Topical steroid addiction

I've read that using topical steroids for extended amount of time can cause topical steroid addiction and that when you try to withdraw from using them, the symptoms mimic spreading eczema. Is this true?

24 June 2020

Last clinically reviewed in September 2019 by Jo Poolman, Registered nurse and team manager of AXA PPP healthcare's Health at Hand team.

There is no evidence that topical steroids change the nature of the underlying disease, so I think the above statement is not correct. Topical steroids have been used for many years and remain one of the most important treatments for eczema. If they are used correctly they can control symptoms such as inflammation and irritation and are known to improve the patient’s quality of life.

Eczema is a condition where the skin becomes inflamed due to a defect in the body’s immune system. Once the skin has become inflamed and irritated, a steroid cream is needed to reduce these symptoms. To begin with, the lowest effective strength of steroid cream should be used to achieve this. Once the redness and inflammation has settled the steroid cream can be stopped. Moisturising creams should then be continued daily to try to prevent the eczema from returning.

There is no cure for eczema. Management with the correct application of moisturising creams  - or emollients - help control it, along with steroid creams when it flares up.

The most common side effect of prolonged high-dose steroid cream use is thinning of the skin. This is why strong steroid creams should only be used regularly under the guidance of a dermatologist. If eczematous skin is left untreated the skin can become thickened.

Other eczema treatments

In addition to the regular application of moisturisers and occasional use of topical steroids to control flare-ups, other eczema treatments include:

  • antihistamines to help control severe itching
  • bandages, special body suits or 'wet wraps' to trap moisture next to the skin, help sooth the affected area and provide a physical barrier to scratching, allowing the skin to heal underneath
  • short term use of antibiotics and antiseptics - usually in a moisturising base - if an eczema patch becomes infected
  • Topical calcineurin inhibitors, such as tacrolimus ointment and pimecrolimus cream, for eczema in sensitive sites or that isn't responding to simpler treatments
  • More potent oral medications, given under the supervision of skin specialists for people with severe or widespread atopic eczema not responding to topical treatments. These work by dampening down the immune system and include: oral steroids (prednisolone), azathioprine, ciclosporin, methotrexate and mycophenolate mofetil.

Self help tips for managing eczema symptoms

There are also lots of things you can do to help ease your eczema symptoms and prevent flare-ups:

  • Moisturise your skin as often as possible, ideally at least 2-3 times each day.
  • Avoid putting your fingers back and forth into the pot of moisturiser, as it may become contaminated and be a source of infection.
  • Wash with a moisturiser or soap substitute, and avoid soap, bubble baths, shower gels and detergents.
  • Try not to scratch - it may provide short term relief but will make your skin itchier in the long term. Smooth a moisturiser onto itchy skin, or try these tips from the NHS:
    • Try gently rubbing your skin with your fingers instead.
    • If your baby has atopic eczema, anti-scratch mittens may help
    • Keep your nails short and clean to minimise damage to the skin from unintentional scratching.
    • Keep your skin covered with light clothing to reduce damage from habitual scratching.
  • Dietary changes - aome foods, such as eggs and cows' milk, can trigger eczema symptoms. Always consult a GP or other qualified medical practitioner before making significant changes to your diet. This is particularly important when it comes to children. If a food allergy is found to be a significant trigger for your, or your child's symptoms, you may be referred to a dietitian (a specialist in diet and nutrition). They can help to work out a way to avoid the food you're allergic to while ensuring you still get all the nutrition you need.
  • Wear powder-free vinyl (non-rubber) gloves to protect your hands and avoid contact with irritants, such as when doing housework.
  • Rinse well after swimming and apply plenty of your moisturiser after drying.
  • Wear comfortable clothes made of materials such as cotton, and avoid wearing wool next to your skin.
  • Wash clothes with a non-biological washing powder and use a double rinse cycle to remove detergent residues.
  • Do not keep pets if there is an obvious allergy to them.
  • Keep cool. Overheating can make eczema itch more.
  • Treat eczema early - the more severe it becomes, the more difficult it is to control.

Sources

British Skin Foundation

NHS Eczema pages

National Eczema Society 

You may also be interested in...

Eczema through the ages

Atopic eczema

Corticosteroids (topical)

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