Topical Steroid Withdrawal: Causes, Symptoms and Prevention

Medically Reviewed by Poonam Sachdev on January 11, 2024
7 min read

Topical steroid withdrawal is a side effect of stopping topical steroids.

Most people who take topical steroids don't have any problem with these medicines. But taking too much or stopping the steroids too quickly can cause rebound symptoms such as burning, redness, and itchy skin. Topical steroid withdrawal symptoms may be worse than the skin condition for which you were taking the steroid treatment.

Other names for topical steroid withdrawal are:

  • Steroid cream withdrawal
  • Steroid addiction syndrome
  • Topical steroid addiction
  • Red skin syndrome

Many people who've had topical steroid withdrawal say its symptoms are severe and life-altering. Yet some dermatologists question whether it even exists.

There's still a lot we don't know about topical steroid withdrawal. It's not clear why it happens, who gets it, and how high the steroid dose has to be to trigger it.

What are topical steroids?

Topical steroids are among the most commonly prescribed rub-on medicines for skin conditions such as psoriasis and eczema. These creams bring down swelling and slow the growth of skin cells to give you clearer skin. They reduce inflammation and ease skin irritation. These medicines come in various strengths from mild to very potent and can be purchased over the counter or prescribed by your doctor. Topical steroids and formulations include:

  • Ointments (hydrocortisone, triamcinolone acetonide, fluocinonide, clobetasol propionate)
  • Creams (hydrocortisone, fluocinonide acetonide, desoximetasone, clobetasol propionate)
  • Lotions (desonide, triamcinolone acetonide, clobetasol propionate)
  • Gels (desonide, desoximetasone, betamethasone dipropionate augmented, clobetasol propionate)
  • Sprays (hydrocortisone, triamcinolone acetonide, clobetasol propionate)
  • Foams (desonide, betamethasone valerate, clobetasol propionate)
  • Tape (flurandrenolide) 
  • Shampoo (clobetasol propionate)
  • Solutions (hydrocortisone, mometasone furoate, fluocinonide, halcinonide)

Whether topical steroid withdrawal is real depends on who you ask. Many doctors say steroid withdrawal isn't an actual diagnosis. Some researchers have called it "steroid phobia." They say it's an irrational fear that prevents people from staying on the treatment they need.

But people who've had symptoms after stopping topical steroids say withdrawal is very real. The National Eczema Association (NEA) has received so many reports of steroid withdrawal syndrome that in 2015 it published a review of 34 studies on the subject that included more than 1,000 people. The NEA concluded that withdrawal is a side effect of topical steroid misuse, but more research needs to be done to help us better understand it.

In 2021, the NEA published an updated review that confirmed topical steroid withdrawal can happen after people use these medicines for a long time. The NEA said doctors should educate their patients about the risks and follow up with them while they use these medicines.

Topical steroid withdrawal is a group of side effects some people get when they use too much of these medicines, stay on them for too long, or stop taking them too quickly. Withdrawal symptoms can appear anywhere from days to weeks after stopping the use of topical steroids. Later, symptoms can also appear on areas of the skin untreated by the topical steroid.

The skin symptoms include:

  • Burning, stinging, or painful skin
  • Skin sensitivity to sunlight
  • Redness, or rash on the arms or legs, also known as "red sleeve"
  • Itching
  • Peeling, cracking, or flaking
  • Swelling
  • Infection
  • Pus-filled bumps
  • Nodules under the skin
  • Thickened, wrinkled skin ("elephant wrinkles")

You're more likely to see topical steroid withdrawal symptoms on areas such as your face and genitals. That's because the cream absorbs more easily into these areas.

People with topical steroid withdrawal also report non-skin symptoms, such as:

  • Trouble sleeping
  • Hair loss
  • Shivering
  • Tiredness
  • Depression

Symptoms are often worse right after you stop taking steroids. First, the skin turns red, then it becomes itchy. Eventually, the skin clears, but you may have repeat periods of symptoms called flares. Withdrawal symptoms can last anywhere from a couple of months to many years.

Topical steroid withdrawal can have a huge effect on people's lives. These severe symptoms may make it hard to have a normal work or social life.

