What is the range, extent and type of evidence about topic steroid withdrawal in research literature and social media platforms? A Protocol for an Evidence and Gap Map

Abstract

Topical corticosteroids (TCS) have been the mainstay of treatment for many skin disorders, including chronic conditions such as atopic dermatitis (most common form of eczema), for more than 60 years. Research has shown that TCS are effective(1) but that their use is associated with a number of adverse effects such as atrophy, striae, rosacea, perioral dermatitis, acne and purpura. (2) Topical steroid addiction (TSA) is also an adverse effect, first recognised by Sneddon(3) in 1969 - although he did not use the word ‘addiction’. According to Fukaya et al, (4) the term ‘addiction’ was first used by Burry(5) in Australia in 1973, who described how patients, like their skins, were ‘hooked’ on TCS and “...afraid to stop using the topical steroids because of the rebound inflammation that would follow” (p. 396). Writing in 1979, Kligman & Frosch(6) described addiction as an “insidious type of side reaction,” often unrecognised, as “both physician and patient may fail to incriminate the steroid” (p. 24). However since then, there has been increasing recognition of TSA and interest in topical steroid withdrawal (TSW), particularly amongst ‘patients’, as demonstrated by the growth in social media addressing the side effects on those who discontinue long-term use of TCS.