Contact dermatitis Diagnosis and treatment

There may be more cases within the MHRA Yellow Card database that are potentially topical steroid withdrawal reactions, but due to a lack of information we cannot determine them as such at this time. In essence, simply following the course of treatment prescribed to you, not exceeding the recommended dosage, frequency, or duration, will leave you fairly unlikely to develop topical steroid withdrawal. Topical steroids should normally only be used in short courses of two weeks or less, unless directed by your GP or consultant.

• We can prescribe a range of emollients and moisturisers that prevent drying and cracking.
• They can also be used alongside chemotherapy treatment – for example, as part of a combination of drugs known as ‘CHOP’ or ‘CVP’.
• Topical corticosteroids are known to constrict blood vessels in the skin and therefore some reddening of the skin would be expected on withdrawal.
• IgE Reactions may be induced by salts, such as succinate or rarely by certain diluents such as carboxymethylcellulose or metabisulfite.

Most of these side effects are already listed individually for topical corticosteroids. This paper by Sheary reviews some individual cases and the literature, including the review by Hajar above. The author concludes that the issue is under recognised and that most cases are caused by prolonged or inappropriate use of topical corticosteroids.

Why are steroids used in cancer treatment?

The steroid most commonly used to treat skin lymphomas is called prednisolone. For severe or widespread lichen planus, the mainstay of treatment is with a course of steroid tablets. If there is little improvement in the rash, second line treatment with narrow band UVB therapy or acitretin (a tablet treatment) may be considered. If there is a poor response to second line treatment, third line tablet treatments including methotrexate, and hydroxychloroquine can be considered.

• Unless instructed otherwise by your doctor, follow the directions on the patient information leaflet that comes with the medicine.
• You should not breastfeed while you are using topical chemotherapy.
• If you use them for a long time, particularly the more potent ones, you may get side effects such as thinning of the skin, dilated (widened) blood vessels or an acne-like rash.
• It is quite common for levels of lipids (fats) to rise in your blood and your doctor should give you drugs to reduce your lipid levels from the start of treatment.
• Radiotherapy uses high energy X-rays and electrons to destroy abnormal cells.
• Try to avoid injuring or scratching your skin as it can make new spots of lichen planus appear, particularly in an active phase.

Disclaimer – the author PCDS cannot accept responsibility for any misleading or incorrect statements, and the management of individual patients remains the direct responsibility of the individual doctor. We do however hope that visitors to this site can contact us regarding comments that are considered misleading or incorrect so that we can continue to improve the site. Image Rights – The PCDS would like to thank Dermatoweb, DermQuest (Galderma), and others who have contributed images.

Topical corticosteroids treatment pathway

Your doctor will consider the area of skin where you need to use it, how often you’ll use it and the condition of your skin. You should wash off any steroid cream applied to your breasts before feeding your baby. A few people with advanced T-cell skin lymphoma have a stem cell transplant. It involves high-dose chemotherapy followed by treatment with immature cells (stem cells) to help your bone marrow recover.

How to treat withdrawal from topical corticosteroids

However, in most patients lichen planus will heal within 18 months, and not return, although some patients may have further episodes many years later. Unfortunately, some types of lichen planus, such as those affecting the scalp, nails, mouth or genitalia, can last for many years. Even after active lichen planus has cleared, darker stains than the original skin colour may persist on the skin for a long time, particularly in Asian or Afro-Caribbean skin. These symptoms could suggest that your blood sugar levels have temporarily risen and you may have steroid-induced diabetes.

This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have. Your dose legit site to buy steroids may need to be reduced slowly over a few weeks or months. If you’ve been taking corticosteroids for a while, you may also need tests before you stop taking them.

It can be used on its own or in combination with PUVA for skin lymphoma that is advanced or has come back (relapsed). Although interferon-alfa improves skin lymphoma for many people, it doesn’t usually clear up completely. Some people remain free of skin lymphoma (in remission) for up to 5 years after receiving PUVA treatment. If the lymphoma comes back, you can have another course of phototherapy.

Download our information about steroids (pdf) –

GCs are the most potent and effective drugs in the prevention and suppression of inflammation caused by mechanical, chemical, infectious and immunological stimuli. The mechanisms of action of steroids can be divided into mechanisms of genomic action and mechanisms of non-genomic action. Talk to your doctor or nurse about effective contraception before starting your cancer treatment.