Topical Corticosteroid Associated Syndromes - Potential Treatment Strategies. Literature Review

Abstract

Overuse of topical corticosteroids is a global phenomenon that is underrecognized, underreported and has been sparsely investigated. The treatment and management of patients who because of topical corticosteroid use develop symptoms has not been established. This review aims to investigate and summarize the literature surrounding treatment and management of topical corticosteroid associated syndromes which is defined as any syndrome where the underlying cause suspected to be linked to long term topical corticosteroid use. The PubMed and Scopus databases were searched for relevant studies on 14 September 2023. A total of 134 results was gathered. Relevant publications are those that meet the inclusion criteria being original studies concerning the treatment or management of patients with prolonged topical corticosteroid use on any part of the body for any reason and that followed the clinically expected profile of topical corticosteroid addiction that is rebound redness, burning and pruritus. This review found and reviewed 27 relevant publications which investigated the use of topical calcineurin inhibitors, rich platelet plasma injection, oral gabapentinoids, oral doxycycline, oral beta blockers, dupilumab, topical tranexamic acid and tofacitinib. Most reports are case studies and are limited in their designs. Due to a lack of data, no recommendations can be formulated and further research is imperative in order to manage these patients using evidence-based medicine. This review found a difference in treatment used depending on the location of the TCS application. Dupilumab was used only in atopic dermatitis where TCS was applied on various large parts of the skin. Rich platelet plasma therapy, topical tranexamic acid and tofacitinib was used only in steroid induced rosacea where TCS was applied on the face. Gabapentinoids and beta blockers was only used in red scrotum/vulva syndrome where TCS was applied on the genitals. From this limited data, it is possible /that these clinical entities should remain distinct and should be treated as such, but further research is required.