PS36 Unseen and untreated: topical steroid withdrawal in patients with skin of colour

Abstract

Topical steroid withdrawal (TSW) is an increasingly recognized condition, characterized by cutaneous inflammation, burning, itching and peeling following prolonged, frequent overuse of medium-to-high-potency topical corticosteroids (TCS). It is frequently associated with significant psychological distress. Patients with skin of colour remain under-represented in the literature, and the clinical and psychosocial impact of TSW in this group is poorly described. We describe the demographic, clinical and psychosocial characteristics of patients with skin of colour diagnosed with TSW attending a specialist dermatology service. A retrospective case review was conducted of all patients with skin of colour and a diagnosis of TSW attending a tertiary psychodermatology clinic. Data collected included demographics, dermatological history, past medical and psychiatric history, history of atopy, previous treatments, social history and psychological parameters. Treatments initiated and clinical outcomes were recorded. Six patients were identified, all of whom had experienced prolonged TCS use. There was female predominance (four of six) and the mean age was 35 years (range 27–43). Ethnicities represented included Black African, Asian Pakistani, Asian British Bangladeshi and mixed Caribbean/White. All patients had a history of eczema, often with severe inflammatory phenotypes at presentation, including lichenification, papulonodular disease and follicular accentuation. Psychiatric comorbidity was documented in three patients, most commonly anxiety and/or depression and skin picking disorder. Patient-reported outcome measures were recorded in two patients, with noted moderate-to-severe impairment of quality of life and clinically significant psychological distress. Following diagnosis with TSW, patients were managed with combinations of psychological interventions, psychiatric medication and skin-directed treatment (without the use of TCS). This case series highlights the significant dermatological and psychosocial burden of TSW in patients with skin of colour. Delayed recognition of eczema, severe inflammatory phenotypes and prolonged exposure to potent TCS may increase vulnerability to TSW. Psychological morbidity remains under-recognized due to limited use of validated assessment tools.