What problems can occur when using cortisone? What is “Topical Steroid Withdrawal”?

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  • What is “topical steroid withdrawal”, cortisone withdrawal or “topical steroid withdrawal” (TSW)? ❓
  • Topical corticosteroid withdrawal (= cortisone creams applied to the skin) refers to a rare adverse reaction due to the use of a topical steroid (= cortisone cream) after it has been discontinued. This reaction can occur after prolonged, inappropriate and/or frequent use/abuse of medium to high potency topical corticosteroids (= cortisone). ℹ️
  • The symptoms are also known as “red skin syndrome” because the skin is very red in color, especially where the veins run under the skin. 🔴
  • It can present as red, burning skin or a rash, e.g. “steroid rosacea” or “perioral dermatitis”. 💡
  • It can sometimes be difficult to distinguish it from an atopic dermatitis flare-up. ℹ️
  • Patients with red, burning skin after withdrawal of topical steroids (= cortisone creams) can be distressed by the intensity of the itching, lack of sleep and difficulty with treatment. 😩😪
  • Psychological support can therefore be very, very helpful to get through this. 👩‍⚕️
  • It can help to go out and live your everyday life as you always have. Or to take a step back and only stay in your closest private environment, where you feel very comfortable. It’s very individual and you have to find out for yourself what works. 👤

Recommendations for action

✅ If you have been using cortisone creams for a long time and now suddenly stop using them and have very red / burning skin: talk to your doctor about whether this could be the symptoms of “cortisone withdrawal” (instead of moderate / severe atopic dermatitis).
✅ For the red, burning skin, cold compresses can help to alleviate some of the symptoms. Psychological support can also help to get through this difficult phase. Talk to your doctor to see if they can recommend someone.


🌐 You can find more information on “cortisone withdrawal syndrome” here and here.


Topical Steroid Withdrawal or also called topical steroid withdrawal, cortisone withdrawal. What is it? Topical steroid withdrawal is a phenomenon that has been around for a very long time, but has only been well described medically in recent years. It is a syndrome for which atopic dermatitis sufferers who have regularly used or taken cortisone or antihistamines or other such medications for a long time are particularly at risk. The characteristics are as follows: You have used the medication in question regularly over a long period of time – a few weeks can be enough – and it is also possible that you have used it exactly as the doctor told you, and that you still end up with this syndrome. Another characteristic is that these medications and creams gradually work worse and worse and the skin still gets worse, even though you may have used the medication. It is often the case that the doctor prescribes stronger and stronger medication in an attempt to get this thing under control again, but these medications still gradually work worse and worse. And it is the case – in English it is also called red skin syndrome – that the pattern of the redness of the skin follows the pattern of the blood veins. In other words, where there are veins under the skin, the skin is red, and where there are no veins under the skin, the skin is not red. This is an important distinguishing feature between atopic dermatitis and topical steroid withdrawal, because it is not necessarily the case with atopic dermatitis that the redness of the skin follows the pattern of the blood vessels. Topical steroid withdrawal is often misdiagnosed as severe atopic dermatitis. But that’s not it! Topical steroid withdrawal is an iatrogenic condition, which means it’s caused by doing the things your doctor told you to do. If you have this now and you’ve noticed it and you stop taking the medication, then you get the withdrawal symptoms I was talking about. It looks like extreme neurodermatitis, the skin is red, the skin often oozes, there’s bad itching and a few more symptoms, then it can take months to years to heal, and the healing is not linear, that it’s really bad at the beginning and then it gradually gets better and better, but it can be that it’s really bad at the beginning and then it gets a little better and then it gets really bad again and then it gets better again…it’s very individual. But the body can do it. The body manages it on its own and it heals again. It takes months to years, depending. Of course, the longer you have been taking topical steroids, the longer it will take to heal. Psychological support can be very, very helpful to get through something like this. And it can be helpful to stay at home, to surround yourself with important people, with people who are good for you. But it can also help to go out and live your everyday life as usual. It’s very individual and you also have to look at it: What is good for my skin and what is not. And what doesn’t do you good, you simply leave out. So it’s also important to take responsibility for yourself.

Medical disclaimer

The contents of this app / pages do not constitute medical recommendations. It is general information or the presentation of your own tracking data. Before you change anything in your therapy plan, please always talk to your doctor first.


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