Topical Corticosteroids(TCS) are easily absorbed through the skin surface, particularly on the face. They liaise with the systemic corticosteroids secreted by the adrenal gland to reduce pain and swelling associated with an inflammatory process.
A dermatology journal first recognised Topical Steroid Withdrawal (TSW) in 1979, but recent cases spread online through social media have brought a tidal wave of awareness to surface. It is now acknowledged by the National Eczema Society in the USA, earning the name ‘’Red Skin Syndrome’’.
Why are Topical Steroids Used On The Face?
Topical steroids are sometimes used on the face to treat various skin conditions like eczema, psoriasis, or dermatitis. These medications are effective at reducing inflammation, redness, and itching. However, it’s crucial to be cautious when using topical steroids on the face, as the skin in this area is more sensitive and thinner compared to other parts of the body.
Reasons for Caution:
- Thinner skin on the face makes it more susceptible to side effects like skin thinning (atrophy), pigmentation changes, and the development of small blood vessels (telangiectasia).
- The face has more sebaceous glands, which may alter the absorption and effects of topical steroids.
- The proximity to the eyes increases the risk of conditions like glaucoma or cataracts when steroids are absorbed into the bloodstream.
Given these considerations, dermatologists usually prescribe lower-potency steroids for facial use and recommend using them for shorter periods. Non-steroidal alternatives like calcineurin inhibitors may also be considered for treating facial skin conditions.
The integration of low potency hydrocortisone in cosmetic skin products is also a growing application for facial steroid use.
What does topical steroid withdrawal look like on the face?
Some people with topical steroid withdrawal may experience itching of the skin where topical steroids were applied. Itching usually follows a period of burning and stinging and occurs once the redness starts to fade.
Burning and stinging of the skin:
Usually more prominent in the Erythematoedematous type of rash than in the Papulopustular type of rash, many people experience a burning and stinging sensation over the skin where the topical steroid was applied. The heat, the sun, sweat and oftentimes water, can exacerbate the stinging of the skin.
Red flushed face
Some people who develop topical steroid withdrawal on the face may experience episodes of hot flushes. When these episodes occur, their face will flush red and may feel warm.
Other symptoms of topical steroid withdrawal on the face include:
- Enlarged lymph nodes (commonly on neck)
- Eye dryness and irritation
- Flaking skin
- Hair loss (eye brows and head)
- Intense Itching
- Hypersensitivity of the skin to water, movement, moisturizer, fabrics, temperature, etc.
- Nerve pain
- Metallic smell
- Papules and pustules
- Atrophy and skin thinning
Based on systematic review of research to date by the National Eczema Association, both types primarily affect the face of adult females and are mostly associated with inappropriately using mid- to high-potency topical corticosteroids daily for more than 12 months.
How long does topical steroid withdrawal on the face take to heal?
Unfortunately, there is no specific time frame of healing.The skin is the largest organ of the body and it needs time to heal, especially after a long period of steroid damage and a suppressed immune system. In the case of topical steroid withdrawal, the time it needs to heal can vary very much from person to person. Each person with topical steroid withdrawal are in different stages of healing and this can often be cyclical.
Our Mission at TSW Assist
Our mission here at TSW Assist is to gather insights of medications, products, routines, supplements, and therapies that can help manage the symptoms experienced during withdrawal period from topical steroids. There is currently no cure for topical steroid withdrawal but these insights come directly people with TSW who have had success in symptomatic relief during their withdrawal period.