Face Steroid Withdrawal: What You Need to Know

May 27, 2024

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If you’ve been using topical corticosteroids on your face to treat a skin condition like eczema or psoriasis, you may have experienced the frustrating and sometimes painful symptoms of face steroid withdrawal when trying to stop the medication. This condition, also known as topical steroid withdrawal (TSW) or “red skin syndrome,” can cause a range of symptoms on the face, including rednessburningitching, and flaking.

In this article, we’ll take an in-depth look at the causes, symptoms, and management of steroid withdrawal on the face, as well as related issues like topical steroid withdrawal on the hands. Whether you’re currently going through TSW or are considering tapering off your topical steroids, understanding what to expect and how to cope can help you navigate this challenging process.

What is Face Steroid Withdrawal?

Face steroid withdrawal is a condition that can occur when you stop using topical corticosteroids on your face after a prolonged period of use. Topical steroids are medicated creams, ointments, or lotions that are applied directly to the skin to reduce inflammation and irritation. They are commonly prescribed to treat facial rashes like eczema, psoriasis, and seborrheic dermatitis.

While topical steroids can be very effective at controlling facial rashes in the short term, long-term use can sometimes lead to adverse effects, including skin thinning, changes in pigmentation, and a phenomenon known as “rebound” or “withdrawal” dermatitis[1].

Steroid withdrawal on the face can range from mild to severe and may include symptoms like:

  • Redness and flushing of the skin
  • Burning and stinging sensations
  • Intense itching
  • Skin peeling and flaking
  • Swelling and puffiness, especially around the eyes
  • Oozing and weeping of clear fluid from the skin
  • Skin sensitivity and tenderness to touch

These symptoms often appear within days to weeks of stopping the topical steroid and can be more severe and widespread than the original skin condition being treated[1].

Topical Steroid Rebound on the Face

One specific type of face steroid withdrawal is known as “topical steroid rebound” or “rebound dermatitis.” This occurs when the skin becomes so used to the anti-inflammatory effects of the topical steroid that it can’t function normally without it. When the medication is stopped, the skin experiences a sudden flare-up of inflammation and irritation, often spreading beyond the original treatment area[1].

Rebound rashes on the face are more likely to occur with higher-potency topical steroids and after longer durations of use. They can be very distressing and may require additional treatment to manage symptoms.

GDD2 TSW

Perioral Dermatitis and Steroid-Induced Rosacea

Two other conditions that can be related to face steroid withdrawal are perioral dermatitis and steroid-induced rosacea.

Perioral dermatitis is a rash that appears around the mouth, often with small, red, pus-filled bumps and mild peeling or flaking[2]. It is commonly triggered by the use of topical steroids on the face, especially around the mouth and nose. While the exact cause is unknown, it is thought to be related to changes in the skin’s microbiome and barrier function induced by the steroids[2].

Steroid-induced rosacea, on the other hand, is a type of acne-like eruption that can occur on the cheeks, nose, and forehead after prolonged use of topical steroids[3]. It is characterized by redness, flushing, and the appearance of small, red, pus-filled bumps. Like perioral dermatitis, it is thought to be related to changes in the skin’s microbiome and vasculature caused by the steroids[3].

Both of these conditions can be challenging to treat and may require a combination of oral antibiotics, topical anti-inflammatory medications, and gentle skin care. Working with a dermatologist who is familiar with these conditions is important for getting an accurate diagnosis and appropriate treatment plan.

Perioral Dermatitis

Symptoms of Topical Steroid Withdrawal on the Face

The symptoms of topical steroid withdrawal on the face can vary from person to person and may depend on factors like the potency and duration of steroid use, as well as individual skin characteristics. However, some common symptoms include:

Facial Redness and Flushing

One of the most noticeable symptoms of face steroid withdrawal is facial redness or flushing, also known as “steroid dermatitis” or “red face syndrome.” This can range from a mild, blotchy redness to a deep, almost purple hue that feels hot and burning to the touch.

The redness may be accompanied by swelling, especially around the eyes and cheeks, giving the face a puffy, inflamed appearance. In some cases, the redness may have a distinct pattern, such as a “butterfly rash” across the cheeks and nose or a “headlight” distribution around the eyes[1].

