An Updated Systematic Review of Topical Corticosteroid Withdrawal (TCSW): Steroid Addiction or Adverse Drug Effect?

Topical corticosteroid withdrawal (TCSW) can occur after prolonged topical corticosteroid (TCS) use. Despite the effectiveness of TCS in treating dermatological conditions, the phenomenon of steroid phobia has been gaining attention on social media platforms. This has contributed to increased anxiety among patients and potentially influenced their treatment adherence. This review aims to update the findings of two studies by investigating the latest research on TCSW. A systematic search was conducted in Ovid MEDLINE, PubMed, and the Cochrane Library from October 2020 to June 2024. Seven studies were included in the analysis, including five case reports, one case series, and one qualitative cross-sectional survey, reflecting the limited and descriptive nature of the currently available evidence on TCSW. TCSW appears to predominantly occur in adult women (90%) using TCS for atopic dermatitis (99.5%), mostly on the face (90%). Common symptoms include burning (89.8%), itching (85.6%), and skin hypersensitivity (82.3%), with erythema (89.6%) and desquamation (88.7%). TCSW appears to occur more commonly in women using high-potency TCS on the face long-term. Inconsistent diagnostic criteria, variable definitions, and the primarily descriptive nature of the currently available evidence complicate accurate diagnosis and treatment of TCSW. Increased awareness, education, and research on standardized criteria and management strategies are essential.