Topical Steroid Withdrawal: What It Is and What the Evidence Says

If you stopped a steroid cream and your skin turned red, hot and raw, you are not imagining it. The UK medicines regulator, the MHRA, has recognised topical steroid withdrawal as a possible reaction after long term use of topical corticosteroids (Drug and Therapeutics Bulletin, 2021). The research is still young and doctors do not all agree on it, so this article sets out what the evidence actually shows, what it does not show yet, and how to care for your skin while you work with your GP or dermatologist.

Reviewed October 2026. This article is for information only and is not medical advice.

What is topical steroid withdrawal?

Topical steroid withdrawal (TSW) describes a reaction that can appear after stopping a steroid cream or ointment that has been used often and for a long time. A systematic review of 34 studies found that reported cases were mostly on the face or genital area (99.3%), mostly in women (81%), and mainly after long term use of potent steroids (Hajar, 2015). An update of that review in 2021 found the same pattern: prolonged use of moderate to high strength steroids, usually on the face (Hwang and Lio, 2021).

What are the symptoms of topical steroid withdrawal?

Burning and stinging are the most reported symptoms, and redness is the most common sign (Hajar, 2015). The most recent review found burning in 89.8% of cases, itch in 85.6%, skin sensitivity in 82.3%, redness in 89.6% and peeling in 88.7% (Choi, 2026). Researchers describe two patterns: one with spots and bumps, and one with red, swollen skin that burns more.

In a UK clinic series of 19 people, the most common features were redness, burning skin pain, sensitivity, heavy flaking, poor sleep and severe itch, and many people also struggled with anxiety and low mood (Brookes, 2023). A small study at the US National Institutes of Health found that burning, flushing and difficulty regulating body temperature helped tell TSW apart from eczema (Shobnam, 2025).

Is topical steroid withdrawal the same as an eczema flare?

This is where the science is honestly unsettled. There are no agreed diagnostic criteria yet (Brookes, 2023; Choi, 2026). In a survey of 168 Dutch healthcare professionals, 12.2% firmly believed TSW is a distinct condition, 17.6% believed it does not exist, and most put the symptoms down to eczema flares, a side effect of steroid use, or both (Vroman, 2025). Because it can look so similar to eczema, it is easy to be dismissed, and patients in the UK series described exactly that (Brookes, 2023).

What causes topical steroid withdrawal?

We do not know yet. The most detailed study so far, a pilot of 16 people at the US National Institutes of Health, found changes in how skin cells use energy in their mitochondria, involving a molecule called NAD+. Steroid exposure triggered the same changes in skin cells and in healthy volunteers (Shobnam, 2025). As a cell scientist I find this exciting, but it is one small pilot study and it needs to be repeated in larger groups before we can say this is the cause.

How long does topical steroid withdrawal last?

There are no controlled studies that answer this, so be wary of anyone who gives you a fixed timeline. In a case series of 10 children followed for 18 months to 4 years after stopping steroids, the early months were hard for the children and their families, but all of them improved. At their last review, 4 had clear skin and 4 had returned to their original eczema (Sheary, 2019). In the UK series, people improved when they had open, supportive consultations and earlier access to conventional treatment options (Brookes, 2023).

Should I stop using my steroid cream?

Please do not stop or change a prescribed treatment without talking to your GP, pharmacist or dermatologist. Steroid creams are still a first line treatment for eczema. A review of long term safety from the University of Nottingham found reassuring results for skin thinning when steroids were used on and off to treat flares for up to five years, although it also found no long term studies on TSW itself (Harvey, 2023). If you are worried, ask your doctor about reducing gradually, other treatments, and psychological support. Get urgent medical help if your skin is weeping, crusting, very painful or blistering, or if you feel unwell or feverish, as these can be signs of infection.

How can I care for my skin during topical steroid withdrawal?

Skin going through withdrawal has a very weak barrier, so the aim is to be as gentle as possible:

• Keep washing short and lukewarm, and use a mild cleanser or plain water.
• Moisturise while skin is still slightly damp to reduce water loss.
• Choose products with short ingredient lists, and patch test anything new on a small area first, because withdrawal skin can react to almost anything.
• Wear loose, soft cotton and keep your bedroom cool, as many people struggle with flushing and temperature changes.
• Protect your sleep and ask for support with stress and mood. You do not have to manage this alone.

You can read more about how the barrier rebuilds itself in our guide on how to repair your skin barrier, and use our flare plan to keep track of what helps you.

References

1. Topical corticosteroid withdrawal reactions (summary of MHRA Drug Safety Update, 2021). Drug Ther Bull. 2021;59(12):184. doi:10.1136/dtb.2021.000062
2. Hajar T et al. A systematic review of topical corticosteroid withdrawal ("steroid addiction") in patients with atopic dermatitis and other dermatoses. J Am Acad Dermatol. 2015;72(3):541-549. doi:10.1016/j.jaad.2014.11.024
3. Hwang J, Lio PA. Topical corticosteroid withdrawal ('steroid addiction'): an update of a systematic review. J Dermatolog Treat. 2022;33(3):1293-1298. doi:10.1080/09546634.2021.1882659
4. Choi H et al. An updated systematic review of topical corticosteroid withdrawal (TCSW): steroid addiction or adverse drug effect? Cureus. 2026;18(4):e107365. doi:10.7759/cureus.107365
5. Brookes TS et al. Topical steroid withdrawal: an emerging clinical problem. Clin Exp Dermatol. 2023;48(9):1007-1011. doi:10.1093/ced/llad161
6. Shobnam N et al. Topical steroid withdrawal is a targetable excess of mitochondrial NAD+. J Invest Dermatol. 2025;145(8):1953-1968. doi:10.1016/j.jid.2024.11.026
7. Vroman F et al. Topical steroid withdrawal: perspectives of Dutch healthcare professionals. Acta Derm Venereol. 2025;105:adv44209. doi:10.2340/actadv.v105.44209
8. Sheary B. Topical steroid withdrawal: a case series of 10 children. Acta Derm Venereol. 2019;99(6):551-556. doi:10.2340/00015555-3144
9. Harvey J et al. The long-term safety of topical corticosteroids in atopic dermatitis: a systematic review. Skin Health Dis. 2023;3(5):e268. doi:10.1002/ski2.268

Written by Hana Maatugh, HCPC registered Specialist Biomedical Scientist with twenty years in NHS cellular pathology. About the author