Topical steroid withdrawal: a serious, under-recognised skin condition

Topical steroid withdrawal (TSW) is a serious and often under-recognised dermatological condition. It is an adverse reaction to prolonged use of topical corticosteroids (TCS), which may occur following tapering or sudden cessation of treatment. TCS are widely used in the therapeutic management of various dermatological conditions, demonstrating notable efficacy in treating conditions such as atopic eczema and psoriasis. However, it is now recognised that prolonged use of TCS can lead to the development of TSW. TSW is characterised by the skin's dependence on exogenous steroids, with symptoms emerging when the skin becomes less responsive to treatment; when TCS are tapered or after they are discontinued. Common symptoms of TSW include burning, itching, erythema and skin thinning, which can extend beyond the original areas of steroid application.As public awareness of TSW continues to grow, the condition has also emerged as a pressing focus in dermatological research. Despite these advancements, the underlying pathophysiology of TSW remains intricate and only partially understood. Diagnosis poses a significant challenge due to the highly variable clinical presentations, emphasising the critical need for timely recognition. Early and accurate recognition not only prevent potential mismanagement but also ensure that patients receive the comprehensive support necessary to navigate this often-debilitating condition.This report presents and dissects a clinical case of TSW and includes a detailed account from a TSW patient over a period of 22 months. The report aims to highlight the complexities involved in diagnosing and managing the condition, emphasise the necessity for heightened awareness among clinicians and encourage the development of tailored interventions in clinical practice to address the unique challenges posed by TSW.