TCS overuse and withdrawal reactions: a UK lay-person’s perspective

[摘要] ‘Corticosteroids suppress the inflammatory reaction during use; they are not curative and on discontinuation a withdrawal reaction (rebound or flare) may occur. Withdrawal reactions are thought to occur after long-term continuous or inappropriate use of topical corticosteroids (particularly those of moderate to high potency).’ 1Topical corticosteroids (TCS) remain the mainstay treatment for atopic eczema in the UK. When judiciously prescribed and regularly monitored, TCS have had enormous benefits for patients. It is also evident from literature searches and communicating with dermatologists that patient or parental underuse, non-compliance, and steroid phobia have been major concerns for some time.2This lay article, however, focuses on the risks associated with overuse of mid-high potency of TCS, and the extreme and debilitating rebound reactions experienced by some adults and children when ceasing to apply TCS after long-term use, referred to as topical steroid withdrawal (TSW).In mid-September 2021, the UK Medicines and Healthcare products Regulatory Agency (MHRA) published two significant documents relating to TSW.3,4 Advice for healthcare professionals in the MHRA documents is to: report suspected adverse reactions to the Yellow Card Scheme (a system for recording adverse incidents with medicines and medical devices in the UK), including after discontinuation of TCS. When considering Yellow Card data alongside the number of patients who use TCS, the MHRA were unable to estimate the frequency of TSW reactions. ‘However, given the number of patients who use topical corticosteroids, [they understood] reports of severe withdrawal reactions to be very infrequent’.4 The MHRA noted that patients had difficulty getting a diagnosis from a healthcare professional and considered that this could be due to a lack of awareness or a lack of recognition of the condition.

[学科分类] 卫生学