A-Z of Corticosteroid Withdrawal: Hypersensitivity

H is for Hypersensitivity

Let me start off by pointing out that most people using steroid creams are probably hypersensitive to start with. For example, the typical steroid cream user probably has a family history of atopy, allergies, asthma and hay fever and started using the creams to control areas of dermatitis on the face or body.

However, the type of hypersensitivity that I am discussing here is the type that we experience when we stop using the steroid creams. Anyone reading this blog regularly will be aware that the skin goes crazy when stopping steroid creams, causing what is known in the medical world as "rebound phenomenon": red, itchy, burning skin. Unfortunately, another side effect of steroid rebound is an increased sensitivity to allergens, with many people reporting skin allergies to things that they had previously had no problems with.

Consider a typical example. A person stops using steroid creams and immediately, the skin goes into a rebound flare. During the next few months, that person may notice skin reactions to things that they were previously tolerant to, for example a pet dog or cat. All of a sudden, they come out in hives whenever they touch their beloved pet. This is just another side effect of steroid withdrawal, and one that Dr Rapaport assures patients will pass eventually. It is important that people prepare for any possible effects of hypersensitivity, as it can be emotionally devastating to suddenly realise you are allergic to your precious pet dog.

Another problem commonly experienced is hypersensitivity to creams applied to the skin. When someone stops using steroid creams, it can be very hard for them to find an alternative, as in the initial stages of withdrawal, everything they put on their skin causes a bad reaction. This actually happened to me, before I knew anything about steroid addiction. I remember being prescribed an emollient cream by my doctor, which I started to use on my face. At first it worked fine, but because I was reducing the steroid cream use, I went into  what I know now to be a rebound flare and my skin started reacting badly to the emollient.

 It can be really hard for people with TSW to find a suitable emollient that they can tolerate. Many use very simple products, such as coconut oil, palm shortening or Vaseline, but what works on one person might not necessarily suit someone else. As the weeks and months go by, the patient will find that the hypersensitivity decreases and that they can use creams that they previously could not tolerate. The same is true for cosmetics as well.

This is an important point to remember if you are considering allergy tests. If someone undergoes allergy testing during steroid withdrawal, it is likely that the test will throw up a  number of "false positives", due to the major changes happening in the body, blood vessels and skin at the time. Therefore any results of allergy tests taken during withdrawal can be very misleading, and a positive result may not indicate a true or permanent allergy to a substance.

Here are some comments from the Google Support group about hypersensitivity to pets:

"I have a small Toto dog and I could pet and hold her before the
withdrawals, but now I cannot touch her. The allergy test showed allergy to
dogs, but they told me just to vacuum good and not touch her and if I do
that, I am okay. "


" I will put it simply and this is true unfortunately. I never was allergic to my dog or any dogs ever before I used steroids. I lived with dogs throughout my whole life! I became allergic to dogs slightly after I became addicted, and even after I had healed once from my 1st withdrawal (this is my second time withdrawing, I coincidentally quit once before for other reasons), I still developed skin rash after 6 months of perfect skin and living with hypoallergenic dogs. I do not know how long it will take, but I presume years before my immune system will ever desensitize to dogs again."


"I have had the same issue.  I am not allergic to anything and have always
been around animals.  I have always had a cat and no issues.  Now I cannot
also kiss my cats or get too close to them, especially on my face because 9
times out of 10 I will get very itchy and get hives too.  I am hoping and
expecting this to go away some day. "

And some comments about hypersensitivity to creams:

"I have happily used Vaseline throughout my withdrawal but just in the
last 2 weeks have found that it is no longer working for me. My skin
has started to feel hot and itchy after putting it on."


"The skin during rebound seems to be hypersensitive
and I feel certain that no external application at all is the least risky
for the skin. Use of soap and shampoo is not recommended because they wash out natural
wax on the skin. I explain that disinfectants are more effective for
sanitary purposes only*. "


Hypersensitivity is one of the longer lasting side effects of steroid withdrawal. it takes a long time, possibly years for the body to return to the state it was in before steroids. Until that time, those of us with TSW will experience hives and reactions to many things that we could previously tolerate.