59:
161:
172:, which requires a stronger topical steroid to get the same result as the first prescription. This cycle is known as steroid addiction syndrome. When topical steroid medication is stopped, the skin experiences redness, burning, a deep and uncontrollable itch, scabs, hot skin, swelling, stinging, hives and/or oozing for a length of time. This is also called 'red skin syndrome' or 'topical steroid withdrawal' (TSW). After the
228:
Diagnosis is based on a rash occurring within weeks of stopping long-term topical steroids. Specific signs include ‘headlight sign’ (redness of the lower part of the face but not the nose or the area around the mouth); ‘red sleeve’ (a rebound eruption stopping abruptly at the lower arms and hands);
219:
in human skin also produce cortisol. Prolonged topical steroid (TS) application changes the glucocorticoid receptor (GR) expression pattern on the surface of lymphocytes; a patient experiencing resistance to a TS has a low ratio of GR-α to GR-β. In addition, the erythema characteristic of ‘red skin
277:
The prevalence of the condition is unknown. Many cases ranging from mild to severe have been reported in both adults and children. One survey of atopic dermatitis patients treated with topical corticosteroids in Japan estimated that approximately 12% of adult patients may appear to be uncontrolled
151:
Treatment involves discontinuing the use of topical steroids, either gradually or suddenly. Counselling and cold compresses may also help. Thousands of people congregate in online communities to support one another throughout the healing process, and cases have been reported in both adults and
189:
The duration of acute topical corticosteroid withdrawal is variable; the skin can take months to years to return to its original condition. The duration of steroid use may influence the recovery factor time, with the patients who used steroids for the longest reporting the slowest recovery.
248:
Treatment involves ceasing all use of topical steroids, either gradually or suddenly. Keeping affected areas dry and disinfected will speed healing. Avoid moisturizer, as any dampness elongates the healing process and encourages bacterial growth. Antihistamines may help for itchiness.
320:
Juhász ML, Curley RA, Rasmussen A, Malakouti M, Silverberg N, Jacob SE (September–October 2017). "Systematic review of the topical steroid addiction and topical steroid withdrawal phenomenon in children diagnosed with atopic dermatitis and treated with topical corticosteroids".
180:
can cease or is less severe than it was before. Topical steroid addiction has also been reported in the male scrotum area. Other symptoms include nerve pain, insomnia, excessive sweating, anxiety, severe depression, fatigue, eye problems, and frequent infections.
198:
To experience this withdrawal, it generally requires the misuse and/or application of a topical steroid daily for 2 to 4 months, depending on the potency of the topical corticosteroid. In some cases, this has been reported after as little as 2 weeks of use.
143:
This condition generally requires the daily application of a topical steroid for more than 2 weeks but sometimes can occur with even less steroid use. It appears to be a specific adverse effect of topical corticosteroid use. People with
550:
Hajar T, Leshem YA, Hanifin JM, Nedorost ST, Lio PA, Paller AS, et al. (March 2015). "A systematic review of topical corticosteroid withdrawal ("steroid addiction") in patients with atopic dermatitis and other dermatoses".
58:
249:
Immunosuppressants and light therapy may also help some people. Psychological support is often recommended. At this time, treatment options that have been documented in literature include
140:
for 2 weeks or longer and then discontinue use. Symptoms affect the skin and include redness, a burning sensation, and itchiness, which may then be followed by peeling.
954:
232:
Differentiating this condition from the skin condition that the steroids were originally used to treat can be difficult. Red, burning skin may be misdiagnosed.
430:
52:
Topical steroid addiction, steroid dermatitis, red burning skin syndrome, red skin syndrome, iatrogenic exfoliative dermatitis (idiopathic erythroderma)
160:
1275:
1039:
947:
294:
frameworks and current research standards for clinical decision-making was performed in 2016 and was republished with updates in 2020.
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1403:
1197:
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1156:
1044:
466:
1382:
1187:
1027:
1023:
220:
syndrome’ is due to a release of stored endothelial nitric oxide (NO) and subsequent vasodilation of dermal vessels.
868:
Hwang J (25 Dec 2020). "Topical corticosteroid withdrawal ('steroid addiction'): an update of a systematic review".
