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What Are The Stages of Topical Steroids Withdrawal?

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What are Steroids?

             Steroids are the hormones the human adrenal cortex produces. They also refer to the synthetic drug with cortisol effects. Steroids which are also known as corticosteroids are very different from steroid compounds used by athletes to enhance their performances. Usually used in medical cases. Medical conditions steroids used to treat include allergies, asthma, dermatitis, hives, Addison's disease, Crohn’s diseases, leukemia, prostate cancer, etc.

         Steroids are classified into types depending on the effect they create within the body. They also produce many side effects such as depression, anxiety, insomnia, hypertension, fluid retention, muscle wasting, decreased height, cataract, glaucoma, peptic ulceration, TSW (topical steroids withdrawal).

Must Read:: Can Blocking Cortisol Lead to Steroid-Like Muscle Gains?

Topical Steroids:

          These are medications in the form of creams, lotions, ointments, solutions, serums, gels, sprays, foam, oils, shampoos and other substances made for skin or scalp. Also, used for anti-inflammatory purposes; to treat or control skin infections such as eczema and dermatitis. Other names for topical steroids are topical corticosteroids, glucocorticosteroids, and cortisone.

Effects of Topical Steroids:

            These steroids cause the same effects as the corticosteroids produced by the adrenal glands located above the kidneys. Other side effects of applying these steroids on the skin or scalp include narrowing blood vessels, suppression of immune response and reduction of cell turnover. All the effects of using these steroids can be classified under the following:

  • Anti Inflammatory
  • Immunosuppressive
  • Anti-Proliferative
  • Vasoconstrictive

The Potency of Topical Steroids: 

The potency of topical steroid refers to the working capacity of the medication and they can be grouped into four:

  • Low Potency: Topical Steroids that can be classified as having low potency include alclometasone dipropionate, hydrocortisone, and desonide. 
  • Moderate Potency: Topical Steroids with medium potency include betamethasone valerate, clocortolone pivalate, flurandrenolide, fluocinolone, fluticasone propionate, and hydrocortisone valerate.
  • High Potency: Topical steroids grouped under this category include desoximetasone, halcinonide, amcinonide, and triamcinolone acetonide.
  • Very High Potency: Topical steroids belonging to this category include betamethasone dipropionate, diflorasone diacetate, fluocinonide, clobetasol propionate, and halobetasol propionate.

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The potency of a Topical Steroid would largely depend on the following factors:

  • Formulating components
  • The amount that reaches the target cells
  • The specific molecule
  • The rate of absorption through the skin.

         You can purchase topical steroids with mild potency, just over pharmaceutical counters but those with high and very high potency should only be on doctor’s prescriptions.

Conditions that would require being treated and controlled by the use of Topical Corticosteroids include:

  • Eczema (atopic eczema): This is a skin condition that causes the skin to feel itchy, scaly, dry and cracked. It may even lead to severe skin inflammation. This inflammation causes the skin to become red, dark brown or gray depending on skin tone. It usually is a long-term condition that affects the major part of the skin such as the hands, backs, knees, faces, scalps, etc. However, it can still be controlled and treated using topical steroids. It is the most common form of eczema.

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  • Dandruff: This is a skin condition that usually affects the scalp making it dry, itchy. It causes white flakes on the scalp and hair. Using a shampoo containing topical corticosteroids should help in treating this skin condition.
  • Psoriasis: This is a skin condition that usually occurs on the elbows, knees, scalp, legs, lower back but can occur on any part of the body. It causes a small patch of red, flaky, crusty and itchy skin. This chronic disease caused by the multiplied production of skin cells resulting in a build-up. This skin condition can also be controlled by the use of topical steroids.
  • Nappy Rash: This is a skin condition in babies that causes a sore and itchy red patch of skin on the baby’s bottom-most especially. It can also happen in the form of spots or blisters. Using a cream containing topical steroids can help with this situation, especially when it is in its severe state.

Lichen Planus:

This is a skin condition that can occur in the mouth, groin, nails and other parts of the body. It causes a cluster of glossy elevated colored blotch on the affected area. This area is usually sore, itchy and red. Using a medication containing topical steroids can help with this condition.

  • Discoid Lupus Erythematous: This is a condition that causes skin rashes, extreme fatigue and inflammation of the joints. It can also lead to weight loss and extreme joint pain. This condition can be controlled by using creams that contain topical steroids.
  • Skin Irritation: Skin irritation who is characterized by swollen, itchy and red parts of the skin can be caused by many factors. An insect bite is a factor. Applying a medication that contains topical steroids would be effective in alleviating the pains.

Combination with Other products:

         Topical steroids are usually used with other ingredients such as anti-bacteria and anti-fungal to create a more effective result. The risks involved in using topical steroids with other drugs are quite low and there is no significant effect on the potency of topical steroids when combined with other products. 

        These other drugs do not affect the concentration or effect of topical steroids. However, it is strongly advised that the use of other topical medications should not be carried out at the same time as topical corticosteroids to avoid creating more adverse effects.

