treatment goal is to completely stop the TC and repair the skin damage. Patients should be counseled about the withdrawal rebound. 

• Psychological support is frequently required. While some advocate for a quick stop of TC with supportive measures, others recommend a gradual withdrawal with declining TC potency to avoid the severely unpleasant rebound.

• Symptoms last two weeks, followed by desquamation. The erythema clears up but returns within a fortnight. A second flare typically develops within two weeks, followed by resolution. Before a complete cure, many such flares with decreasing severity followed by longer-lasting resolves to occur; the duration is determined by the duration of administration of the topical corticosteroid.

• This flare and resolution pattern repeat itself, albeit with shorter flare durations and longer resolution periods each time.

    2. Topical calcineurin inhibitors

• The use of topical calcineurin inhibitors is controversial. Some doctors found it to be highly useful.

• Some doctors found it to be unnecessary and may increase the burning sensation

    3. Oral antibiotics

Oral antibiotics such as doxycycline or minocycline, as well as metronidazole, can be beneficial.

    4. Oral antihistaminics 

Oral antihistaminics may be required to reduce the related itching.

    5. Other measures

Other supportive therapies include regular cold compresses, Burrows compresses for moist weepy lesions, and the use of bland emollients to relieve dryness.