Topical corticosteroids and withdrawal reactions
Safety leaflet on topical corticosteroids and withdrawal reactions to help patients and their carers to use these medicines safely.
This safety leaflet will help you to understand topical corticosteroids and withdrawal reactions. You should always use your medicines as instructed by your doctor or healthcare professional. Keep this leaflet in a safe place as you may need to read it again. A PDF version is available: .
For further information on using topical corticosteroids safely, and a full list of possible side effects, read the Patient Information Leaflet that came with your medicine, and keep it handy. Patient Information Leaflets for each medicine are also available on the MHRA’s website.
Key messages
- Topical corticosteroids are medicines used on the skin to reduce inflammation
- When used correctly, topical corticosteroid medicines are safe and effective treatments for skin disorders
- Seek medical advice before using your topical corticosteroid on a new body area, as some areas of the body are more prone to side effects
- Different topical corticosteroids have different strengths (known as potencies) and your prescriber will decide on the correct potency for you
- Using too little of the cream or ointment can prolong treatment time and increase the risk of certain side effects
- If you’ve been using these medicines continually for a long time, consider asking your prescriber for a treatment review
- If you have a flare-up or your skin condition returns shortly after stopping treatment, and you have been using topical corticosteroids without stopping for a long time (usually over 12 months in adults), you may be experiencing a type of topical steroid withdrawal reaction – these can sometimes be severe
- Contact your doctor if you experience any of the following after stopping treatment:
- redness or darkening of skin colour, which can extend beyond the initial area treated
- burning, stinging, itching or peeling of the skin, or oozing open sores
About Topical Steroids
Steroids are natural chemicals produced by the body and also are manufactured to be used as medicines. There are different types of steroids. The most common type used to treat skin problems are the corticosteroids.
Corticosteroids treat skin conditions by reducing inflammation. Corticosteroids used on the skin are ‘topical corticosteroids’. These may come in the form of creams, ointments, lotions, mousses, shampoos, gels or tapes.
Different topical corticosteroids have different strengths, or potencies. A useful table of product potencies is available from the Bridgewater Community Healthcare NHS.
Your doctor (or another prescriber) will decide on the correct strength for you based on your condition, your age, and the area of your body to be treated.
Your doctor may prescribe more than one topical corticosteroid. These may be of different potencies and for you to apply to different body areas. Some body areas are more prone to side effects from corticosteroids than others. These areas include the face, especially the eyelids, the groin and under the arms or breasts. This is why it is important that you don’t treat a new body area with your topical corticosteroid unless your doctor has told you to do so. Remember that the percentage concentration stated on the tube only applies to that particular corticosteroid.
Safe Use of Topical Corticosteroids
When used correctly, topical corticosteroids are a safe and effective treatment. You should follow your doctor’s instructions on how to use your medicine. Your doctor will explain where, how often and for how long to use your topical corticosteroid. They are usually applied once or twice a day, and your doctor will tell you what is best for your skin condition.
It is important not to under-use or over-use topical corticosteroids. Use enough of the preparation to cover the area treated. Finger-tip application units can help with this. You can also find a factsheet from the National Eczema Society.
Most people prescribed topical corticosteroids will also be prescribed an emollient, which is a moisturiser that hydrates and soothes the skin. You can use the topical corticosteroid and the emollient at the same time of day. However, you should wait 20 to 30 minutes between applying the two treatments. If used close together, the emollient could dilute the topical steroid and reduce the steroid’s effectiveness.
Special Considerations for Children
Topical corticosteroids are used for the treatment of inflammatory conditions of the skin, such as eczema and psoriasis. They may be used alongside emollients.
Topical corticosteroids can be used safely in children if recommended by a healthcare professional. However, children, especially infants, are particularly susceptible to side effects with corticosteroids.
This means it is important to use only the amount advised by a doctor and for a short amount of time. If your patient leaflet does not specify fingertip applications for children by age, please confirm with your child’s doctor the correct amount to apply. You can also refer to the information on topical corticosteroids produced by Guy’s and St Thomas’ NHS Trust.
Be careful not to use too little. This can mean that the corticosteroid needs to be used for longer than necessary. Seek medical advice if your child’s eczema or skin condition does not improve or worsens with treatment. If a stronger topical corticosteroid is prescribed and there is still no improvement, discuss with your child’s doctor or a healthcare professional as soon as possible
Topical Steroid Withdrawal Reactions
If your skin condition gets worse or does not get better, it is important that you return to your doctor for advice. You might have developed a different condition, which may need a different treatment.
It is not unusual for skin conditions to flare or return shortly after stopping topical corticosteroids. Sometimes a severe type of topical steroid withdrawal reaction can occur, which may also be known by the terms red skin syndrome or topical steroid addiction. Based on the number of patients who use these medicines, reports of these types of severe withdrawal reactions seem to be very infrequent.
Topical steroid withdrawal reactions are usually seen after long-term use of these medicines. For example, longer than 12 months in adults. They have also been seen after as little as 2 months of continual use in children. Withdrawal reactions are also usually seen if the medicine was used very often or for prolonged periods of time. Reactions are more common after use in sensitive areas such as the face or genitals.
Topical steroid withdrawal reactions have not been reported when topical steroids are used to treat suitable conditions for short periods of time or with short breaks in treatment over an extended period. It is very important that you follow your doctor’s instructions. You should also read the Patient Information Leaflet included with your medicine.
Signs of severe topical steroid withdrawal reactions include redness of the skin. This redness can extend beyond the area treated with the topical corticosteroid. Redness can be a spectrum of pink, to purple, which may show as darkening of the normal skin tone and can vary depending on the skin tone of the individual. Other signs include burning or stinging, intense itching, peeling of the skin, or oozing open sores. These signs may occur days or weeks after stopping treatment.
Other Effects of Over-Use
Over-using topical corticosteroids can also lead to other possible side effects during treatment. These include colour changes or thinning of the skin. Another rare side effect is Cushing’s syndrome, a disorder with a red, puffy and rounded face, high blood pressure, weight gain, and changes in sugar levels in the blood and urine. A full list of side effects is included in each medicine’s Patient Information Leaflet.
If you are worried about a suspected side effect, you should speak to your doctor or pharmacist.
It is very important that you follow instructions from healthcare professionals. You should also read the patient information leaflet included with your medicine.
Help and Advice on Managing Your Condition
Your GP, dermatologist or another healthcare professional can provide further information, including help and advice on managing your condition. The following charities or organisations also have resources:
- National Eczema Society (NES)
- Psoriasis Association
- Psoriasis and Psoriatic Arthritis Alliance
- British Association of Dermatologists (BAD)
- Medicines for Children
The BAD and NES have published a statement on topical steroid withdrawal. This discusses treatment options.
Please report medicine side effects directly to the MHRA on the Yellow Card website, or via the free apps (‘Yellow Card Scheme’ in the Google Play Store or ‘Yellow Card – MHRA’ in the Apple App Store), or by phoning the free phoneline (0800 731 6789).
The Medicines and Healthcare products Regulatory Agency (MHRA) is the government agency responsible for regulating medicines in the UK and ensuring their safety, quality and effectiveness. We continually review the safety of all medicines in the UK and inform healthcare professionals and the public of the latest updates.
Leaflet last reviewed in April 2022. This advice will next be reviewed in April 2023. If you have any feedback regarding this leaflet, please email info@mhra.gov.uk.