No one knows for sure what causes topical steroid withdrawal. One idea is that stopping steroids makes your body release a substance that widens blood vessels under the skin. Those wider blood vessels may be the cause of symptoms such as redness and itching.

Topical steroid withdrawal usually affects people after they have used a topical steroid for a long time. The longer you use this medicine and the higher the dose of steroids you take, the greater your risk of having symptoms.

When you take steroids for a long time, your body starts to become dependent on the medicine. Then you may need more and more of the steroid to get the same skin clearing as you did before. Once you're dependent, going off steroids may make your symptoms worse.

Your risk of topical steroid withdrawal may be higher if you:

  • Are female
  • Use a moderate- or high-strength steroid
  • Apply the medicine to your face or genitals
  • Use steroids every day for a long period
  • Don't take any breaks from the medicine
  • Have allergies

Some over-the-counter skin-lightening compounds, typically unregulated and heavily used in some Asian and African countries, can contain steroids. Long-term, unsupervised use of these agents on sensitive areas (such as the face) can lead to not only steroid-caused acne but also topical steroid withdrawal symptoms.

If your dermatologist prescribes a topical steroid, ask them about the risks. One way to avoid withdrawal symptoms is to use the smallest possible dose of steroids for the shortest period.

If you need to stay on treatment longer, use a nonsteroid medicine. Only add in steroids from time to time as you need them.

Nonsteroid topicals include anthralin, calcipotriene (Dovonex), calcitriol (Vectical), pimecrolimus (Elidel), roflumilast (Zoryve), tacrolimus (Protopic), tapinarof (Vtama), and tazarotene (Tazorac).

If you have symptoms, see the doctor who treats your psoriasis. Your doctor will first make sure that your symptoms aren't a flare of psoriasis or another skin condition, such as eczema.

The doctor can help you slowly taper off these medicines by lowering the dose a little bit at a time. Going off the medicine will give your skin time to heal. How long it takes for symptoms to clear up is different for each person.

Here are a few things you can do in the meantime to treat topical steroid withdrawal symptoms:

  • Apply ice or cool compresses to your skin.
  • Take an over-the-counter antihistamine to relieve the redness and itch.
  • Use moisturizers and emollients to soothe your skin.

Other treatments to consider:

  • Over-the-counter pain relievers
  • Oral corticosteroids to help taper off topical steroids
  • Light therapy
  • Antibiotics, if your skin becomes infected

The eczema treatment dupilumab (Dupixent) shows promise as a treatment for topical steroid withdrawal. But research hasn't proved that it works, and it isn't approved for this purpose.

If topical steroid withdrawal has had a negative effect on your life, talk to a counselor or therapist. You can also reach out to an organization called the International Topical Steroid Awareness Network (ITSAN). ITSAN offers resources to help you manage withdrawal symptoms.

There is emerging medical agreement that misusing topical steroids can lead to a number of harmful physical and emotional side effects. The use of over-the-counter and unregulated skin-lightening products containing topical steroids is especially prevalent in some Asian and African countries and can result in multiple steroid-caused skin conditions. If you're prescribed a topical steroid, use it where and as directed by your doctor to help prevent topical steroid withdrawal.

What are the side effects of stopping steroid cream?

If you use topical steroids as directed by your doctor, you should have no side effects when you stop using them. However, if you use them longer than prescribed (usually 12 months or more), you may be at risk for topical steroid withdrawal. Side effects can include:

  • A recurrence of your original condition
  • Redness
  • Burning and itching
  • Peeling
  • Pus-filled or open sores

How long does it take to wean off steroid cream?

Talk with your doctor about how to stop your topical steroid use. After you stop their use, it can take anywhere from a couple of days to several months to see improvement in your skin. For a small number of people, this can take several years.

What amount of topical steroid leads to withdrawal?

The exact amount is unknown. Rather, it's believed that how long topical steroids are used and where, as well as their potency (strength), can cause withdrawal symptoms. If you notice any signs of skin irritation, you should talk with your doctor. Withdrawal can be prevented by not using topical steroids as frequently or by reducing their potency. You should especially avoid using medium-strength and highly potent topical steroids on your face for a long amount of time.

Is steroid cream withdrawal rare?

Yes. Taking a topical steroid medicine as prescribed reduces your risk of withdrawal symptoms.