Managing Topical Corticosteroid Withdrawal

Written by Dr Stephanie Bowe, starting the Dermatology HST in July 2022

Topical corticosteroids are the first-line therapy for the treatment of atopic dermatitis and many other inflammatory dermatoses. 1

The term topical steroid withdrawal describes an adverse effect that generally occurs with inappropriate prolonged use of high-potency topical corticosteroids. 2,3

The British Association of Dermatology, in conjunction with the National Eczema Society, released a position statement on topical steroid withdrawal in January 2021, which summarised topical steroid use including its limitations and adverse effects. 2

This was an important step in acknowledging these patients and their symptoms but clarity of terminology for dermatology professionals is vital.

Millions of people use social media every day and often get health related information from these platforms. We used hashtag data from Social Media platforms to explore content relating to topical steroid withdrawal. A hashtag is a metadata tag that is prefaced by the hash symbol which enables tracking of trending terms.

Using a data analytics platform, we retrospectively analysed the hashtag #topicalsteroidwithdrawal across the Social Media platforms Instagram and Twitter, Facebook, Reddit, LinkedIn, YouTube and Pinterest over a 5 year period, from the 8th of February 2016 until the 8th of February 2021. We also gathered #topicalsteroidwithdrawal data from the worldwide web (WWW), which included data from TikTok.

We analysed the languages in which #topicalsteroidwithdrawal was posted in, the countries where it was posted, and the hashtags that were used most commonly with #topicalsteroidwithdrawal

Across all Social Media platforms there was a 274% increase in social media mentions of #topicalsteroidwithdrawal in 2020 compared with 2016 (Figure 1). There were 20,555 total mentions,1,997,689 interactions, 9,769,738 total reach, 38,061 shares, 1,762,271 social media likes, 20,419 total social media mentions and 136 webmentions.

The number of Social Media and Webmentions mentions increased from 2016 to 2020 (Figure 1). The countries that #topicalsteroidwithdrawal is most commonly mentioned in are (in descending order): USA, UK, Japan and Canada, The languages it is most commonly mentioned in are: English (95%), German (0.9%), Japanese (0.83%) and Spanish (0.83%).

Regarding Instagram alone, we found a 288% increase in number of mentions and a 592% increase in performance of #topicalsteroidwithdrawal in 2020 when compared to 2016 (Figure 1). Top associated hashtags included (number of times the associated hashtag was used): #TSW (10450), #eczema (7305), #redskinsyndrome (5940), #topicalsteroidaddiction (5729), #rss (3121), #eczemarelief (2427), #thisisnoteczema (2347), #eczemahealing (2047).

Our results confirm an increase in the presence of user-generated content relating to TSW on Social Media, particularly on Instagram, and also highlight the large numbers of users exposed to this content. Our data suggests the USA and UK are the countries with the highest number of posts containing #topicalsteroidwithdrawal and correspondingly the majority of posts are in English. The top associated hashtags are generally related to eczema and other terms describing the various symptoms (eg. #eczemarelief, #thisisnoteczema).

TCS are an essential part of the treatment of many inflammatory dermatoses but our study has exposed how they may be presented negatively on social media in the context of #topicalsteroidwithdrawal. 4,5 Ideally, patients requiring TCS should have a clinical diagnosis made by a dermatologist and should be counselled regarding the risks from prolonged daily use of TCS beyond their approved indication. 1,2 Confusing the signs and symptoms of an underlying dermatologic condition for steroid withdrawal could lead to unnecessary withholding of much needed topical anti-inflammatory therapy.

Health professionals should be aware of information available online to better understand the patient perspective. An awareness of the influence Social Media platforms can have on perceptions of TCS can bridge the doctor-patient gap, foster trust, counter misinformation and promote education. 5

References

  1. Samarasekera EJ, Sawyer L, Wonderling D, Tucker R, Smith CH. Topical therapies for the treatment of plaque psoriasis: systematic review and network meta-analyses. Br J Dermatol. 2013 May;168(5):954–67.
  2. [No title] [Internet]. [cited 2022 May 9]. Available from: https://cdn.bad. org.uk/uploads/2022/04/12091607/ Position-statement-on-Topical- Steroid-Withdrawal.pdf
  3. Sneddon IB. Varicose ulcers and use of topical corticosteroids. Br Med J. 1968 Mar 2;1(5591):579–80.
  4. Hwang J, Lio PA. Topical corticosteroid withdrawal (’steroid addiction’): an update of a systematic review. J Dermatolog Treat. 2021 Feb 4;1–6.
  5. DeBord LC, Patel V, Braun TL, Dao H Jr. Social media in dermatology: clinical relevance, academic value, and trends across platforms. J Dermatolog Treat. 2019 Aug;30(5):511–8.

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