Doxycycline may be a safer first option for treating a blistering skin condition

Many emollients can be bought easily in supermarkets, pharmacies, or over the counter. Topical corticosteroids usually need a prescription or consultation with a pharmacist, as they are medicated and should only be used during a flare-up, following medical advice. When looking at the symptoms of eczema, it is important to note that eczema is different for everyone.

  • Black skin may be particularly susceptible to eczema, but the severity of flare-ups is often underestimated as the redness from inflammation may be difficult to see.
  • ‘Eczema’ is a term which comes from the Greek word ‘to boil’ and is  used to describe red, dry, itchy skin which can sometimes become weeping, blistered, crusted, scaling and thickened.
  • Both of these medications can help to treat outbreaks of eczema and dermatitis of the scalp, or psoriasis affecting the scalp, and effectively calm redness and irritation.
  • Topical steroid withdrawal will develop within weeks of ceasing treatment, and will (at least initially) be confined to the area that was being treated.
  • The Yellow Card scheme run by the MHRA is the UK system for collecting and monitoring information on safety concerns such as suspected side effects involving medicines.
  • All caregivers provided their children with treatment for topical steroid addiction or withdrawal symptoms, which included discontinuation of topical corticosteroid use.

The MHRA received an enquiry from a patient representative to the Yellow Card scheme about the risk of topical steroid withdrawal reactions, which triggered this assessment. In essence, simply following the course of treatment prescribed to you, not exceeding the recommended dosage, frequency, or duration, will leave you fairly unlikely to develop topical steroid withdrawal. Topical steroids should normally only be used in short courses of two weeks or less, unless directed by your GP or consultant. The longer you’ve been using a treatment, the longer you should take to wean yourself off it — don’t simply stop overnight when you’ve been applying a topical steroid for a year, consult a medical professional first. That said, the use of topical corticosteroids has been known to cause an adverse reaction in adults and children.

Types of topical corticosteroids

Eczema can be caused by a variety of factors, such as genetics and skin type. If one or both of your parents have eczema, you are more likely to develop symptoms yourself. While the cause of eczema may not be known, there are certain things that may trigger your symptoms. One of our doctors will review your order and prescribe a treatment if suitable. Hay fever season coincides with the time of year when children love being outside. Here are a doctor’s tips for managing your child’s hay fever symptoms.

  • Cases without a clear temporal association were excluded, as were case series without a definitive number of cases and reviews of expert opinion.
  • This is sometimes referred to as Topical Steroid Addiction (because it may seem as if more TCS is needed to achieve the same benefit).
  • The dose of steroid will be adjusted to reduce the risk of side effects.
  • They were randomly assigned to start either 0.5mg/kg body weight prednisolone or 200mg doxycycline daily, for six weeks.
  • Medical professionals often talk about the ‘potency’ of topical steroids — how strong they are.

Use a very gentle pH neutral skin cleanser and a non-occlusive moisturiser. A light moisturiser several times a day is better than a heavy moisturiser applied once. This will allow the skin to breathe, protect it from water loss, but not clog pores. You will need to stop exfoliating products, acids, peels, scrubs, masks, astringents and any thing else that can disrupt the skin barrier.

About topical corticosteroids

Following an increasing number of patient enquiries to the US National Eczema Association, Hajar and colleagues sought to review the current evidence regarding addiction and withdrawal of topical steroid withdrawal. Cases without a clear temporal association were excluded, as were case series without a definitive number of cases and reviews of expert opinion. The Yellow Card scheme run by the MHRA is the UK system for collecting and monitoring information on safety concerns such as suspected side effects involving medicines. Suspected side effects are reported by health professionals and the public, including patients, carers and parents. All Yellow Card reports received are entered onto the MHRA’s adverse drug reaction database so that they are available for signal detection.

  • No further scans to check for birth defects will be required due to use of a systemic corticosteroid.
  • My body was ripped to shreds with open wounds and scabs and I was red raw.
  • Topical steroid withdrawal reactions are thought to result from prolonged, frequent, and inappropriate use of moderate to high-potency topical corticosteroids.
  • However, they can be extremely successful in helping to relieve symptoms like itching, irritation and skin flare-ups.

The itch had mostly disappeared but had been replaced by severe burning, which was only relieved by further topical corticosteroid application. The appearance of the dermatitis changed and was more of a hyperaemia. Topical corticosteroids are anti-inflammatory preparations applied directly to the skin. They come in many forms including ointments, creams, lotions and tapes. Ointments are generally used for dry skin conditions however if the skin is wet and weepy a cream is usually preferred.

In this situation, medicine that suppresses the immune system is usually required (see above). All medicines or vaccines can cause adverse reactions in some people. Adverse drug reactions reported to the MHRA are looked at and used to assess the balance of risks and benefits of medicines and vaccines.

Self care

Typically, people are affected during spring (trees) and summer (grasses). Gently rinse lather off skin leaving a thin layer of the ointment on the skin. You might need to cold turkey with all your products for a while until your skin is under control again. When Mr Rowe first stopped using the creams he had been addicted to, he saw little to no improvement for eight months.

To confuse things, the spots in perioral dermatitis look a lot like the spots in rosacea when they are examined down the microscope. Acne differs from perioral dermatitis as acne causes comedones whereas perioral dermatitis does not. Perioral dermatitis and periorificial dermatitis can be quite distressing and upsetting. ‘Some people refer to this as steroid withdrawal or steroid addiction, however, this isn’t something that is formally recognised by dermatologists. One 2003 study from Japan, found that 12 per cent of adults who were taking steroids to treat dermatitis developed RSS. Also known as red skin syndrome, the disorder does not have many statistics to show how common it is.

Clinical signs of infected eczema include weeping, pustules, crusts, fever and malaise, or atopic eczema failing to respond to therapy or rapidly worsening atopic eczema. In this article, we’ll cover what it involves, how it can manifest, how you can treat it, and how you can avoid it so you don’t need to deal with it at all. Stronger steroid creams are available if you’re finding that weaker treatments aren’t proving to be effective or if you have particularly thick skin. The active ingredient in Eumovate is clobetasone, a moderately potent corticosteroid that reduces redness, itching and swelling. It may also be used as a preventative measure for flare-ups and has very few side effects for adults and children. There are many different types and strengths of topical corticosteroids.

We identified 55 reports in the Yellow Card database that are probable reports of topical steroid withdrawal reactions and 62 further reported reactions potentially indicative of topical steroid withdrawal reactions. The authors proposed a possible mechanism could be that a potent topical corticosteroid causes a thinning of the naturally thin stratum corneum on the face. They postulated that this increased thinning allows more allergens to penetrate, inducing persistent flares of the atopic dermatitis. As a result, the patient uses more topical corticosteroid to treat the flare, but this causes further thinning of the stratum corneum and, consequently, greater allergen penetration, causing more flares.

For more information on how any of our treatments can help you, please get in touch. Yes, you can lead a full life including sports, swimming and travel. You may need to make minor changes such as keeping moisturiser with you at school, work or when away from home. Keep up to date with the latest research about eczema and all things skin related with our newsletter. Skin becomes dry, not because it lacks grease or oil, but because it fails to retain water.