Understanding Topical Steroid Withdrawal in Kids with Eczema: What Parents Should Know
Parents worried about “steroid withdrawal”? What pediatric dermatologists want you to know
Fears about stopping topical steroids are showing up more and more in pediatric clinics, often after families see dramatic posts on social media. These worries can make conversations about treating eczema stressful for both parents and doctors. A recent episode of the Society for Pediatric Dermatology podcast “Don’t Be Rash” featured a discussion about how to evaluate suspected topical steroid withdrawal and how to keep families engaged in care.
Quick summary
Topical steroid withdrawal (TSW) refers to a worsening skin reaction that some people say happens after stopping strong steroid creams or ointments that were used for a long time. Reports of TSW mostly involve adults (often women) and affect the face or genital area after inappropriate use of very strong steroid creams. Pediatric specialists say true TSW is rare in children.
Why these fears are growing
Social media often features personal stories warning about steroid use. One analysis found many posts were personal accounts describing bad experiences and discouraging steroid use. Some confusion can also start in primary care when families are told to use steroid creams “only for 7 days” or “only during bad flares.” Those brief instructions can imply that longer use is always harmful, which isn’t the full picture.
How doctors approach a child who looks like they might have TSW
When a child comes in with very red, peeling, or shedding skin, doctors consider several common causes before assuming TSW. These include:
- an undertreated eczema flare, especially if something in the child’s environment is still triggering the rash;
- a bacterial infection (often Staphylococcus) that causes crusting and oozing;
- eczema herpeticum, which is a herpes simplex virus infection that can cause many similar-looking punched-out round crusts inside eczema areas and redness that extends beyond the usual rash borders;
- allergic contact dermatitis to a skin product (for example, one recent case turned out to be a lanolin allergy around the mouth).
These conditions require different treatments, so doctors try to rule them out first. Neither of the pediatric dermatologists on the podcast recalled diagnosing TSW in a child; the few cases they remembered involved adults who used ultrapotent steroid creams on the face for many years.
How clinicians can talk about the fear of TSW
Dismissing a family’s concern can harm trust. A better approach is to validate the worry and ask what specifically they fear. From there, clinicians can explain that when steroid creams (topical corticosteroids) are used appropriately under a doctor’s supervision, the risks are generally low. Regular follow-up lets a clinician watch treated areas for things like skin thinning, acne, or stretch marks (striae).
It’s important to emphasize that treatment decisions should be made together with a doctor or dermatologist. If families remain worried about steroid use, there are alternatives and strategies that may reduce or avoid steroid exposure.
Nonsteroidal creams that may help
New, nonsteroidal prescription creams give doctors options to use less steroid over time. Examples include ruxolitinib cream (Opzelura), roflumilast cream (Zoryve), and tapinarof cream (Vtama). These creams:
- may be used as first-line therapy for mild to moderate eczema;
- can serve as maintenance treatment after a short course of steroid cream clears the rash;
- may also help control flares in people who are on systemic medicines such as dupilumab (Dupixent).
These options can support a steroid-sparing plan, but whether they are appropriate depends on the child’s age, severity of eczema, and other medical factors. Talk with a dermatologist about risks, benefits, and follow-up.
The bigger picture: this is often a communication challenge
The podcast conversation framed suspected pediatric TSW more as a problem of fear and misunderstanding than a common diagnosis. Care that carefully checks for look-alike conditions, listens to parents, and offers alternatives when appropriate can both treat the skin and keep families involved in care.
Tracking visible changes
Keeping a simple photo diary of the rash over days or weeks can help families and doctors see whether a treatment is working or whether the rash is changing in a worrying way. Photos can make follow-up visits more informative.
When to see a doctor right away
Contact your child’s doctor promptly if your child has any of the following:
- rapid spreading redness or a rash that is getting much worse;
- new painful areas, deep blisters, or areas that bleed;
- crusting, oozing, or yellow crusts that could mean infection;
- fever, lethargy, or other signs of systemic illness;
- any sudden change that feels different from usual eczema flare-ups.
Important note
This article is for information only and is not medical advice. Treatment choices should be discussed with your child’s doctor or a dermatologist. If you are worried about infection, severe symptoms, or rapid changes, seek medical care right away.
Sources
- Podcast: Society for Pediatric Dermatology, “Don’t Be Rash” episode featuring Andrew Krakowski, MD, and Mercedes E. Gonzalez, MD. (Discussion of parental concern about topical steroid withdrawal and pediatric evaluation.)
- Hajar T, Leshem YA, Hanifin JM, 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.e2. doi:10.1016/j.jaad.2014.11.024 (Source: journal article)
- Nickles MA, Coale AT, Henderson WJA, et al. Steroid phobia on social media platforms. Pediatr Dermatol. 2023;40(3):479-482. doi:10.1111/pde.15269 (Source: journal article)