TSW

Burning and Stinging Sensations

Another common symptom of face steroid withdrawal is a burning or stinging sensation on the skin, often described as a feeling of “pins and needles” or a “sunburn-like” pain. This can be very uncomfortable and may be triggered by things like heat, sweat, or even gentle touch.

The burning and stinging may be worse at night, interfering with sleep and causing significant distress. Some people also report a feeling of “tightness” or “dryness” on the face, as if the skin is being stretched or pulled.

TSW

Intense Itching

Intense itching is another hallmark symptom of face steroid withdrawal, often described as a “deep, bone-itch” that feels impossible to satisfy. The itching may be constant or may come and go in waves, and can be so severe that it interferes with daily activities and sleep.

Scratching the itch can lead to further irritation and damage to the skin, as well as increasing the risk of infection. Many people with face steroid withdrawal find that traditional anti-itch remedies like antihistamines or calamine lotion are ineffective, and may need to rely on other coping strategies like cold compresses or distraction techniques.

Skin Peeling and Flaking

As the skin goes through the withdrawal process, it may start to peel and flake off in large, moist sheets or fine, dry scales. This is known as “skin shedding” or “dermatitis exfoliativa” and can be both physically and emotionally uncomfortable.

The peeling and flaking can reveal red, raw, oozing skin underneath, which can be painful and prone to infection. In some cases, the flaking may be so severe that it interferes with vision or breathing, requiring medical attention.

GD3 TSW

Swelling and Puffiness

Swelling and puffiness, especially around the eyes and cheeks, is another common symptom of face steroid withdrawal. This can give the face a “moon-faced” appearance and may be accompanied by fluid retention in other parts of the body.

The swelling may be worse in the morning and may fluctuate throughout the day based on factors like hydration, salt intake, and activity level. In severe cases, the swelling may interfere with vision or breathing and may require medical intervention.

TSW 1

Oozing and Weeping

In some cases, face steroid withdrawal can cause the skin to ooze and weep clear or yellowish fluid, especially in areas where the skin is raw or cracked. This can be messy and uncomfortable, and may increase the risk of infection.

Oozing and weeping skin may be a sign of a secondary bacterial or fungal infection, which can require treatment with oral or topical antibiotics. Keeping the skin clean and moisturized can help prevent infections and promote healing.

GDD2 TSW

Skin Sensitivity and Tenderness

Finally, many people with face steroid withdrawal report increased skin sensitivity and tenderness to touch, pressure, or temperature changes. This can make everyday activities like washing the face, applying makeup, or even resting the head on a pillow uncomfortable.

The sensitivity may be related to changes in the skin’s nerve endings and blood vessels caused by the steroids, and may take time to resolve as the skin heals. Using gentle, fragrance-free products and avoiding harsh scrubs or exfoliants can help minimize further irritation.

Skin Sensitivity

Topical Steroid Withdrawal on the Hands

In addition to the face, the hands are another common area affected by topical steroid withdrawal. This is because the skin on the hands is thin and delicate, and is frequently exposed to irritants like water, soap, and friction.

Symptoms of topical steroid withdrawal on the hands may include:

  • Redness and inflammation, especially on the palms and fingers
  • Intense itching and burning sensations
  • Dryness and flaking, with skin that feels rough and scaly
  • Cracking and splitting of the skin, especially around the knuckles and fingertips
  • Oozing and weeping of clear or yellowish fluid
  • Swelling and stiffness of the fingers and joints

In severe cases, the hands may develop deep, painful cracks or fissures that bleed and are prone to infection. The skin may also thicken and take on a leathery or wrinkled appearance, known as “elephant skin.”

Treating topical steroid withdrawal on the hands can be challenging, as the hands are constantly in use and exposed to irritants. However, some strategies that may help include:

  • Wearing gloves to protect the hands from water, soap, and other irritants
  • Applying thick, fragrance-free moisturizers multiple times a day to keep the skin hydrated
  • Using gentle, non-foaming cleansers and lukewarm water to wash the hands
  • Patting the hands dry instead of rubbing with a towel
  • Applying topical anti-inflammatory medications like calcineurin inhibitors or low-potency steroids under the guidance of a dermatologist
  • Taking oral antibiotics if secondary infections develop

In some cases, topical steroid withdrawal on the hands may be so severe that it interferes with daily activities like writing, typing, or holding objects. Working with an occupational therapist or hand specialist may be necessary to develop adaptive strategies and prevent further damage to the skin.

