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Glucocorticosteroids or glucocorticoids are stress hormones that aim to prepare the body to respond to infections, diseases and other stressful events like surgery, accidents and even pain caused by the withdrawal of certain medications  etc. Prednisone is a synthetic form of glucocorticoid that is mainly prescribed for therapeutic reasons to minimize the intensity of inflammatory or autoimmune reactions in the body and is not generally considered a drug of abuse.
However, surprisingly, abrupt cessation of therapy is associated with moderate to severe withdrawal symptoms. The intensity or severity of symptoms is dependent on the duration of therapy, underlying medical conditions and dosage frequency of prednisone. Withdrawal symptoms can include:. In some susceptible patients, abrupt prednisone withdrawal may also lead to severe complications like acute adrenal crisis, which is a life-threatening condition that is marked by high grade fever, excessive sweating, changes in the complexion of skin, low blood pressure, dehydration, abdominal pain, flank pain, joint pain, changes in heart rate, rigors and shaking chills - ultimately culminating in confusion, delirium and coma or even death.
The human body is very sensitive and calculated when it comes to the maintenance of its internal environment, so in situations where we consume glucocorticoids from external sources like prednisone , the human adrenal glands shut down the production of glucocorticoids. This creates a deficit in internal production, but as long as you are getting prednisone from external sources, no complications or adverse effects are observed. However, in case of abrupt cessation  , the human body retaliates to low glucocorticoids by:.
Healthcare providers therefore usually prescribe prednisone for limited periods of time and taper the dosage as soon as the acute symptoms are well under control. Clinical studies indicate that well-executed withdrawal of prednisone decreases the requirement of insulin and antihypertensive drugs for the control of blood pressure and a better serum lipid profile . In general, people who develop topical steroid withdrawal can develop one of two main types of rashes: erythematoedematous "red and swollen" and papulopustular "bumpy".
The rashes are usually limited to the areas of skin where topical steroids were applied, and more often affect the face or genital areas because of the thinner skin in these areas. These two types of rashes, as well as other symptoms seen in topical steroid withdrawal, are described below.
People with topical steroid withdrawal who develop the erythematoedematous form of rash will experience the following. This type of rash is seen more commonly in people who used the topical steroid for an underlying skin condition such as atopic dermatitis eczema or seborrheic dermatitis. People with topical steroid withdrawal who develop the papulopustular form of rash will experience the following.
This type of rash is seen more commonly in people who used the topical steroids for acne or for cosmetic appearances. Topical steroid withdrawal usually occurs in adults older than 18 years old and has been reported more frequently in women. Most people who use topical steroids as directed do not get topical steroid withdrawal.
Risk factors for developing topical steroid withdrawal include using mid- or high-potency steroids, using topical steroids more frequently or for a longer duration than recommended and using topical steroids on the face or groin region. Most cases of topical steroid withdrawal have been described in people who use mid- or high-potency topical steroids.
For example, creams and ointments tend to be stronger than lotions and solutions. Examples of mid- and high-potency topical steroids include triamcinolone 0. This may cause topical steroid withdrawal. High-potency topical steroids are typically not to be used more than once daily, and for no longer than three weeks at a time. In some cases, your physician may recommend using a mid- or high-potency topical steroid intermittently, such as twice a week as maintenance therapy.
In addition, most physicians will recommend tapering the topical steroid once the skin condition has resolved. Most people who develop topical steroid withdrawal use topical steroids daily and for more than 12 months. Using topical steroids on the face or groin regions increases the risk of developing topical steroid withdrawal. This is because the skin on the face and groin regions is thinner and absorbs topical steroids more easily, predisposing the individual to develop topical steroid withdrawal in those areas.
Treatment for topical steroid withdrawal involves discontinuing the use of topical steroid medications and managing the symptoms of the withdrawal. Specific treatment options include:. In most cases of topical steroid withdrawal, the first step in treatment is to discontinue the use of topical steroid medications.
