A-Z of Corticosteroid Withdrawal: Burning

B is for Burning

Eczema should not burn.

Eczema itches, stings, flakes and weeps, but it should not burn.

Therefore, if someone has an eczema-like rash and it is burning, it may not be eczema, it may be steroid cream addiction.

I first heard this on a teleconference on corticosteroid addiction with Dr Rapaport MD, an expert in this subject, who has treated over 2000 people with steroid cream addiction. When I heard him talking about the fact that eczema does not burn, it was like the penny dropped and the scales fell from my eyes. it was the first time that I realised that this fine red rash covering my body was not eczema at all. it was Red Skin Syndrome. I recalled the eczema I had as a child. He was right. It never burned. Yet now, after years of steroid use, my skin burned, oh boy, did it burn! It burned every time I tried to stop the steroid creams for a day or two. It burned if I tried to use an emollient on my skin instead of a steroid, and the weird thing was that I never made the connection in my head and thought that there was anything odd about my "eczema".

Of course, realising what is wrong is one thing. Dealing with it is another. Once I stopped the steroid creams the burning started big time. The burning reaction varies depending on the potency of steroids used on the skin and the duration, but it is always nasty. Within two or three days of stopping the steroid creams, my face felt as if it was on fire. The skin was bright red and hot to the touch. this is caused by the fact that the blood vessels in the skin have been suppressed for so long and can finally "run free". This causes some vessels to almost double in size as the excess nitric oxide in the blood dilates them, causing the skin to redden considerably.

In my case, the burning lasted for about two months and then started to subside. Thankfully, now I have been off the creams for five months, burning is no longer an issue for me. I think it is one of the most intense initial symptoms, but also one of the first to go. if you google the term "steroid rebound", you will find a lot of information about the burning associated with steroid withdrawal. it is the reason that many decide to taper off steroid gradually, rather than quitting cold turkey, but that is a decision for the individual to make.

Here is a picture of my burning skin, taken very early on in withdrawals:

And here are some pictures of others with burning skin due to corticosteroid withdrawal:

Here is a quote from a medical article by Betsy Bates in 2003:

"Dr. Rapaport, who confessed he is "fairly passionate about this subject," believes dermatologists are too quick to prescribe superpotent corticosteroids and to dismiss as "crazy" patients who develop a classic pattern of symptoms that include burning sensations that may seem disproportionate to clinically apparent skin findings.


He described 100 patients who presented with a consistent pattern of clinical symptoms after having been treated with corticosteroids for 2 months to 40 years, often by a series of physicians who prescribed increasingly potent formulations when symptoms failed to resolve. In these patients, many of whom are atopic, a chronic eczematoid rash is accompanied by what he termed "fierce burning."The rash may appear in odd locations, and it does not worsen with wind, dry winter weather, or harsh soaps."

And here are some comments from the members of the Google forum:

"I'm experiencing burning on my face and
neck for the first time since August this week. The back of my neck is
particularly bad. The weird thing is that the skin looks practically
normal, despite the feeling like there's a blowtorch on it. Hardly any
oozing either. Dr Rap describes this in his paper - disproportional
burning in relation to how it looks."


"The burning skin seems to start getting more intense from 4pm each
day.  The nights can find me burning up so much on neck arms shoulders
that lying down becomes unworkable - requires even more antihistamines
and valium before relief comes."

"I tolerated the burning better as it eased up in my baths. I also got relief
for the burning from ice and tylenol and rest. Most of my burning is now in
7th month,  is gone and it is the rashes, oozing, red bumps on my stomach
and arms and insane itching."

Therefore, I repeat what I said at the beginning: Burning skin may be a sign of steroid cream addiction rather than a symptom of regular eczema.