Since the late 1940’s topical corticosteroids (steroids) have been giving quick and effective relief to sufferers of eczema, dermatitis and many other skin conditions. They come as an ointment, cream or solution and are available via prescription or over the counter.
Many validate their use and celebrate them for the significant improvements in life quality. However decades of misuse has lead to a phenomenon known as topical steroid addiction (TSA). TSA is also seen as a withdrawal process, because it occurs after stopping topical steroids use.

Do you suffer from a skin condition that calls for topical steroid use? You might want to reconsider how it’s affecting your skin and if it’s worsening your condition in the long term.

What is topical steroid addiction

Topical steroid addiction is also known as topical steroid withdrawal (TSW) or red burning skin syndrome (RBSS). It occurs once prolonged use of topical steroids are discontinued. The withdrawal process is what researchers refer to as “steroid rebound phenomenon”, which is when skin cells start to degenerate. The condition is characterized by red, itchy, burning skin,  the same symptoms it’s suppose to be treating. Dermatologist Dr Peter Lio from Feinberg School of Medicine suggests this is the most elusive part of topical steroid addiction, because the signs and symptoms are the same as eczema itself. Perhaps this is the most dangerous aspect and why TSA is so prevalent.

Confusing topical steroid withdrawal with for eczema, or vice versa can lead to inappropriate treatment.  So, it’s important that care is taken to prevent unnecessary and unwanted side effects.

When topical steroid use becomes a problem

Addiction, dependence and withdrawal are all commonly accepted concepts with drug use. Yet with topical steroids it remains undiagnosed.
This may be because not everyone experiences symptoms. For some, it can take as little as two weeks of using topical steroids for withdrawal to become a problem. But it is still unclear why some are affected and others are not.

To be sure topical steroid addiction doesn’t become a continuous cycle in your life, keep these points in mind

• Daily use of topical steroids shouldn’t be continuously used for more than 2-4 weeks, depending on their strength. Frequency should then be tapered.
• Your doctor or health care practitioner should aim to implement a safe and effective long term treatment, which does not depend on topical steroids.
• Ask for refills after evaluation of your doctor.

Where to find additional for help with topical steroid addiction

There are also organisations, such as The International Topical Steroid Addiction Network (ITSAN), which is a non profit charity that grew from a sufferer’s experience. It now has an international community and offers a survival guide for coping with topical steroid withdrawals. ITSAN is dedicated to raising awareness about TSA and consists of members who support, comfort and encourage one another. It’s also a platform of resources for the individual, caregiver and healthcare practitioner to work their way through treatment options.

In the end, what’s most important is that skin conditions like eczema are safely treated, and that adverse effects of the treatment themselves are kept to a minimum. While the use topical steroid treatment is highly effective, the withdrawal is a debilitating condition. If you suffer with a skin condition and the dependence of topical steroid use, find the right support and help to get you through it.

Find out more about topical steroid addiction in this video ITSAN put together

ITSAN2015 from Shoshana Productions on Vimeo.