A systematic review of topical corticosteroid withdrawal (“steroid addiction”) in patients with atopic dermatitis and other dermatoses. Hajar T. et al. J Am Acad Dermatol. 2015 Mar;72(3):541-549.e2. doi: 10.1016/j.jaad.2014.11.024. Epub 2015 Jan 13.
Introduction
-Topical corticosteroids are used for prolonged periods in many dermatological affections, the most common one is Atopic Dermatitis (AD).
-A lot of postings in Social Media discourage use of topical steroids in the treatment of AD, because of a so called “addiction risk”
Methodology
-294 patients out of 34 case studies were obtained (1969-2013; retrospective study)
Observations
Burning and stinging were the most frequently reported symptoms (65.5%) with erythema being the most common sign (92.3%)
2 types of reactions occur:
-Erythematoedematous type: there is more burning and stinging; ths skin shows erythema, desquamation and scaling. This type is most often seen following withdrawal when treating an ezematiform condition( (AD), seborrheic dermatitis…)
-Papulopustular type. There is less burning and stinging but the presence of papules, nodules and pustules. This type is most often seen in steroid use for comsetic use or when treating acneiform disorders.
Management
-discontinuation of topical steroids
-erythematoedematous: antihistamines, ice/cool compresses, and psychological support
-papulopustular subgroup: treatment with oral antibiotics
Take home messages
-The two types of reaction are an adverse effect of prolonged use of potent (strong) topical corticosteroids (not an addiction)
-Prevention by using moderate strength steroids as well as calcineurin inhibitors seems warranted (if possible). Also overlooked and facilitated prescriptions as well as their renewal should be carefully assessed for by doctors.
-Based on the case reports published, Women over the age of 18 are the most commonly described. Based on this, those which are primarily affected by Atopic Dermatitis would be less at risk.
-This retrospective collection of studies is based on very poor evidence* (Case reports) and prospective studies are strongly needed:
-To measure the how frequent the condition is
-To acknowledge or not the existence of corticosteroid “addiction”
*4 according to GRADE guidelines
Article selection: Prof Dr Jean-Hilaire Saurat – dermatologist. Geneva, Switzerland
+41 22 738 18 48