The UK remains deeply concerned about the humanitarian crisis in Gaza. The destruction of water and hygiene infrastructures has contributed to an increase in severe environmental health hazards across the Gaza strip. Last financial year, the UK provided £81 million of humanitarian and early recovery support to Palestine, including specific funding for water, sanitation and hygiene services. We continue to call on the Israeli authorities to fully enable the UN and other humanitarian organisations to deliver essential humanitarian aid, including clean water and essential healthcare. The Foreign Secretary raised concerns about the humanitarian situation when she spoke with Israeli Foreign Minister Sa'ar in April.

Clinicians are expected to work with patients to make decisions about their care and treatment as part of shared decision-making, including discussing risks, benefits, and possible consequences of different options through information-sharing. Further information on shared decision-making can be found on the National Institute for Health and Care Excellence’s website:

https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/shared-decision-making

Topical corticosteroids are an important and effective treatment for inflammatory skin conditions, including eczema, when used appropriately. It is essential that healthcare professionals are aware of both the benefits and potential risks associated with their use, particularly where treatment is prolonged or involves higher‑potency products.

The Medicines and Healthcare products Regulatory Agency has taken steps to strengthen awareness of topical corticosteroid safety, including public drug safety updates and clearer product information to highlight the risk of adverse effects, including withdrawal reactions, when use has been prolonged or inappropriate. These measures are intended to support informed discussions between clinicians and patients and safer prescribing practice.

Clinical guidance for healthcare professionals is already in place through National Institute for Health and Care Excellence clinical knowledge summaries, which set out best practice on the appropriate potency, duration, and frequency of topical corticosteroid use, and emphasise the importance of regular review. Decisions about diagnosis and management, including recognition of adverse reactions, remain clinical matters for individual healthcare professionals, who are expected to apply this guidance alongside their clinical judgement and the patient’s circumstances.

The Department will keep emerging evidence under review and will work with regulators, the National Health Service, and professional bodies to support ongoing education, promote safe use of medicines, and improve awareness of potential adverse effects among clinicians, including general practitioners and dermatologists.

Topical corticosteroids are an important and effective treatment for inflammatory skin conditions, including eczema, when used appropriately. It is essential that healthcare professionals are aware of both the benefits and potential risks associated with their use, particularly where treatment is prolonged or involves higher‑potency products.

The Medicines and Healthcare products Regulatory Agency has taken steps to strengthen awareness of topical corticosteroid safety, including public drug safety updates and clearer product information to highlight the risk of adverse effects, including withdrawal reactions, when use has been prolonged or inappropriate. These measures are intended to support informed discussions between clinicians and patients and safer prescribing practice.

Clinical guidance for healthcare professionals is already in place through National Institute for Health and Care Excellence clinical knowledge summaries, which set out best practice on the appropriate potency, duration, and frequency of topical corticosteroid use, and emphasise the importance of regular review. Decisions about diagnosis and management, including recognition of adverse reactions, remain clinical matters for individual healthcare professionals, who are expected to apply this guidance alongside their clinical judgement and the patient’s circumstances.

The Department will keep emerging evidence under review and will work with regulators, the National Health Service, and professional bodies to support ongoing education, promote safe use of medicines, and improve awareness of potential adverse effects among clinicians, including general practitioners and dermatologists.

The Department and NHS England do not hold data on the proportion of prescribers and pharmacists who have received training on the risks of topical steroid withdrawal.

Initial education and training and continued professional develop is wide ranging, including dermatology. Clinicians would be expected to provide advice and counselling to patients in-line with guidance issued by the Medicines and Healthcare products Regulatory Agency on the safe use of topical steroids and topical steroid withdrawal.

There has been no national assessment of need for a dedicated referral and support pathway for topical steroid withdrawal (TSW). Care for patients presenting with TSW is provided through services commissioned by individual integrated care boards.

The Elective Reform Plan, published January 2025, outlines actions that will help ensure care is delivered in the right place. This includes expanding the use of Advice and Guidance, a clinical collaboration tool that supports timely specialist input and helps patients receive care in the right setting, including for dermatology care.

