Rebounding triad (severe itching, dryness and burning) after facial corticosteroid discontinuation defines a specific class of corticosteroid‐dependent dermatitis

Abstract

In patients with dermatitis, the sudden discontinuation of topical corticosteroid (TC) use after long-term treatment could cause flaring symptoms (named "rebounding responses"). Diagnostic criteria for facial corticosteroid-dependent dermatitis (FCDD) are vague and uncertain. We aim to define a category of patients with clinical rebounding triad including severe itching, dryness and burning. Patients with FCDD (n = 268) were evaluated to determine distinctive rebounding triad manifestations after TC cessation. Data on history of facial TC use and rebounding presentations were collected. A group of chronic dermatitis patients (n = 83) with rebounding triad after TC discontinuation were enrolled and added to patients with FCDD presenting triad symptoms. Patients without triad were compared with triad-positive patients. Eighty-five patients who displayed triad manifestations after TC cessation showed longer (93.1 ± 53.6 vs 9.6 ± 5.5 weeks, P < 0.001) and more frequent (7.7 ± 4.5 vs 2.3 ± 1.6 times/week, P < 0.001) use of TC. Similar results were observed after adding 83 dermatitis patients who experienced triad after TC cessation. Multivariate analysis showed that mean duration of TC use (odds ratio [OR] = 1.83, 95% confidence interval (95% CI) = 1.042-3.218, P = 0.035) and mean frequency of TC use (OR = 2.802, 95% CI = 1.135-6.918, P = 0.025) were independent predictors of rebounding triad after TC cessation. Duration and frequency of TC use were the main factors predicting rebounding triad.