Red burning skin

Red burning skin, also known as topical steroid addiction and steroid dermatitis, has been reported in long-term users of topical steroids.^[1][2] It generally requires the applying of a topical steroid at least daily for more than a year.^[3] It has already been described in adults.^[3]

Signs and symptoms

TSA is characterised by uncontrollable, spreading dermatitis and worsening skin inflammation which requires a stronger topical steroid to get the same result as the first prescription. When topical steroid medication is stopped, the skin experiences redness, burning, itching, hot skin, swelling, and/or oozing for a length of time. This is also called 'red skin syndrome' or 'topical steroid withdrawal'(TSW). After the withdrawal period is over the atopic dermatitis can cease or is less severe than it was before.^[4]

Duration

The duration of acute topical corticosteroid withdrawal and time to peak is variable from days to months, before eventually the skin becomes ‘normal’. It can take weeks to years to return to the skin's original condition.^[5] The duration of steroid use may influence the recovery factor time, with patient's who used steroids for the longest reporting the slowest recovery.

Mechanism of action

Historically, it was believed that cortisol was only produced by the adrenal glands. Recent research has shown that keratinocytes in human skin also produce cortisol.^[6] It is believed that prolonged and continuous exposure to topical steroids interferes with the body's ability to regulate cortisol production.

History

The first description of the condition occurred in 1979.^[7]

References