MHRA Advises Clinicians to Be Vigilant of Topical Steroid Withdrawal Reactions

Pavankumar Kamat

September 16, 2021

The Medicines and Healthcare products Regulatory Agency (MHRA) has issued a drug safety update highlighting the possibility of adverse reactions (rarely severe) upon discontinuation of topical corticosteroids, often after prolonged continuous or inappropriate use of moderate to high potency steroidal agents. 

Patients have commonly reported a specific type of topical steroid withdrawal reaction presenting as intense skin redness that extends beyond the initial treatment region, accompanied by burning or stinging that is worse than the original condition. It is often hard to distinguish topical steroid withdrawal reactions from a rebound (or flare) of the underlying skin condition, which could benefit from further topical steroid treatment. Skin biopsy is usually unable to differentiate topical steroid withdrawal reactions from a flare due to overlapping histopathology.

A topical steroid withdrawal reaction is more likely if:

  • The primary symptom is burning rather than itching.

  • Skin redness is not patchy, but confluent.

  • Rash mimics atopic dermatitis but occurs in unusual areas and is 'different' from the skin condition the patient has previously experienced.

  • A moderate or high potency topical corticosteroid has been continuously used for a long duration.

Topical steroid withdrawal reactions can occur with daily use for more than a year and as little as two months in children. Individuals with atopic dermatitis have the highest risk of developing topical steroid withdrawal reactions.

In its review, the MHRA identified 55 Yellow Card reports suggestive of topical steroid withdrawal reactions, primarily reported by patients and also considered evidence from the available literature. The frequency of such reactions could not be estimated, but severe withdrawal reactions have not been reported very frequently.

The MHRA advises clinicians to prescribe the lowest potency topical corticosteroid required for effective treatment. Reducing the potency or frequency of application (or both) can be considered for patients currently receiving long-term topical corticosteroid treatment. Clinicians should also educate patients on the amount of product to be used and the optimal duration of treatment, particularly on sensitive parts of the body, including the face and genitals.

Clinicians are also advised to remain watchful for the signs and symptoms of topical steroid withdrawal reactions and carefully review the position statement from the National Eczema Society and British Association of Dermatologists.

The Summary of Product Characteristics and the Patient Information Leaflet for products containing topical corticosteroids are being updated to reflect the updated safety information.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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