13th April 2026

Newsletter Monday

I am going to make a prediction that a lot of people reading this newsletter have, at some point, used a steroid cream on their skin.

Not because I possess any mystical powers, but because they’ve been around for decades and the conditions they’re used for are very common. If you’ve spent any time in general practice, they are part of the everyday toolkit.

With that in mind, a BBC News article caught my attention this weekend.

It focused on a small number of individuals describing something called topical steroid withdrawal, with the added hook that doctors can’t agree whether it even exists.

Oh hello. What’s this all about then?

In many ways, this is a familiar pattern in healthcare.

Conditions that are common, not life-threatening, but do require treatment, often don’t get the depth of explanation they deserve.

Not through lack of care, but because the system runs on time constraints.

You see it with statins.

With contraception.

With thyroid medication.

And yes, with steroid creams.

Most people do absolutely fine. Some get side effects. A few feel the treatment hasn’t worked at all.

Around 240 people contacted the journalist to share their experiences.

et against the millions of prescriptions for topical steroids issued every year, that gives some important perspective.
​

Meanwhile online...

But now, in a world where experiences are shared widely and quickly, those gaps in understanding get filled in after the fact, often in ways that are more alarming than accurate.

So let me fill in a few of those gaps.

What to understand about steroids.

Steroids work by reducing inflammation.

You can take them as tablets, have them intravenously, or apply them directly to the skin. We’ll stick to creams, because that’s where most people come across them.

Eczema (or dermatitis) is an inflammatory skin condition with a mix of triggers.

There’s often a genetic tendency, but it can also be driven by irritants — things like soaps, chemicals, even increasingly things like gel nails or eyelash glue.

Sometimes the trigger is obvious.

Often it isn’t.

That’s what makes it frustrating.

A topical steroid can settle the inflammation.

It can calm a flare.

But it doesn’t cure the underlying tendency for the skin to react.

And that’s the bit that often gets lost.

These treatments are designed to be used for control, not cure.

Used appropriately, they are very effective.

But they are not designed for continuous, long-term, unreviewed use — particularly the stronger ones.

If they are used in that way, two things can happen:

• the skin becomes less responsive
• and when the treatment is stopped, the inflammation can return, sometimes quite dramatically

This is what people often describe as “rebound,” and it’s likely part of what sits behind the stories you see online.

For most people, this doesn’t happen.

Most eczema flares settle quickly with appropriate use of a topical steroid.

But eczema itself hasn’t gone anywhere.

It can, and often will, come back.

Which is why the real cornerstone of management isn’t the steroid.

It’s the boring bit.

Regular, consistent use of emollients to support the skin barrier.

Not glamorous.

Not quick.

Quite inconvenient at times.

But effective.

Steroid creams aren’t the enemy.

They’re a useful tool when you understand what they’re there to do.

The problem isn’t that they “don’t work.”

It’s that they’re often expected to do something they were never designed to do.

If you use them with a clear plan — when to start, when to stop, and what sits alongside them — they can make a significant difference.

And if you’ve ever felt unsure about that plan, you’re not alone.

That’s not a failure of the treatment.

It’s usually a gap in the explanation, which is easily skipped in a system that never has enough time.