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Review
. 2014 Oct 14:6:131-8.
doi: 10.2147/dhps.s6920. eCollection 2014.

Topical steroid addiction in atopic dermatitis

Mototsugu Fukaya  1 , Kenji Sato  2 , Mitsuko Sato  3 , Hajime Kimata  4 , Shigeki Fujisawa  5 , Haruhiko Dozono  6 , Jun Yoshizawa  7 , Satoko Minaguchi  8
Affiliations
Review

Topical steroid addiction in atopic dermatitis

Mototsugu Fukaya et al. Drug Healthc Patient Saf. .

Abstract

The American Academy of Dermatology published a new guideline regarding topical therapy in atopic dermatitis in May 2014. Although topical steroid addiction or red burning skin syndrome had been mentioned as possible side effects of topical steroids in a 2006 review article in the Journal of the American Academy of Dermatology, no statement was made regarding this illness in the new guidelines. This suggests that there are still controversies regarding this illness. Here, we describe the clinical features of topical steroid addiction or red burning skin syndrome, based on the treatment of many cases of the illness. Because there have been few articles in the medical literature regarding this illness, the description in this article will be of some benefit to better understand the illness and to spur discussion regarding topical steroid addiction or red burning skin syndrome.

Keywords: atopic dermatitis; corticosteroid; eczema; rebound; red burning skin syndrome; topical steroid addiction.

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Figures

Figure 1
Figure 1
(A) A typical appearance of TSA, with prurigo-like eruption before withdrawal. (B) Appearance just after trial of decreasing the amount of potent topical steroids. The severity of addiction is so intense that the patient cannot safely withdraw by a gradual-decrease method. (C) The rebound erythema is spreading after complete cessation of steroids. (D) The appearance after 1 year. The rebound has almost subsided but hypersensitivity still remains. Abbreviation: TSA, topical steroid addiction.
Figure 2
Figure 2
The procedures of withdrawal in a severe case of TSA. Notes: (A) Before withdrawal; (B) 2 weeks after withdrawal; (C) 3 months after withdrawal; and (D) 13 months after withdrawal. Abbreviation: TSA, topical steroid addiction.
Figure 3
Figure 3
A case presenting hypersensitivity after topical steroid withdrawal. Note: The skin where a band-aid was placed and detached (yellow arrows) shows an irritated appearance in the left photo, while almost normal after 1 year (right).
Figure 4
Figure 4
An example of typical demarcation around the wrists seen in the rebound eruption. Notes: (A) at the peak of rebound, (B) 1 month later, and (C) 2 months later.
Figure 5
Figure 5
The result of immunohistochemical staining, using an antibody against PCNA (A) before and (B) after 2 weeks’ application of 0.05% clobetasol propionate twice a day, on a healthy adult forearm. Note: The epidermis became obviously thinner, and PCNA-positive nuclei (brown) decreased. Abbreviation: PCNA, proliferative cell nuclear antigen.
See this image and copyright information in PMC

References

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