TSW on the Arm

Diagnosing face steroid withdrawal and related conditions like perioral dermatitis and steroid-induced rosacea can be challenging, as the symptoms can mimic those of other skin conditions like eczema, psoriasis, and acne. However, there are some key features that can help distinguish these conditions:

ConditionKey Features
Face steroid withdrawal– History of prolonged topical steroid use on the face
– Redness, burning, and itching that appears within days to weeks of stopping the steroid
– Rash that spreads beyond the original treatment area
– Failure to respond to traditional eczema or psoriasis treatments
Perioral dermatitis– Rash that appears around the mouth, often with small, red, pus-filled bumps
– Mild peeling or flaking of the skin
– May be triggered by topical steroid use, especially around the mouth and nose
– Responds to oral antibiotics and topical anti-inflammatory medications
Steroid-induced rosacea– Acne-like eruption on the cheeks, nose, and forehead
– Redness, flushing, and small, red, pus-filled bumps
– May be triggered by prolonged topical steroid use on the face
– Responds to oral antibiotics and topical anti-inflammatory medications

To diagnose these conditions, your dermatologist will typically:

  • Take a thorough medical history, including details about your topical steroid use and any other skin conditions you may have
  • Perform a physical examination of your skin, noting the location, appearance, and severity of your symptoms
  • May perform a skin biopsy to rule out other conditions like skin cancer or infections
  • May order blood tests to check for underlying health conditions that could be contributing to your symptoms

It’s important to be honest with your dermatologist about your topical steroid use, even if you have been using them without a prescription or for longer than recommended. This information can help your doctor make an accurate diagnosis and develop an appropriate treatment plan.

Treating and Managing Face Steroid Withdrawal

Treating face steroid withdrawal can be a long and challenging process, as the skin needs time to heal and regain its natural balance. However, there are several strategies that can help manage symptoms and promote healing:

Discontinuing Topical Steroids

The first step in treating face steroid withdrawal is to discontinue the use of topical steroids. This should be done under the guidance of a dermatologist, as abruptly stopping high-potency steroids can sometimes worsen symptoms.

In some cases, your dermatologist may recommend tapering off the steroids gradually over a period of weeks or months, depending on the potency and duration of use. This can help minimize the severity of withdrawal symptoms and allow the skin time to adjust.

TSW 1

Gentle Skin Care

Gentle skin care is essential for managing face steroid withdrawal and promoting healing. This includes:

  • Using lukewarm water and gentle, fragrance-free cleansers to wash the face
  • Applying thick, fragrance-free moisturizers multiple times a day to keep the skin hydrated
  • Avoiding harsh scrubs, exfoliants, and other irritating products
  • Protecting the skin from sun exposure with broad-spectrum sunscreen and protective clothing

Your dermatologist may also recommend specific products or ingredients that can help soothe and repair the skin, such as:

  • Ceramides and hyaluronic acid to help restore the skin’s natural barrier
  • Niacinamide and licorice root extract to help reduce inflammation and redness
  • Aloe vera and colloidal oatmeal to help soothe itching and irritation

Artboard 1

Topical and Oral Medications

In addition to gentle skin care, your dermatologist may prescribe topical or oral medications to help manage specific symptoms of face steroid withdrawal. These may include:

  • Topical calcineurin inhibitors like tacrolimus or pimecrolimus to help reduce inflammation and itching
  • Oral antibiotics like doxycycline or minocycline to help treat secondary infections and reduce inflammation
  • Oral antihistamines like diphenhydramine or hydroxyzine to help reduce itching and improve sleep
  • Topical or oral antifungal medications like ketoconazole or fluconazole to help treat fungal infections that can develop during the withdrawal process

It’s important to use these medications only as directed by your dermatologist and to report any side effects or worsening of symptoms.

tacrolimus

Wet Wraps and Compresses

Wet wraps and compresses can be helpful for managing severe face steroid withdrawal symptoms like intense itching, burning, and oozing. To use a wet wrap:

  1. Soak a soft, clean cloth or gauze in lukewarm water and wring it out until it’s damp but not dripping
  2. Apply a thick layer of moisturizer or healing ointment to the affected skin
  3. Wrap the damp cloth or gauze around the affected area, making sure it’s not too tight or restrictive
  4. Cover the wet layer with a dry layer of cloth or gauze to help retain moisture
  5. Leave the wrap on for several hours or overnight, then gently remove and cleanse the skin

Wet wraps can help soothe and hydrate the skin, reduce inflammation, and promote healing. However, they should be used with caution and under the guidance of a dermatologist, as overuse can sometimes lead to skin maceration or infection.