How Topical Corticosteroids Are Used:

           If you purchase any type of topical steroid from over the pharmaceutical counter, ensure you follow the instructions on the leaflet. Otherwise, you should adhere strictly to the doctor’s prescription. Most times, these substances are applied to the affected part once or twice daily for two weeks or more. It should be used less frequently as treatments commence. The use of these medications should be reduced to once a day to avoid the occurrence of topical steroid withdrawal. 

Doctors Prescribe Steroids

            Also, it should not be applied all over the body but rather, just the affected parts of the body. It should be applied gently into the skin. If you use emollients, avoid using both substances at the same time. Give a 30 minutes time difference between the applications of both substances. These emollients help to relieve skin irritation and dryness.

The Finger Print Unit

            The fingerprint unit acts as a guide for the use of the right dosage of topical steroids in the treatment of skin conditions. You squeeze a quantity of the product from the tip of your finger to the first crease. This quantity should be enough to treat skin conditions that occur over a patch of your skin that is two times the size of your palm. However, the dosage will still depend on what is being treated and the part of the body it is being treated. This is major because some parts of the body have thinner skin layers and hence more sensitive, than other parts. This dosage often referres to as FTUs(s).

           The absorption of topical steroids into the body occurs in different ways. For instance, the greatest absorption happens through the skin layer of the genitals, eyelids, and creases. Hence, potent and highly potent topical steroids should not be used on these parts of the skin.

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             The least absorption of topical steroids occurs through the skin layer of palms and soles. Hence, low and moderately potent topical steroids may seem ineffective when applied to these parts of the skin. Using bandages or wraps to occlude the affected part would also help to increase the absorption of topical steroids through the skin layer.

Below is the recommended dosage for each part of an adult's body, using the Finger Print Unit 

  • 0.5 FTU for the skin found around the genitals.
  • 1 FTUs for skin located around the hands, elbows, and knees.
  • 1.5FTUs for the skin located around the feet, including the soles.
  • 2.5 FTUs for skin located around the face and neck
  • 3 FTUs for the skin located around the scalp
  • 4 FTUs for the skin located around the hand, arm and the buttocks
  • 8 FTUs for the legs and chest or the legs and the back

Who should use Topical Corticosteroids?

             Adults and children can use topical steroids. However, if you have infected skin, broken skin or skin conditions like acne and open sores, avoid the use of topical steroids for treatment. Topical steroids should only be used by pregnant and nursing mothers in necessary situations. Research shows that the prolonged use and abuse of these substances can cause defects in the unborn child.

         Therefore, the use of topical steroids with high potency should not be practiced by nursing and breastfeeding mothers. There is no proof if the content can make contact with the breast milk mother apply all caution during usage, of topical steroids, even of low potency. Do not apply topical steroids to a nursing mother’s breasts and if she must use these medications, she should also be careful to wash off the cream from her breasts before breastfeeding her child. This safety measure is very important to prevent the child from being harmed.

Side effects of using Topical Steroid Withdrawal:

           For the use of most medications, there are side effects that may occur with different individuals. These side effects should not be confused with Topical Steroid Withdrawal. The side effects include:

  • Some individuals may experience certain internal side effects that are similar to the symptoms of crushing syndrome.
  • It can also result in skin thinning; that is the reduction of skin elasticity.
  • Stretch marks in armpits or genitals.
  • Tearing of the skin due to the extreme thinness of the skin layer.
  • The enlargement of blood vessels.
  • The thickness and increased length of hair.
  • It can also lead to cataracts and glaucoma when used frequently over the eyelids.
  • Stinging of the skin can also occur when the topical steroids applies to areas of the skin that have inflammation or are broken. 
  • The use of topical steroids can also heighten the effects of other skin infections such as herpes simplex.

Topical Steroid Withdrawal:

          This is also known as red skin syndrome or steroid dermatitis, which occurs after a person ceases to use topical steroids after prolonged regular use or the abuse of topical steroids. This condition usually occurs with the use of topical steroids with high levels of potency. The symptoms are mostly on the face and genitals. There is, however, no exact time or duration that these symptoms take to appear. It differs in individuals; in some, it may be a few months while for others, it could take many years. Individuals with atopic dermatitis and women who blush often are at more risks. Very few reports have occurred in children. The first known case of topical steroid withdrawal happened in 1979.

Causes:

           This condition mainly caused by the abuse, prolonged or regular use of topical steroids for usually more than a year. It was once believed that cortisol is only produced by the adrenal glands. However, recent research has proven that keratinocytes in human skin should also be included in the list. The prolonged or regular use of topical steroids would cause an adverse expression on the surface of lymphocytes.

Diagnosis:

           We mustn't attribute every skin condition to Topical Steroids Withdrawal. Some symptoms of Topical Steroid Withdrawal are redness and rash on the face, excluding the nose, and around the lips. This rash would usually begin from the part of the skin that initially had the condition that was to be treated. Redness of the arms with exception to the palms and fingers. The reduction of the elasticity of the skin can also be a way to tell if you have this condition. A burning feeling under the skin also forms part of the diagnosis. The reddened part of the skin may not just be a patch. It may also appear as the original skin condition the topical steroid applied to treat or control. Your skin can also feel thickened and swollen.

