Discontinuation of a topical corticosteroid after prolonged use can result in the topical corticosteroid withdrawal syndrome. Many cases involve improper use of a potent corticosteroid cream, with the cream masking rather than treating the underlying condition.


Synonyms: topical corticosteroid discontinuation syndrome, topical steroid addiction


General features of the topical corticosteroid withdrawal syndrome:

(1) A patient applies a topical corticosteroid cream on a skin condition.

(2) If the topical therapy is stopped then the skin lesion flares up.

(3) Many patients will restart the steroid cream and will continue to apply the cream for a long period of time.

(4) If the flare up can be managed by other means then the intense reaction tends to recede with time.


The skin reaction may take the form of:

(1) erythema

(2) burning and stinging

(3) erythematoedematous rash

(4) papulopustular rash


The most commonly affected sites are the face and groin.


If a potent topical corticosteroid is used or if the therapy is used over a wide area then systemic absorption may occur and there may be systemic adrenal insufficiency.


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