1089:
66:
Red burning skin syndrome from topical steroids. Face pattern with nose sign and spared palms (soles also spared)
1413:
1234:
1059:
291:
168:
Topical steroid addiction (TSA) is characterised by uncontrollable, spreading dermatitis and worsening skin
995:
1270:
88:
1408:
1316:
1175:
389:
461:
1372:
1365:
1182:
980:
586:
Smith MC, Nedorost S, Tackett B (September 2007). "Facing up to withdrawal from topical steroids".
240:
This condition can be avoided by not using steroid creams for periods of time longer than 2 weeks.
1328:
1287:
1079:
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893:
815:
338:
83:
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568:
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177:
145:
71:
1338:
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690:
649:
639:
595:
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522:
512:
475:
330:
100:
1377:
1343:
1333:
1282:
1258:
1253:
1192:
1074:
173:
137:
599:
164:
Red burning skin syndrome from topical steroids. Typical pattern on lower arms and hands
1323:
1263:
1207:
767:
740:
654:
627:
527:
500:
1397:
1170:
1119:
1084:
1049:
985:
897:
287:
216:
856:
819:
342:
1248:
790:
Cirillo N, Prime SS (June 2011). "Keratinocytes synthesize and activate cortisol".
254:
169:
881:
501:"Rational and ethical use of topical corticosteroids based on safety and efficacy"
334:
1160:
1144:
1139:
1064:
718:
266:
262:
76:
27:
This article is about the consequences of topical steroids. For other uses, see
17:
695:
564:
1360:
1124:
1099:
1008:
963:
626:
Fukaya M, Sato K, Sato M, Kimata H, Fujisawa S, Dozono H, et al. (2014).
250:
757:
704:
278:
cases, although they are in fact addicted to a topical corticosteroid (TCS).
1292:
517:
479:
889:
811:
776:
663:
607:
572:
536:
446:
922:
1217:
1165:
258:
208:
932:
644:
1226:
431:"Topical corticosteroid addiction and withdrawal - An overview for GPs"
212:
32:
803:
159:
1221:
719:"Topical steroid addiction: Calls for more support for patients"
28:
936:
261:. Some physicians have also seen positive outcomes with oral
739:
Ghosh A, Sengupta S, Coondoo A, Jana AK (September 2014).
912:
462:"Misuse and abuse of topical steroids: implications"
229:and ‘elephant wrinkles’ (reduced skin elasticity).
1352:
1216:
1098:
1017:
994:
971:
916:
115:
107:
95:
82:
70:
48:
43:
857:https://nationaleczema.org/blog/tsw-need-to-know/
835:"Topical Steroid Withdrawal in Atopic Dermatitis"
628:"Topical steroid addiction in atopic dermatitis"
683:Journal of the American Academy of Dermatology
553:Journal of the American Academy of Dermatology
323:Journal of the Dermatology Nurses' Association
948:
741:"Topical corticosteroid addiction and phobia"
8:
111:Using steroid creams for less than two weeks
91:, burning sensation, desquamation, itchiness
955:
941:
933:
913:
152:children. It was first described in 1979.
57:
40:
766:
756:
694:
653:
643:
621:
619:
617:
526:
516:
424:
422:
420:
418:
416:
414:
412:
410:
384:
382:
380:
378:
376:
374:
372:
853:What the eczema community needs to know.
460:Nnoruka EN, Daramola OO, Ike SO (2007).
370:
368:
366:
364:
362:
360:
358:
356:
354:
352:
315:
313:
311:
309:
307:
136:, has been reported in people who apply
303:
734:
732:
7:
1276:Hydroxyethyl starch-induced pruritus
600:10.1097/01.NURSE.0000287732.08659.83
215:glands, but research has shown that
1040:Urushiol-induced contact dermatitis
870:Journal of Dermatological Treatment
851:Ballard, A. (2021, March 22). TSW:
632:Drug, Healthcare and Patient Safety
390:"Topical corticosteroid withdrawal"
207:Historically, it was believed that
1113:Autoimmune progesterone dermatitis
679:"Corticosteroid-dependent scrotum"
25:
677:Kling C, Obadiah J (2005-03-01).
499:Rathi SK, D'Souza P (July 2012).