          When you use this product with the right frequency, dosage and over the appropriate duration, it helps with the treatment and control of skin conditions. Side effects and topical steroids withdrawal only occur, when you use the product in larger quantities or frequently over a long period; beyond the prescriptions of doctors, dermatologists, and physicians. It is also important that the use of this treatment need to be under the supervision of a dermatologist.

             Deciding not to use topical steroids to treat or control skin conditions due to the knowledge of these side effects and topical steroids withdrawal, may not be the best of choices as these substances can prove the effective in the treatment of skin conditions; especially when used according to prescription and over the right duration. Besides, this condition is pretty rare both in adults and children. 

Major signs and symptoms of topical steroid withdrawal include:

  • Spreading Dermatitis through the skin; usually starting from the location or region previously affected by the skin condition that treates.
  • Skin Inflammation accompanied by a burning, stinging sensation.
  • Redness of the skin; usually the face excluding the nose and around the lips.
  • Swelling of different regions of the skin. This particular symptom is one the affected individual should waste no time in informing the physician or dermatologist.
  • Intense itching in various areas of the skin is also a sign or symptom.
  • Increased skin sensitivity to other topical products or atmospheric conditions.
  • Oozing of liquid substances from the different parts of the skin.

      These symptoms may develop weeks or months after the stoppage of the use of topical steroids withdrawal. It is usually different per individual but most cases happen with individuals who have used the product for more than 12 months.

Must Read:: How Do You Get Rid of Steroid Acne?

        These signs and symptoms can also be classified into two types. Both referred to as erythema to edematous and papulopustular. The erythema to edematous type is found in individuals with atopic or seborrheic dermatitis where it is accompanied by swelling, burning, redness of the skin and heightened skin sensitivity. All these symptoms would occur within a fortnight from the stoppage of the use of topical steroids.

          The papulopustular type is found in individuals who have used these medications for the treatment of acne. This comes with symptoms such as pimples, nodules, and redness. This is when this product is for cosmetic purposes.

Prevention of Topical Steroids Withdrawal

             The most effective method of prevention is to use these medications strictly based on prescriptions. These symptoms are more likely to appear of these medications that are misused. The more frequently topical steroids are used, the more likely for the individual to develop topical steroids withdrawal. The more potent the topical steroid and if used for a longer period than prescribed, the higher the probability of having topical steroids withdrawal. Use topical steroids to treat or control skin conditions and not for cosmetic purposes. Preventing these withdrawal symptoms is quite simple if you adhere to the above guidelines. However, in totally preventing topical steroids withdrawal, treatment of chronic skin conditions with the use of topical steroids shouldn't avoid or discourage.

Treatment of Topical Steroid Withdrawal:

           No one treatment widely agrees upon. However, the first step would be to consult your dermatologist or skin care physician. There has to be a diagnosis to be sure that the symptoms noticed are of topical steroids withdrawal and not another skin condition like eczema. 

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          Once the diagnosis has been made, the next step would be to stop the wrong use of these medications. There have been some arguments as to stopping the use of these medications abruptly or gradually. However, there is not any significant difference in the results produced by both actions. It highly advise to stop the use of the medications immediately.

Psychological Support

          Support and psychological care should also be patient. Other ways to help with the condition are the use of ice compresses, systemic doxycycline, tetracycline or calcineurin inhibitors. Ointments and balms such as shea butter have also be found to be helpful during this time. Epsom salt bath is also helpful in the recovery process. Antihistamines should be used to help with the intense itching of the skin that also occurs as a symptom. Immunosuppressants suggest to help as well.

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       Another method would be to use oral steroids to reduce the symptoms. If it has led to secondary infections, oral antibiotics should be used. Patients should use soaps and detergents that would be suitable for sensitive skin. Also, wear clothes that are milder and softer on the skin to help reduce irritation. There have also been suggestions for natural and alternative medicine. However, these methods takes to approve your doctor before attempting to use them so they do not worsen the condition.

Duration of Treatment:

           The duration of treatment and recovery is not the same for everyone. However, it usually influence by the period through which these medications used; the longer the period of use would mean a longer period for recovery. The duration of recovery and the time it would take for the skin to return to normal would depend on the treatment used as well. This duration can be months or even years for certain individuals. It advise to take steps to rather prevent this from occurring that having to wait for so long for your skin to return to normal.

Conclusion

              In conclusion, topical steroids are very effective in the control and treatment of skin conditions; both mild and chronic conditions. It may lead to an eventual cure for some but for others, it may just help relieve the symptoms. However, if used in excess, abused, used in large quantities and over a long period, it may lead to topical steroid withdrawal. Though this condition is quite rare, it advise that it prevents strictly following prescriptions. It would be good to also have your treatment monitored by your dermatologist or physician.

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