Some physicians may recommend tapering the topical steroid slowly, due to concern that stopping the topical steroid suddenly may worsen the withdrawal symptoms. However, other physicians may recommend stopping the topical steroid suddenly once withdrawal symptoms develop since some studies show no difference between stopping suddenly and stopping gradually.
Some physicians may recommend applying ice or cool compresses to the skin to alleviate stinging, burning, or itching. People with steroid withdrawal syndrome who experience significant itching may benefit from antihistamine medications , which prevent the body from releasing substances that contribute to the itching.
The doctor may recommend one of two types of antihistamines. Some people with steroid withdrawal syndrome may benefit from a course of certain antibiotic medications, such as tetracycline, doxycycline, or erythromycin. These antibiotic medications have anti-inflammatory effects as well, and therefore may be helpful in controlling symptoms. Antibiotic medications are more often used for people with the papulopustular type of rash. Some physicians may recommend that people with topical steroid withdrawal complete a short course of oral steroid medications, such as prednisolone.
Topical steroid withdrawal is only due to the excess use of topical steroids, so a course of oral steroids would not worsen the symptoms and may help by reducing inflammation throughout the body. Because steroid withdrawal syndrome can cause a fair amount of distress due to the symptoms and the appearance of the rash, some people with steroid withdrawal syndrome may benefit from psychological support such as counseling. If you develop any symptoms of topical steroid withdrawal after using topical steroids, you should see your physician.
He or she can determine if your symptoms such as skin redness, swelling, burning, or itching, are in fact due to topical steroid withdrawal. Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions. Liu received his medical degree from the University of Pennsylvania Perelman School of Medicine and is pursuing a career in ophthalmology. He has published research in multiple ophthalmology and healthcare journals and has received awards from Research to Prevent Blindness.
In his free time, he enjoys running, biking, and spending time with his friends and family. Questions may relate to diseases, illnesses, or conditions you may have or that may run in your family. Your answers will help us provide you with medical information and identify services that may be relevant to your health. Buoy Health uses reasonable physical, technical, and administrative safeguards such as firewalls, encryption, identity management, and intrusion prevention and detection to protect your information.
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Verified By Experts Icon. Verified by experts 7 min read. No Ads. Tom Liu, MD. Ophthalmology Resident, University of Pennsylvania. Jeffrey M. Last updated August 27, Heart Icon. Speech Bubble Icon. Share Icon. Facebook Icon. LinkedIn Icon. Pinterest Icon. Pocket Icon. Share Link Icon. Copied to clipboard. Table of Contents. Topical steroid withdrawal questionnaire Use our free symptom checker to find out if you have topical steroid withdrawal. Topical steroid withdrawal symptoms Topical steroid withdrawal symptoms usually develop within days to weeks after stopping a topical steroid medication.
Erythematoedematous rash People with topical steroid withdrawal who develop the erythematoedematous form of rash will experience the following. Redness and swelling of the skin: This will be at the site of topical steroid application. Skin that is scaly or peeling Red bumps may or may not be present Defined rash border: In some people who develop this type of rash on the face, there may be a sharp cutoff between the red and normal-appearing parts of the skin, with sparing of the nose and ears.
Papulopustular rash People with topical steroid withdrawal who develop the papulopustular form of rash will experience the following. Redness with prominent red bumps and pus-filled bumps: These will appear over the area of topical steroid application. Less prominent swelling No skin peeling Other symptoms Other symptoms associated with topical steroid withdrawal include the following.
Burning and stinging of the skin: Most people experience a burning and stinging sensation over the skin where the topical steroid was applied. This is usually more prominent in the erythematoedematous type of rash than in the papulopustular type of rash.
In some cases, the skin may feel outright painful. The burning and stinging may be exacerbated with exposure to heat or the sun. Itchy skin: Some people with topical steroid withdrawal may also experience itching of the skin where topical steroids were applied. Itching usually follows a period of burning and stinging and occurs once the redness starts to fade.
The itching may be severe enough to interfere with sleep. Facial hot flashes: Some people who develop topical steroid withdrawal on the face may experience episodes of hot flashes.
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