Social media storm in 2023 onwards, although already talked about prior to 2021.

No medical definition, of course. So hard to research or talk about. Concerns are around skin inflammation in previously unaffected areas, flares when you stop using topical steroids, and chronic red, inflamed skin (potentially thickened/lichenified).

Social media talks about “Sleeve sign” (palms less affected than other areas of arm), “headlight sign” (mid-face less affected than rest).

There are a range of different issues:

• Erythroderma – widespread inflammation (more than 90% of body surface area), with accompanying problems with sleep, temperature control, blood pressure, fluid balance. Serious, often needs hospital treatment.
• Papulopustular lesions – can be side effect of topical steroids, esp on face. Can obviously get worse on stopping steroids. Steroids can cause acne/rosacea, so you might be better with antibiotics etc. Or could be infection eg herpes, hand/food/mouth.
• Tachyphylaxis – where previously effective medicine stops working. Seen with other medicines too.
• Other physical symptoms eg lethargy, dizziness. Beware adrenal suppression!
• Natural progression of eczema – steroids work, so when you stop giving them, the eczema often comes back.
• Contact dermatitis related to preservative in creams.

Try to be supportive of concerns! Agree practical plans, offering alternatives to topical steroids if people would otherwise stop using them.

[Joint statement from National Eczema Society and BAD 2024 – https://eczema.org/blog/topical-steroid-withdrawal-updated-joint-statement/]