Topical Steroid Withdrawal: A Case Series of 10 Children

Abstract

SIGNIFICANCETopical steroid withdrawal is discussed widely in social media, and some patients with a history of long-term topical steroid use are self-diagnosing this condition. There is little information in medical literature about what happens when chronic topical steroid therapy is stopped, especially in children. This study followed 10 children for between 18 months and 4 years after their parents decided to cease their topical steroid use. The children experienced typical topical steroid withdrawal symptoms for many months, how ever, all eventually improved.Concerns about topical steroid withdrawal are causing some patients to cease long-term topical corticosteroid therapy, however, little is known about the ensuing clinical outcomes. This qualitative case series studied 10 children whose parents stopped their chronic topical corticosteroid use and subsequently developed features typically reported in adults experiencing topical steroid withdrawal. Patients were seen in an Australian general practice between April 2014 and October 2018, with follow-up periods ranging from 18 months to 4 years. Symptoms were difficult initially for the children and their families, however, all ultimately improved. At the final review, 4 of the children had clear skin and another 4 had symptoms consistent with their original, pre-treatment atopic dermatitis. More research is required into long-term topical corticosteroid use and its discontinuation, including topical steroid withdrawal, particularly in the pediatric population.

Diagnosis of a recurred lesion in dermatophytosis patients after 2 weeks of antifungal therapy: A prospective observational study

“…Risk factors like topical steroid use, atopic dermatitis, disease in family, and contact with pets are known to complicate and prolong the course of dermatophytosis, alter the clinical morphology of tinea lesions, and develop dermatoses unrelated to fungal infection. [ 8 9 10 11 12 16 17 24 ] In the present study, risk factors observed were topical steroid use, disease in family members, atopic dermatitis, and contact with pets. In the patients with recurrent lesions, 66.66% were fungal test negative (developed dermatoses unrelated to fungal infection) and 33.33% had a fungal infection.…”

“…Recently, few researchers reported that dermatophytosis patients may develop various lesions such as complicated/drug-resistant tinea, adverse effect unique to prolonged topical steroid use (“topical steroid withdrawal syndrome”), and chronic eczema/post-traumatic eczema at the previous sites of dermatophytosis. [ 1 6 7 8 9 10 11 12 13 14 15 16 17 18 19 ] Further, it is interesting to note that researchers did not find any correlation between risk factors like fungal infection of nail and disease in family members with the chronic dermatophytic infection. [ 20 21 22 ] Hence, it is important for physician to appropriately diagnose the recurrent lesions at the treated site of dermatophytosis prior to initiating therapy.…”

Steroid Phobia: Is There a Basis? A Review of Topical Steroid Safety, Addiction and Withdrawal

“…The genomic pathway refers to the actions of the glucocorticoid receptor and its subsequent transcriptions of genes with anti-inflammatory functions and downregulation of pro-inflammatory genes. The non-genomic pathway is responsible for the rapid effect of TCS by affecting target [12,14,23,66,68] Burning or pain [12,17,23,66] Itching [12,16,23,26,66,68] Pustulation or Acneiform lesions [12,30] Vesiculation [12,66] Desquamation and skin shedding [23,26,66] Lymphadenopathy [23,66] Red sleeve sign Erythematous rash ending abruptly at the dorsal and palmar border, sparing the palms and soles [11,15,16,23,66]…”

“…The rationale proposed for an immediate cessation without a taper is that the vasoconstrictive properties of TCS contributing to TSA/TSW would still remain despite a lower potency [12]. General measures recommended during the withdrawal phase include lifestyle modifications such as dietary changes and stress control [12], psychological support [12,15,18], cold water and ice [12,66], systemic antibiotics and astringents to prevent and treat concomitant bacterial infection [12,15], analgesics [12] sedatives [12] antihistamines [66], anxiolytics [12], and oatmeal-containing bath products [12]. Other treatments tried include topical calcineurin inhibitors [67], crisaborole [67], phototherapy [67], cyclosporin [12,67], and dupilumab [67].…”

“…Other treatments tried include topical calcineurin inhibitors [67], crisaborole [67], phototherapy [67], cyclosporin [12,67], and dupilumab [67]. Acneiform eruptions like steroid rosacea and perioral dermatitis can be treated with oral antibiotics such as doxycycline [66]. Response to therapy was inconsistent and studies were low quality, being limited to case reports or small series and thus cannot be used to generate recommendations for treatment.…”