Navigating the Challenges of Topical Steroid Withdrawal

Topical Steroids are a common prescription in modern society, with corticosteroids commonly prescribed for eczema. These are prescribed to newborns ranging from adults, increasing dosages over time. Due to this, Topical Steroid Withdrawal (TSW) is rising. Those who have relied on these topical treatments are stopping use and experiencing subsequent debilitating whole-body withdrawal symptoms. This condition is only partially accepted within the dermatology field, making it difficult for those relying on conventional medicine to support this withdrawal adequately.

What is Topical Steroid Withdrawal?

TWS, also known as ‘red skin syndrome’ due to the whole body redness and inflammation that can occur systemically, refers to a group of symptoms 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, and 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 skin wrinkling in 56% due to the lack of skin integrity and thinner skin post-long-term use(1).

Topical steroids commonly prescribed in Australia are potent long-term include: Elocon, Sigmacort, Halog Ointment, Lidex Cream and Florone Ointment. Short-term steroid use’s commonly accepted symptoms 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, it can still occur.  The longer the usage, the more likely systemic withdrawal symptoms will 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 service is for eczema, and resolving 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 more substantial skin cell barrier, leading 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 and make these essential in treating the original use of topical steroid use alongside the withdrawal symptoms. Essential fatty acids can be found in fatty fish, salmon, mackerel, chia seeds, flax seed oil and walnuts. High therapeutic dosages through supplementation to support TSW are crucial in combination with dietary changes.

Zinc

Zinc is a micronutrient essential to human health; in terms of skin health, zinc plays a central role in the wound healing process and skin cell repair(3), supporting a reduction in inflammation, oxidative stress and scar formation. Zinc dosing must be correlated based on patients’/copper levels to ensure optimum dosage and high dosing where appropriate.

Herbal Support

Adrenal support post topical steroid use is essential due to the effects steroid use can have, suppressing 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 entirely inflammation-driven, as most chronic conditions are(5), dietary changes will always make the most significant 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 depends on the individual but is richer in fruits, vegetables, omega-3 foods, healthy fats and lean protein—minimising or strictly avoiding dairy, sugar and gluten intake.

Creating a support network

Due to the nature of Topical Steroid Withdrawal nature, creating a support network during more challenging times is essential for mental health, keeping up with daily tasks and ensuring a wholesome and healthy diet is maintained. The lack of a timeline for when the symptoms will end can be callous, making this even more critical. Other online support websites such as ITSAN(4) and Topical Steroid Withdrawal Facebooks groups can significantly assist in reassuring you are not alone and that there is an end in sight.

I’d like to point out that working with a team of professionals (naturopathy, psychology, an experienced TSW dermatologist and a supportive GP) to help with your topical steroid withdrawal journey is very important. A naturopath is invaluable to make your post-steroid use journey smoother regarding skin repair, nutritional factors, improving stress response, decreasing insomnia symptoms and overall healing time.

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