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Topical Steroid Withdrawal — SCE Dermatology MCQ

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ModerateInflammatory DermatosesTopical Steroid WithdrawalSCE Dermatology

A 19-year-old woman with atopic eczema has been using potent topical corticosteroids on her face for 8 months. She develops erythema, telangiectasia, and papulopustular lesions on her cheeks and perioral area that worsen when she tries to stop the steroid. What is the most likely diagnosis?

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Correct answer: E — Topical corticosteroid withdrawal (steroid-damaged skin)

Topical corticosteroid withdrawal (steroid-damaged/dependent skin) occurs after prolonged use of potent topical corticosteroids, particularly on the face. Features include rebound erythema, burning, telangiectasia, and papulopustules that flare on attempted discontinuation. BAD guidelines recommend gradual withdrawal of the topical steroid with substitution of calcineurin inhibitors (tacrolimus/pimecrolimus) as steroid-sparing agents on the face. Perioral dermatitis can be steroid-induced but is a distinct entity.

Reference: BAD 2021 Position Statement on Topical Corticosteroid Withdrawal