792:Journal of Cellular Biochemistry
1150:Hyperkeratotic hand dermatitis
1108:Autoimmune estrogen dermatitis
1:
1359:substances taken internally:
1198:Nutritional deficiency eczema
1004:Pityriasis simplex capillitii
882:10.1080/09546634.2021.1882659
855:National Eczema Association.
745:Indian Journal of Dermatology
505:Indian Journal of Dermatology
1157:Autosensitization dermatitis
1045:African blackwood dermatitis
467:Expert Review of Dermatology
335:10.1097/JDN.0000000000000331
103:after frequent long-term use
1383:Papuloerythroderma of Ofuji
1188:Juvenile plantar dermatosis
435:Australian Family Physician
1430:
1135:Topical steroid withdrawal
1090:Protein contact dermatitis
696:10.1016/j.jaad.2004.10.202
565:10.1016/j.jaad.2014.11.024
126:Topical steroid withdrawal
44:Topical steroid withdrawal
26:
1203:Sulzberger–Garbe syndrome
211:was only produced by the
65:
56:
1235:Lichen simplex chronicus
758:10.4103/0019-5154.139876
1060:Abietic acid dermatitis
518:10.4103/0019-5154.97655
480:10.1586/17469872.2.1.31
292:evidence-based medicine
833:Lio PA (August 2019).
429:Sheary B (June 2016).
165:
1271:Drug-induced pruritus
996:Seborrheic dermatitis
839:Practical Dermatology
290:) in accordance with
286:A systematic review (
163:
1404:Cutaneous conditions
1317:Cholestatic pruritus
1307:due to liver disease
1176:Molluscum dermatitis
176:period is over, the
1373:Nummular dermatitis
1366:Fixed drug reaction
1183:Circumostomy eczema
981:Prurigo gestationis
645:10.2147/dhps.s69201
203:Mechanism of action
1329:Prurigo pigmentosa
1288:Aquagenic pruritus
1080:Contact stomatitis
1019:Contact dermatitis
166:
156:Signs and symptoms
148:are most at risk.
134:steroid dermatitis
1391:
1390:
1302:Adult blaschkitis
1239:Prurigo nodularis
1130:Eyelid dermatitis
1070:Airbag dermatitis
973:Atopic dermatitis
930:
929:
804:10.1002/jcb.23081
559:(3): 541–549.e2.
178:atopic dermatitis
146:atopic dermatitis
123:
122:
38:Medical condition
16:(Redirected from
1421:
1339:Puncta pruritica
1312:Biliary pruritus
957:
950:
943:
934:
914:
902:
901:
876:(3): 1293–1298.
865:
859:
849:
843:
842:
830:
824:
823:
798:(6): 1499–1505.
787:
781:
780:
770:
760:
736:
727:
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715:
709:
708:
698:
674:
668:
667:
657:
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623:
612:
611:
583:
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547:
541:
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530:
520:
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490:
489:
487:
486:
457:
451:
450:
426:
405:
404:
402:
400:
386:
347:
346:
317:
138:topical steroids
130:red burning skin
128:, also known as
101:topical steroids
61:
41:
21:
18:Red burning skin
1429:
1428:
1424:
1423:
1422:
1420:
1419:
1418:
1414:Corticosteroids
1394:
1393:
1392:
1387:
1378:Pityriasis alba
1348:
1344:Uremic pruritus
1334:Prurigo simplex
1283:Senile pruritus
1259:Pruritus vulvae
1254:Pruritus scroti
1225:
1212:
1193:Nummular eczema
1094:
1075:Baboon syndrome
1021:
1013:
990:
967:
961:
931:
926:
925:
911:
906:
905:
867:
866:
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850:
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832:
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428:
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408:
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388:
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350:
319:
318:
305:
300:
284:
275:
265:and/or topical
246:
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158:
39:
36:
23:
22:
15:
12:
11:
5:
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1363:
1356:
1354:
1350:
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1347:
1346:
1341:
1336:
1331:
1326:
1324:Prion pruritus
1321:
1320:
1319:
1314:
1304:
1298:
1297:
1296:
1295:
1285:
1280:
1279:
1278:
1267:
1266:
1264:Scalp pruritus
1261:
1256:
1251:
1242:
1241:
1231:
1229:
1214:
1213:
1211:
1210:
1208:Xerotic eczema
1205:
1200:
1195:
1190:
1185:
1180:
1179:
1178:
1173:
1168:
1154:
1153:
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968:
962:
960:
959:
952:
945:
937:
928:
927:
921:
920:
918:
917:Classification
910:
909:External links
907:
904:
903:
860:
844:
825:
782:
751:(5): 465–468.