No specific guidance has been issued on recording suspected topical steroid withdrawal in patient medical records, including to general practitioners. The Medicines and Healthcare products Regulatory Agency has issued guidance documents on topical steroid withdrawal, which are available at the following two links:

https://www.gov.uk/drug-safety-update/topical-corticosteroids-information-on-the-risk-of-topical-steroid-withdrawal-reactions

https://www.gov.uk/drug-safety-update/topical-steroids-introduction-of-new-labelling-and-a-reminder-of-the-possibility-of-severe-side-effects-including-topical-steroid-withdrawal-reactions

The National Institute for Health and Care Excellence has also published guidance, which is available at the following link:

https://cks.nice.org.uk/topics/corticosteroids-topical-skin-nose-eyes/management/topical-skin-treatment/

The health and care professional regulators are responsible for the regulation of health and care professionals across the United Kingdom.

Regulators require all registrants to work within their scope of practice by only practising in areas where they have appropriate knowledge, skills, and experience. This also applies to prescribing.

The General Medical Council, the Nursing and Midwifery Council, the Health and Care Professions Council, and the General Pharmaceutical Council each publish guidance on prescribing for their registrants, which includes signposting to the Medicines and Healthcare products Regulatory Agency which monitors the safety of medicines.

Regulators can take action through fitness to practise processes where professionals on the register fail to uphold professional standards or practise outside of relevant guidance, posing a risk to patient safety.

Regulated healthcare professionals need to meet the standards of proficiency, conduct, and performance set by the relevant professional regulator, which are independent of the Government. It is the responsibility of individual employers to ensure their staff have appropriate access to ongoing training and professional development to provide safe and effective care.

Work is progressing at pace to develop the design and operating model for the new integrated organisation, and to plan for the smooth transfer of people, functions, and responsibilities.

It is only right that with such significant reform, we commit to carefully assessing and understanding the potential impacts, as is due process. These ongoing assessments will inform our programme as appropriate.

At this stage, we do not anticipate any impacts on Structured Medication Reviews relating to long-term topical steroid use, nor on the operation of Directed Enhanced Services.

NHS England is not aware that the Medicines and Healthcare products Regulatory Agency (MHRA) has issued a National Patient Safety Alert on topical steroid withdrawal (TSW). NHS England's Patient safety team issued this National Patient Safety Alert in 2020, and it is available at the following link:

https://www.england.nhs.uk/2020/08/steroid-emergency-card-to-support-early-recognition-and-treatment-of-adrenal-crisis-in-adults/

The safety alert mentions topical steroids, although they are not the focus of the alert. These alerts are a contractual requirement as set out in clause 33.8 of the NHS Standard Contract and so integrated care boards are expected to include consideration of these as part of their wider commissioning responsibilities.

The Care Quality Commission Regulation 12: Safe care and treatment' in Guidance on 12(2)(b) states that “Providers must comply with relevant Patient Safety Alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System”. Further information is available at the following link:

https://www.cqc.org.uk/guidance-regulation/providers/regulations-service-providers-and-managers/health-social-care-act/regulation-12#:~:text=Guidance%20on%2012(2)(b)

Additionally, general practitioners are included, with further information is available at the following link:

https://www.cqc.org.uk/guidance-providers/gps/gp-mythbusters/gp-mythbuster-91-patient-safety-alerts

In 2021, the MHRA published a Public Assessment Report (PAR), reviewing the available evidence for TSW reactions. This PAR is available at the following link:

https://www.gov.uk/government/publications/topical-steroid-withdrawal-reactions-a-review-of-the-evidence

The PAR resulted in two Drug Safety Updates in 2021 and 2024 which aimed to raise awareness on the risk of TSW reactions and introduce new labelling. Both updates are available, respectively, at the following two links:

https://www.gov.uk/drug-safety-update/topical-corticosteroids-information-on-the-risk-of-topical-steroid-withdrawal-reactions

https://www.gov.uk/drug-safety-update/topical-steroids-introduction-of-new-labelling-and-a-reminder-of-the-possibility-of-severe-side-effects-including-topical-steroid-withdrawal-reactions

The Medicines and Healthcare products Regulatory Agency (MHRA) is an executive agency of the Department, with responsibility for ensuring medicines meet appropriate standards of safety, quality, and efficacy.

