Eczema

Steroid treatments are frequently used to treat a variety of skin conditions, including eczema. Long-term use of steroids, on the other hand, can result in a variety of side effects, including tachyphylaxis and withdrawal symptoms. In this article, we will look at the prevalence and mechanisms of these side effects in chronic eczema patients.

Tachyphylaxis in Chronic Eczema:

Tachyphylaxis is a rapid decrease in drug response after repeated administration. Tachyphylaxis to steroids is a common occurrence in patients with chronic eczema. According to a study conducted by Hong et al. [1], 58% of patients with chronic eczema who used topical steroids for more than 3 months experienced tachyphylaxis. The study also discovered that tachyphylaxis was more likely in patients who used higher potency steroids, had more severe eczema, and had had the disease for a longer period of time.

The underlying mechanism of tachyphylaxis in chronic eczema is unknown. One theory is that repeated steroid exposure causes downregulation of the glucocorticoid receptor, which reduces steroids' anti-inflammatory effect [2]. Another theory is that repeated steroid exposure induces a proinflammatory state, which counteracts steroids' anti-inflammatory effect [3].

Steroid Withdrawal Symptoms:

When steroids are stopped for an extended period of time, they can cause withdrawal symptoms. Even when steroids are used at therapeutic doses and for a short period of time, withdrawal symptoms can occur. Patients who use steroids for a longer period of time or at higher doses have a higher incidence and severity of withdrawal symptoms.

Withdrawal symptoms usually appear within days to weeks of stopping steroids and can last several weeks to months. Symptoms include itchiness, skin redness, burning, and stinging sensations, as well as recurrent eczema flares [4].

Sibbald et al. [5] discovered that 66% of patients with chronic eczema experienced withdrawal symptoms. The severity of withdrawal symptoms was also found to be positively correlated with the duration and potency of steroid use in the study.

Conclusion:

Steroid treatments are commonly used to treat chronic eczema. However, tachyphylaxis and withdrawal symptoms are common side effects of prolonged steroid use. Patients with chronic eczema should be closely monitored for these side effects, and steroids should be used sparingly or avoided if possible to reduce the risk of these side effects.

References:

[1] Hong J, Koo B, Kwon H, Lee J, Yoon S, Kim B. Tachyphylaxis to topical corticosteroids in atopic dermatitis. J Dermatol. 2015;42(9):876-878.

[2] Barnes P. Mechanisms of action of glucocorticoids in asthma. Am J Respir Crit Care Med. 1996;153(2 Pt 2):S23-S26.

[3] Boumpas D, Chrousos G, Wilder R, Cupps T, Balow J. Glucocorticoid therapy for immune-mediated diseases: basic and clinical correlates. Ann Intern Med. 1993;119(12):1198-1208.

[4] Hajar T, Leshem Y, Hanifin J, 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.

[5] Sibbald C, Drucker A,