Cold compresses can also be helpful for reducing itching, burning, and swelling associated with face steroid withdrawal. To use a cold compress:

  1. Wrap a clean, soft cloth around a handful of ice cubes or a frozen gel pack
  2. Apply the compress to the affected area for 10-15 minutes at a time, several times a day
  3. Be sure to protect the skin from direct contact with the ice or gel pack to prevent frostbite or irritation

Stress Management and Emotional Support

Face steroid withdrawal can be an incredibly stressful and emotionally draining experience. The physical discomfort, combined with the visible changes to your appearance, can take a significant toll on your mental health and self-esteem.

It’s important to prioritize stress management and emotional support during this challenging time. Some strategies that may help include:

  • Practicing relaxation techniques like deep breathing, meditation, or yoga to help reduce anxiety and promote a sense of calm
  • Engaging in gentle physical activity, such as walking or light stretching, to boost endorphins and improve mood
  • Seeking support from loved ones, friends, or a therapist who can provide a listening ear and coping strategies
  • Joining an online or in-person support group for people with TSW, such as those offered by the National Eczema Association or ITSAN (International Topical Steroid Awareness Network)
  • Focusing on self-care activities that bring you joy and comfort, such as reading, listening to music, or spending time in nature

It’s also important to be patient and kind to yourself during the healing process. Face steroid withdrawal can be a long and non-linear journey, with ups and downs along the way. Celebrate small victories and progress, and don’t be discouraged by setbacks or flare-ups.

If you’re struggling with feelings of depression, anxiety, or low self-worth, don’t hesitate to reach out for professional help. Your mental health is just as important as your physical health, and there are resources available to support you through this challenging time.

9 5

Preventing Face Steroid Withdrawal

The best way to prevent face steroid withdrawal is to use topical corticosteroids judiciously and under the close supervision of a dermatologist. Some tips for minimizing your risk of developing TSW on the face include:

  • Using the lowest potency steroid needed to control your symptoms, for the shortest duration possible
  • Applying a thin layer of the steroid only to affected areas of the face, not to healthy skin
  • Following your dermatologist’s instructions for frequency and duration of use
  • Avoiding long-term use of topical steroids on sensitive areas like the face, eyelids, and around the mouth
  • Monitoring for signs of skin thinning, easy bruising, or stretch marks, which can indicate overuse of topical steroids
  • Using non-steroid treatments, such as moisturizers and topical calcineurin inhibitors, to help control facial rashes and reduce the need for topical steroids

If you have been using topical steroids on your face for a long time and are concerned about the risk of withdrawal, talk to your dermatologist about developing a personalized plan for tapering off the medication safely.

It’s also important to be cautious with “natural” or “herbal” remedies for facial rashes, as some may contain undisclosed steroids or other potentially harmful ingredients. Always check with your dermatologist before trying any new skincare products or treatments, especially if you have a history of TSW or other skin conditions.

When to Seek Medical Attention

While some discomfort and skin changes are to be expected during face steroid withdrawal, there are certain symptoms that warrant prompt medical attention. Contact your dermatologist or seek emergency care if you experience any of the following:

  • Signs of skin infection, such as sudden worsening of redness, swelling, pain, or oozing of pus
  • Fever or chills along with your skin symptoms
  • Severe swelling of the face, lips, or tongue that may indicate an allergic reaction
  • Difficulty breathing or swallowing
  • Suicidal thoughts or severe depression that interferes with your daily functioning

Your dermatologist can help you assess the severity of your symptoms and determine if additional treatment or referral to another specialist is necessary.

The Bottom Line

Face steroid withdrawal can be a challenging and emotionally draining experience, but with proper medical guidance and support, it is possible to get through the withdrawal process and achieve healthier, more resilient skin.

