title: A systematic review of topical corticosteroid withdrawal ("steroid addiction") in patients with atopic dermatitis and other dermatoses.
abstract: BACKGROUND
  The National Eczema Association has received increasing numbers of patient inquiries regarding "steroid addiction syndrome," coinciding with the growing presence of social media dedicated to this topic. Although many of the side effects of topical corticosteroids (TCS) are addressed in guidelines, TCS addiction is not.
  
  
  OBJECTIVE
  We sought to assess the current evidence regarding addiction/withdrawal.
  
  
  METHODS
  We performed a systematic review of the current literature.
  
  
  RESULTS
  Our initial search yielded 294 results with 34 studies meeting inclusion criteria. TCS withdrawal was reported mostly on the face and genital area (99.3%) of women (81.0%) primarily in the setting of long-term inappropriate use of potent TCS. Burning and stinging were the most frequently reported symptoms (65.5%) with erythema being the most common sign (92.3%). TCS withdrawal syndrome can be divided into papulopustular and erythematoedematous subtypes, with the latter presenting with more burning and edema.
  
  
  CONCLUSIONS
  Low quality of evidence, variability in the extent of data, and the lack of studies with rigorous steroid addiction methodology are limitations.
  
  
  CONCLUSIONS
  TCS withdrawal is likely a distinct clinical adverse effect of TCS misuse. Patients and providers should be aware of its clinical presentation and risk factors.
authors.affiliation: Oregon Health and Science University, Portland, Oregon.
authors.forename: Tamar
authors.initials: T
authors.lastname: Hajar
authors.affiliation: Oregon Health and Science University, Portland, Oregon.
authors.forename: Yael A
authors.initials: YA
authors.lastname: Leshem
authors.affiliation: Oregon Health and Science University, Portland, Oregon.
authors.forename: Jon M
authors.initials: JM
authors.lastname: Hanifin
authors.affiliation: University Hospital Case Medical Center, Cleveland, Ohio.
authors.forename: Susan T
authors.initials: ST
authors.lastname: Nedorost
authors.affiliation: Northwestern University, Chicago, Illinois.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Lio
authors.affiliation: Northwestern University, Chicago, Illinois.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Paller
authors.affiliation: National Eczema Association, San Rafael, California.
authors.forename: Julie
authors.initials: J
authors.lastname: Block
authors.affiliation: Oregon Health and Science University, Portland, Oregon. Electronic address: simpsone@ohsu.edu.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Simpson
mesh_terms: D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D012871:Skin Diseases / Q000188:drug therapy; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000628:therapy
chemical_list: D000305:Adrenal Cortex Hormones; D003879:Dermatologic Agents
keywords: atopic dermatitis; pruritus; red face; side effects; steroid addiction; topical corticosteroid withdrawal; topical corticosteroids