Tachyphylaxis with Topical Steroid Use

What is it and is it real?

Tachyphylaxis is the phenomenon where the impact of a drug changes with use over an extended period of time.   This is common in some non-dermatologic medications.  For many years tachyphylaxis was believed to occur with topical steroid use in dermatology. For many years dermatologists would rotate therapy or have patients take days or weeks off therapy to avoid developing a tolerance to medications.

But is tachyphylaxis with topical steroid use real?  Many patients believe in it, and many doctors still believe in it, but does that make it real?  A wise dermatologist, Dr. Steven Feldman, put this question to the test and his results were published back in 2006.  In that study, psoriasis patients were given topical steroids to use as a treatment and a log to record their actual use of the topical steroid. Then, the patients’ psoriasis areas were evaluated to look for tachyphylaxis. 

I’ll cut to the chase…. Turns out there is NO tachyphylaxis with topical steroid use on the skin.  What the patients in the study did not know was that there was a counter in the lid of the topical steroid container they were given that recorded each time the lid to the container was opened.  Can you imagine that patients recorded using their medication without ever taking the lid off the container?  Imagine.

Turns out the phenomenon of topical steroids working less well over time is because patients slack off on their use over time.  In fact, observations in many different skin disorders show that the more frequent a patient is seen in the office, the better their skin disorder improves.  This is especially true in chronic disorders like acne, rosacea, psoriasis, and atopic dermatitis.  Patients see the doctor and initially are “gung ho” about using their medication.  Then, they get lazy over time.  About a week before their follow-up visit they “ramp it up” to try to look good for their appointment.  Now, I realize not everyone does this, but it is very common behavior. 

So, if I ask you to come back in 4-6 weeks, it’s because I want to reduce that slacking time and have your skin improve more!  Go ahead and use your medication until your skin disorder totally clears or until your follow-up appointment with no fear of tachyphylaxis.

_______________________________

If you know someone who may find this article helpful, please share it with them! Follow us on social media this week, and subscribe to our growing YouTube channel! If you would like to receive these posts in your email inbox, Subscribe to our Site.