The topical steroid withdrawal and the dependence syndrome

Czech version

Authors: K. Kalina ¹; Z. Krotilová ²
Authors‘ workplace: Klinika adiktologie 1. LF UK a VFN, Praha Přednosta: prof. PhDr. Michal Miovský, Ph. D. ¹; CZ NIC, Praha Generální ředitel: Ondřej Filip ²
Published in: Prakt. Lék. 2024; 104(2): 93-96
Category: Of different specialties

Overview

The topical steroid withdrawal and addiction (red skin syndrome, topical steroid withdrawal and addiction) is a potential complication of long-term or excessive topical steroid therapy. The withdrawal syndrome includes especially physical manifestations resulting from tachyphylaxis, rebound phenomenon and suppression of the HPA axis (erythroderma, burning skin, pruritus, exudation and xerosis, swelling, thermoregulation disorders, worsening of the vision, increased risk of threatening infections, especially bacterial or viral, but also fungal or parasitic, also often alopecia and, in women, amenorrhea). But there are also psychological manifestations (sleep disorders, increased fatigue, depression, anxiety, suicidal thoughts, and even committed suicide). In the case of prolonged topical steroid therapy, on the contrary, feelings of euphoria or emotional lability may appear. The treatment is symptomatic, with regimen measures, lasting months to years. In some cases, chemotherapy, biological treatments or Janus kinase inhibitors are used. It may be appropriate to find a supportive doctor, or consider the contribution of a psychiatrist and psychotherapist. As part of the anamnesis, the information about the use of these drugs, some of which are over-the-counter or may have been given to the patient by a layman, must also be obtained from the patient. As a part of prevention, which is very important, if the treatment is indicated, the patient needs to be properly educated, even if repeatedly, about the correct application and duration of use.

Keywords:

atopic dermatitis – topical steroid withdrawal – topical steroid addiction – erythroderma – topical steroid allergy

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adresa pro korespondenci:
doc. MUDr. PhDr. Kamil Kalina, CSc.
Klinika adiktologie 1. LF UK a VFN
Apolinářská 4, 128 00 Praha 2
e-mail: kamil.kalina@lf1.cuni.cz

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Article was published in

General Practitioner

2024 Issue 2