If you suspect that you may be experiencing face steroid withdrawal or a related condition like perioral dermatitis or steroid-induced rosacea, don’t hesitate to reach out to a dermatologist who is knowledgeable about these conditions. They can help you develop a personalized treatment plan that addresses your specific symptoms and concerns.

Remember, everyone’s journey with face steroid withdrawal is unique, and what works for one person may not work for another. Be patient with yourself and your skin, and don’t hesitate to seek support from loved ones, healthcare providers, and the TSW community as you navigate this challenging process.

TSW 2

Key Points

  • Face steroid withdrawal is a condition that can occur when topical corticosteroids are stopped after prolonged use on the face, leading to symptoms like redness, burning, itching, and flaking.
  • Related conditions like perioral dermatitis and steroid-induced rosacea can also develop from topical steroid use on the face.
  • Symptoms of face steroid withdrawal can include intense itching, burning and stinging sensations, swelling and puffiness, oozing and weeping, and skin peeling and flaking.
  • The hands are another common area affected by topical steroid withdrawal, with symptoms like redness, dryness, cracking, and oozing.
  • Diagnosis of face steroid withdrawal and related conditions relies on a thorough medical history and physical examination by a knowledgeable dermatologist.
  • Treatment of face steroid withdrawal typically involves discontinuing topical steroids, gentle skin care, and medications to manage specific symptoms like itch and inflammation.
  • Wet wraps, cold compresses, and stress management techniques can also be helpful for managing face steroid withdrawal symptoms.
  • Preventing face steroid withdrawal involves using topical steroids judiciously, under the guidance of a dermatologist, and monitoring for signs of overuse.
  • If you suspect you may be experiencing face steroid withdrawal, seek evaluation and guidance from a knowledgeable dermatologist.

Frequently Asked Questions

How long does face steroid withdrawal last?

The duration of face steroid withdrawal can vary widely, but symptoms may persist for several weeks to several months after stopping topical steroids. In some cases, it can take up to a year or longer for the skin to fully heal and recover. Working closely with a dermatologist and practicing gentle skin care can help support the healing process.

Can I use makeup or other cosmetic products during face steroid withdrawal?

It’s generally recommended to avoid makeup and other cosmetic products during the acute phase of face steroid withdrawal, as they can further irritate the skin and delay healing. Once the skin has stabilized and is no longer oozing or weeping, you may be able to gradually reintroduce gentle, fragrance-free makeup and skincare products under the guidance of your dermatologist.

Is face steroid withdrawal contagious?

No, face steroid withdrawal is not contagious. It is an individual reaction to the discontinuation of topical corticosteroids and cannot be spread from person to person.

Can diet affect face steroid withdrawal symptoms?

While there is no specific “face steroid withdrawal diet,” some people find that certain foods may trigger or worsen their symptoms. Common culprits include dairy, gluten, sugar, and processed foods. Keeping a food diary and working with a registered dietitian may help identify potential triggers. However, dietary changes alone are unlikely to resolve face steroid withdrawal.

Are there any natural remedies for face steroid withdrawal?

Some people find relief from face steroid withdrawal symptoms with natural remedies like aloe vera gel, colloidal oatmeal baths, or coconut oil. However, it’s important to talk to your dermatologist before trying any new treatments, as some natural remedies may actually worsen your symptoms or interact with your prescribed medications. Your dermatologist can help you determine which remedies may be safe and effective for your individual case.

If you’re struggling with face steroid withdrawal or related conditions like perioral dermatitis or steroid-induced rosacea, know that you’re not alone. With the right medical guidance, self-care strategies, and support from loved ones and the TSW community, it is possible to get through this challenging time and emerge with healthier, more resilient skin. Don’t hesitate to reach out for help when you need it, and remember to be kind to yourself as you navigate the ups and downs of the healing process.

References

  1. Sheary, B. (2018). Topical steroid addiction and withdrawal-An overview for GPs. Australian family physician, 47(10), 668-671.
  2. Breneman, D. L., Ariano, R., Soter, N. A., & Kempers, S. (1995). Perioral dermatitis: a reappraisal. Journal of the American Academy of Dermatology, 33(5), 789-799.
  3. Chu, C. Y. (2007). Steroid-induced rosacea: a case series. Archives of dermatology, 143(8), 1072-1073.
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