Topical steroid withdrawal syndrome: time to bridge the gap

Cotter, C.; Burton, Tim; Proctor, Andrew; Moss, Celia; Flohr, Carsten

doi:10.1111/bjd.21770

Cited by 16 publications

(10 citation statements)

References 2 publications

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“…Recently, there has been tacit acknowledgement of TSW syndrome (TSWS) and its potential relationship to overuse of TCS, from parts of the UK dermatological community. This is evident in the content of two British Journal of Dermatology (BJD) Perspectives articles; the first (2022), 'Topical steroid withdrawal syndrome: time to bridge the gap' 6 and the second (2023), with contributors from UK patient advocacy group Scratch That, 'Topical corticosteroid withdrawal syndrome: the patient community call for high-quality research, clear definitions and diagnostic criteria'. 7 "'What is the long-term safety of applying steroids to the skin for eczema?'…”

Section: Obstacles Deterrents and Possibilitiesmentioning

confidence: 99%

“…While much can be learned from systematic reviews of earlier studies, when primary source trials and observational studies are lacking it appears doubtful that 'review [ing] critically the long-term safety data on TCSs' 6 will reveal new evidence. A substantive research evidence base will not be realised, unless the dermatological community's case for long-term observational studies is strong enough to attract governmental or other sources of independent funding.…”

Section: Obstacles Deterrents and Possibilitiesmentioning

confidence: 99%

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TCS overuse and withdrawal reactions: a UK lay-person’s perspective

Peacock¹

2023

Br J Gen Pract

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TCS overuse and withdrawal reactions:a UK lay-person's perspective Life & Times 'Corticosteroids suppress the inflammatory reaction during use; they are not curative and on discontinuation a withdrawal reaction (rebound or flare) may occur. Withdrawal reactions are thought to occur after longterm continuous or inappropriate use of topical corticosteroids (particularly those of moderate to high potency).' 1

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Section: Obstacles Deterrents and Possibilitiesmentioning

confidence: 99%

Section: Obstacles Deterrents and Possibilitiesmentioning

confidence: 99%

TCS overuse and withdrawal reactions: a UK lay-person’s perspective

Peacock¹

2023

Br J Gen Pract

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“…A recent paper called for observational studies of TSW and this review reinforces this research gap. 30 Finally, the development of a core outcome set of adverse effects associated with TCS use would standardise the recording of adverse effects for all skin conditions, improve the quality of future research and allow metaanalysis of adverse effect data. used in this review.…”

Section: Recommendations For Future Researchmentioning

confidence: 99%

The long‐term safety of topical corticosteroids in atopic dermatitis: A systematic review

Harvey

Lowe

Santer

et al. 2023

Skin Health and Disease

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BackgroundTopical corticosteroids (TCS) are a first‐line treatment for eczema, but there are concerns about their safety when used long‐term.ObjectivesTo systematically review adverse effects associated with longer‐term use of TCS for eczema.MethodsRandomised controlled trials (RCTs), cohort and case‐control studies reporting adverse effects of TCS (comparators: no TCS treatment, other topicals) in patients with eczema were identified. Included studies had greater than one year of follow‐up, minimum cohort size of 50 participants, or minimum 50 per arm for RCTs. Evidence was GRADE‐assessed. Prospero registration CRD42021286413.ResultsWe found seven studies (two randomised, five observational); two RCTs (n = 2570, including 1288 receiving TCS), two cohort (all received TCS n = 148) and three case‐control studies (cases n = 10 322, controls n = 12 201). Evidence from two RCTS (n = 2570, children, three and five years' duration) comparing TCS to topical calcineurin inhibitors found intermittent TCS use probably results in little to no difference in risk of growth abnormalities, non‐skin infections, impaired vaccine response and lymphoma/non lymphoma malignancies. The five‐year RCT reported only one episode of skin atrophy (n = 1213 TCS arm; mild/moderate potency), suggesting TCS use probably results in little to no difference in skin thinning when used intermittently to treat flares. No cases of clinical adrenal insufficiency were reported in 75 patients using mild/moderate TCS in the three‐year RCT. Small associations between TCS and type‐2 diabetes and lymphoma were identified in two case‐control studies compared to no TCS, but the evidence is very uncertain. No long‐term studies concerning topical steroid withdrawal or eye problems were identified.ConclusionThis review provides some reassuring data on growth and skin thinning when TCS are used intermittently for up to 5 years, but many knowledge gaps remain.

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“…1 Prolonged use, however, may result in topical steroid withdrawal syndrome (TSWS), 1 – 4 also known as red skin syndrome, or topical steroid addiction. 4 , 5 …”

Section: Introductionmentioning

confidence: 99%

“…In July of 2022, the Government of Canada made a statement regarding TSWS in a Health Product InfoWatch article, 4 and a recently published article in the British Journal of Dermatology highlighted the need to “bridge the gap” between patients and providers in relation to prevention, recognition, and treatment of TSWS. 5 …”

Section: Introductionmentioning

confidence: 99%

Topical steroid withdrawal syndrome in a mother and son: A case report

Feschuk

Pratt

2023

SAGE Open Medical Case Reports

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Topical corticosteroids are first-line treatment for many dermatoses, and are generally considered safe and effective. However, topical steroid withdrawal syndrome can result from use of topical corticosteroids, and this condition is not well-known among physicians. This article reports a mother and son whose presentations of topical steroid withdrawal syndrome following the discontinuation of prolonged, high-potency topical corticosteroid use were nearly identical. This report adds to the growing body of evidence that topical steroid withdrawal syndrome is its own entity, rather than an exacerbation of the underlying dermatosis, and adds to the few pediatric reports of topical steroid withdrawal syndrome. Management for both patients involved topical corticosteroid discontinuation; however, it took approximately 2 years before the majority of their topical steroid withdrawal syndrome manifestations resolved. Increased awareness surrounding this condition is essential to facilitate topical steroid withdrawal syndrome prevention and diagnosis and to decrease topical corticosteroid phobia and increase patient–physician trust.

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Topical steroid withdrawal syndrome: time to bridge the gap

Cited by 16 publications

References 2 publications

TCS overuse and withdrawal reactions: a UK lay-person’s perspective

TCS overuse and withdrawal reactions: a UK lay-person’s perspective

The long‐term safety of topical corticosteroids in atopic dermatitis: A systematic review

Topical steroid withdrawal syndrome in a mother and son: A case report

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