MHRA recognises the existence of Topical Steroid Withdrawal

The standard advice for the treatment of eczema in both children and adults has not changed in decades:

• emollients (moisturisers) – used every day to stop the skin becoming dry
• topical corticosteroids – creams and ointments used to reduce swelling and redness during flare-ups

The use of emollients is relatively uncontroversial (although not everyone agrees, especially when dealing with TSW – see the NMT treatment described here). But there has always been some nervousness, especially among patients, over the long term use of topical steroids. Will they thin the skin? What other damage could they do?  However, the official line has remained that topical steroids are the only way to control eczema outbreaks and do not, provided they are used correctly, have any long term or deleterious effect on the skin or the rest of the body.

However, anyone who follows Ruth Holroyds’ What Allergy? blog will know that there is a growing group of those living with long term eczema who do not accept this rosy picture. They believe that their long term use of steroids has further damaged their already damaged skin (and maybe their whole system) and – worse – that they have become addicted to the steroids. As a result stopping using them results in horrendous withdrawal issues: insane itching, nerve pain, lack of sleep, constant skin shedding, inflammation, exhaustion. (For some really graphic pictures of what this can mean see this article.) Although it rarely does, it can take up to five years for these recovery symptoms to finally calm down.

What makes it even more difficult is that until now this group has had no support from their medical teams. Quite the contrary. Ruth has now been discharged from NHS care for her eczema because she has refused further steroid treatment.

So, one can understand why the MHRA’s admission that, actually, there could be a problem here, has been greeted with glad cries:
Patients using topical corticosteroid creams to treat conditions such as eczema or psoriasis are reminded to do so in accordance with advice from their healthcare professional, after a national review found that people using topical steroid for long-periods of time can suffer severe skin withdrawal symptoms.

Not that this acknowledement is really going to help anyone very much as all the MHRA suggests is that ‘anyone experiencing skin redness or burning sensations after they have stopped using these creams or ointments to seek advice from their health professional before using these products again’.  But since steroid use is the only treatment on offer – and  99% of health professionals do not accept that there is an issue with using steroids for eczema control – the only advice that you are likely to get from your health professional is to go back on the steroids. This is certainly what has happened to Ruth and to most of the TSW fraternity.

Still, acknowledgement is acknowledgement and is certainly a step in the right direction so is to be welcomed.

Meanwhile, anyone who wants to know more about the use of steroids in eczema should check into Ruth’s blog where she has a lengthy section about topical steroids, why and how you should stop using them – and a great selection of resources.