Significant Overlap Identified Between Eczema, Topical Steroid Withdrawal Symptoms

New research published in Acta Dermato-Venereologica has shed light on the overlap between topical steroid withdrawal and atopic dermatitis, highlighting patient-reported characteristics among patients who suffer from both conditions.1

These findings resulted from a new observational, cross-sectional study, providing additional insight into the characteristics of topical steroid withdrawal as a consequence of tapering cortisone cream. The underlying pathophysiological mechanisms of topical steroid withdrawal, a negative reaction linked to the use of topical glucocorticoids, remains unclear and lacks established diagnostic criteria.

"We wanted to gain more knowledge about how those who identify as suffering from [topical steroid withdrawal] define the phenomenon and which symptoms they describe," Mikael Alsterholm, a researcher at the University of Gothenburg and senior consultant in dermatology and venereology at Sahlgrenska University Hospital, said in a statement.2

The Swedish research team, led by Sahlgrenska Academy at the University of Gothenburg, sought to evaluate this phenomenon through an evaluation of a large population of patients. The analysis was 1 of the first studies to systematically explore topical steroid withdrawal, with a focus on adult subjects with atopic dermatitis—also known as atopic eczema—and self-described topical steroid withdrawal.1

This observational cross-sectional study was carried out by investigators over a timeframe lasting 4 weeks in 2023, with the research team providing an online questionnaire to participants that was distributed within a Swedish Facebook group and dedicated to topical steroid withdrawal. The survey was anonymous and provided in Swedish, with participants encountered on social media being encouraged to share this survey link.

"It's important that healthcare professionals and researchers are involved in the discussion on [topical steroid withdrawal] and contribute science-based knowledge where possible,” Alsterholm said in his statement. “Cortisone cream is an effective and safe treatment for most people, and at present there's no support for avoiding its use for fear of the types of symptoms described in the context of [topical steroid withdrawal].”2

The research team’s survey was targeted toward participants in the age range of 18 years and older who had reported both atopic eczema and topical steroid withdrawal. Among the 98 individuals who decided to access the questionnaire, a total of 82 ended up completing the questionnaire.

The investigators found that 95% of the questionnaire’s respondents had been female and 74% had been in the age range of 18 - 39 years. Additionally, the research team found that 84% had self-diagnosed topical steroid withdrawal, with almost all reporting symptoms of both atopic dermatitis and withdrawal at the time of their questioning.

Frequently, subjects described topical steroid withdrawal as a dependency on topical glucocorticoids that was then accompanied by adverse reactions to utilization. In their inquiries about reactions, the research team concluded that the most frequently noted physical signs included dryness, erythema, oozing, and desquamation, with symptoms moslty impacting participants’ neck, faces, and upper extremities.

Though less frequent, the team also found that sleep disturbances, itch, and psychological impacts were reported by subjects. Among the survey’s respondents, the investigators found that 60% reported recurring episodes of symptoms they attributed to withdrawal.

Despite the fact that 93% of subjects pointed to topical glucocorticoids as the major trigger for their condition, the research team found that 33% attributed their reaction to oral glucocorticoids. Nevertheless, the team did find that 21% of respondents reported current topical glucocorticosteroid use.

Although the manifestations of withdrawal resemble those of atopic eczema, participants perceived withdrawal as a distinct condition which led to substantial morbidity. Such conclusions highlight the burden of topical steroid withdrawal and the necessity of more detailed understanding and clinical recognition of the condition’s symptoms, demonstrating diverse interpretations of topical steroid withdrawal.

"At the same time, there's a patient group with different experiences, expressed as [topical steroid withdrawal], and their symptoms and the potential causes need to be investigated by means of both research and practical healthcare,” Alsterholm said in his statement. “To do this, we first need to define [topical steroid withdrawal]. While we understand that this is complicated, we hope that this study can help establish such a definition.”2

References

1. Alsterholm, M., af Klinteberg, M., Vrang, S., Sigurdardottir, G., Sandström Falk, M., & Shayesteh, A. (2025). Topical Steroid Withdrawal in Atopic Dermatitis: Patient-reported Characterization from a Swedish Social Media Questionnaire. Acta Dermato-Venereologica, 105, adv40187. https://doi.org/10.2340/actadv.v105.40187.
2. Painful skin when tapering cortisone cream. EurekAlert! January 14, 2025. https://www.eurekalert.org/news-releases/1070376. Date accessed: January 22, 2025.