728:
710:
669:
613:
578:
542:
511:(4): 251–259.
491:
452:
441:(6): 386–388.
406:
348:
329:(5): 233–240.
302:
301:
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296:
283:
280:
274:
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245:
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24:
14:
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1201:
1199:
1196:
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1191:
1189:
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1177:
1174:
1172:
1171:Dermatophytid
1169:
1167:
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1163:
1162:
1158:
1155:
1151:
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1146:
1143:
1142:
1141:
1138:
1136:
1133:
1131:
1128:
1126:
1123:
1121:
1120:Breast eczema
1118:
1117:
1114:
1111:
1109:
1106:
1105:
1103:
1101:
1097:
1091:
1088:
1086:
1085:Metal allergy
1083:
1081:
1078:
1076:
1073:
1071:
1068:
1066:
1063:
1061:
1058:
1055:
1054:
1051:
1050:Tulip fingers
1048:
1046:
1043:
1041:
1038:
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1032:
1029:
1025:
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1016:
1010:
1007:
1005:
1002:
1001:
999:
997:
993:
987:
986:Sweat allergy
984:
982:
979:
978:
976:
974:
970:
965:
958:
953:
951:
946:
944:
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829:
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786:
783:
778:
774:
769:
764:
759:
754:
750:
746:
742:
735:
733:
729:
725:. March 2021.
724:
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295:
293:
289:
288:meta-analysis
281:
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270:
268:
264:
260:
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243:
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235:
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230:
223:
221:
218:
217:keratinocytes
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73:
69:
64:
60:
55:
51:
47:
42:
34:
30:
19:
1306:
1249:Pruritus ani
1246:by location:
1245:
1134:
1056:
1036:
873:
869:
863:
852:
847:
838:
828:
795:
791:
785:
748:
744:
722:
713:
686:
682:
672:
635:
631:
594:(9): 60–61.
591:
587:
581:
556:
552:
545:
508:
504:
494:
483:. Retrieved
474:(1): 31–40.
471:
465:
455:
438:
434:
397:. Retrieved
393:
326:
322:
285:
276:
273:Epidemiology
255:Pimecrolimus
247:
239:
231:
227:
206:
197:
188:
170:inflammation
167:
150:
142:
133:
129:
125:
124:
1409:Drug safety
1161:Id reaction
1145:Dyshidrosis
1140:Hand eczema
1065:Diaper rash
638:: 131–138.
267:Clindamycin
263:Doxycycline
77:Dermatology
49:Other names
1398:Categories
1361:Bromoderma
1125:Ear eczema
1009:Cradle cap
966:and eczema
964:Dermatitis
689:(3): P47.
485:2014-12-18
394:DermNet NZ
298:References
251:Tacrolimus
236:Prevention
174:withdrawal
108:Prevention
1293:Aquadynia
898:231764481
705:0190-9622
244:Treatment
224:Diagnosis
119:Not known
116:Frequency
99:Stopping
72:Specialty
1218:Pruritus
1166:Candidid
1028:irritant
1024:allergic
890:33499686
820:22289437
812:21344493
777:25284851
723:BBC News
664:25378953
608:17728660
573:25592622
537:22837556
447:27622228
343:80154596
259:Dupixent
209:cortisol
185:Duration
89:Red skin
84:Symptoms
1227:Prurigo
1037:plants:
768:4171914
655:4207549
588:Nursing
528:3401837
399:19 July
282:History
213:adrenal
33:Sunburn
1100:Eczema
1057:other:
896:
888:
818:
810:
775:
765:
703:
662:
652:
606:
571:
535:
525:
445:
341:
257:, and
96:Causes
1353:Other
894:S2CID
816:S2CID
339:S2CID
194:Cause
1222:Itch
886:PMID
808:PMID
773:PMID
701:ISSN
660:PMID
604:PMID
569:PMID
533:PMID
443:PMID
401:2016
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