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Background

Topical corticosteroids (TCS) have been the mainstay of treatment for inflammatory dermatoses and are felt to be safe when used appropriately. In response to increased reports about Red Skin Syndrome (RSS) and Topical Steroid Addiction/Withdrawal (TSA/TSW), a systematic review (2015) conducted by the National Eczema Association concluded that RSS/TSA/TSW is a potential adverse effect of prolonged use of topical steroids. The phenomenon of RSS/TSA/TSW has been deemed rare. There is no validated definition, no patient registry, and no evidence-based treatment.

Figure 1. Stages of RSS/TSA/TSW before and after cessation of TCS. Figure 1 (A) A typical appearance of TSA, with prurigo-like eruption before withdrawal. (B) Appearance just after trial of decreasing the amount of potent topical steroids. The severity of addiction is so intense that the patient cannot safely withdraw by a gradual-decrease method. (C) The rebound erythema is spreading after complete cessation of steroids. (D) The appearance after 1 year. The rebound has almost subsided but hypersensitivity still remains 1

Source: Mototsugu Fukaya MD, et al. “Topical Steroid Addiction in Atopic Dermatitis” Drug, Healthcare and Patient Safety, 2014;6: pp.131–138.