CLINICAL
Topical steroid withdrawal
Jennifer Thain talks through how she treated a patient with eczema using a combination light therapy approach
Topical steroid withdrawal (TSW) is an increasingly recognised condition characterised by severe cutaneous flares following the cessation of prolonged corticosteroid use. This case study explores the presentation and successful management of a female patient with chronic eczema and TSW using Dermalux light therapy in conjunction with the twice-daily application of Cellderma GF5 serum.
THE PATIENT
A female patient, aged 28, presented with extensive eczematous dermatitis and a history of long-term topical corticosteroid use. Her condition was complicated by TSW, characterised by skin barrier dysfunction and persistent weeping lesions. She reported a recurrent cycle of corticosteroid prescription, withdrawal-induced flares, and subsequent re-prescription of increasingly potent formulations.
The patient initially developed dermatitis symptoms during the Covid-19 pandemic, attributing the onset to prolonged mask use. Due to limited access to in-person consultations, she was prescribed 1% topical corticosteroids remotely, followed by progressively stronger formulations as tolerance developed. Despite medical recommendations advocating for a gradual tapering approach to corticosteroid discontinuation, her prescribing physician instructed her to immediately cease usage, leading to severe withdrawal symptoms. Gradual tapering of topical corticosteroids is recommended to minimise the risk of withdrawal symptoms and adverse effects. This approach involves reducing the potency and frequency of application over time, rather than abrupt discontinuation. For example, after two to four weeks of daily use, it’s advisable to decrease the application frequency to twice weekly and opt for a lower-potency steroid.