In 2021, the MHRA published a Public Assessment Report (PAR), reviewing the available evidence for topical steroid withdrawal (TSW) reactions, which can be found at the following link:

https://www.gov.uk/government/publications/topical-steroid-withdrawal-reactions-a-review-of-the-evidence

To inform this report, a comprehensive review of the available evidence was undertaken. This included an assessment of data from Yellow Card reports to identify suspected spontaneous cases of TSW reactions associated with topical corticosteroids on the Yellow Card database, as well as information from the published literature and other medicines regulators. The review considered whether regulatory action was required to minimise the risk of these events.

The PAR resulted in two Drug Safety Updates in 2021 and 2024 which aimed to raise awareness on the risk of TSW reactions and introduce new labelling. Both updates are available, respectively, at the following two links:

https://www.gov.uk/drug-safety-update/topical-corticosteroids-information-on-the-risk-of-topical-steroid-withdrawal-reactions

https://www.gov.uk/drug-safety-update/topical-steroids-introduction-of-new-labelling-and-a-reminder-of-the-possibility-of-severe-side-effects-including-topical-steroid-withdrawal-reactions

The MHRA uses the Medical Dictionary for Regulatory Activities (MedDRA) to code suspected adverse drug reactions reported by patients and healthcare professionals via the Yellow Card scheme. MedDRA is an international, clinically validated medical terminology used by regulatory authorities and the biopharmaceutical industry throughout the entire regulatory process, from pre-marketing to post-marketing safety monitoring. MedDRA is updated twice annually, and new terms can be proposed by any MedDRA users. Following the publication of the PAR, the term “Topical steroid withdrawal reaction” was added to MedDRA as a lower level term in version 24.1 and made available to users of the Yellow Card website in February 2022 as part of routine updates. This helps to ensure that more reports pertaining to TSW reactions are appropriately captured. The MHRA continues to closely monitor Yellow Card reports submitted for suspected TSW reactions.

The MHRA continues to engage with the British Association of Dermatologist who have also released a statement, which is available at the following link:

https://cdn.bad.org.uk/uploads/2024/02/22095550/Topical-Steroid-Withdrawal-Joint-Statement.pdf

The Medicines and Healthcare products Regulatory Agency (MHRA) has reviewed topical steroid withdrawal (TSW) reactions and first communicated about these reactions in September 2021 through our Drug Safety Update (DSU), which is widely disseminated among health care professionals. This communication can be found at the following link:

www.gov.uk/drug-safety-update/topical-corticosteroids-information-on-the-risk-of-topical-steroid-withdrawal-reactions

The MHRA had continued to monitor reports of TSW reactions and undertook a further review in 2024, resulting in an additional DSU publication which can be found at the following link:

www.gov.uk/drug-safety-update/topical-steroids-introduction-of-new-labelling-and-a-reminder-of-the-possibility-of-severe-side-effects-including-topical-steroid-withdrawal-reactions

During this review advice was sought from dermatologists, the National Eczema Society, and the Commission on Human Medicines. Consequently, the MHRA took forward a number of actions including ensuring there are updated warnings in the product information that is supplied with the creams, and the inclusion of information regarding the potency of topical steroids on the packaging. The British National Formulary (BNF) has updated their topical steroids potency information in line with the outcomes of the MHRA review. BNF treatment summary for topical corticosteroids, including information on withdrawal reactions, can be found at the following link:

https://bnf.nice.org.uk/treatment-summaries/topical-corticosteroids/

Furthermore, the MHRA engaged with the British Association of Dermatologists who have released an updated statement that can be found at the following link:

https://cdn.bad.org.uk/uploads/2024/02/22095550/Topical-Steroid-Withdrawal-Joint-Statement.pdf

Following these discussions, the British Association of Dermatologists has formed a Topical Steroid Withdrawal Working Party Group in collaboration with National Eczema Society, Scratch That, Primary Care Dermatology Society, and the British Dermatological Nursing Group. A Topical Steroid Withdrawal Joint Statement from the Topical Steroid Withdrawal Working Party Group is available at the following link:

https://www.bad.org.uk/topical-steroid-withdrawal-joint-statement

The objective of the TSW Working Party Group is to develop an expert consensus guidance on supporting people with concerns about TSW, including a Patient Information Leaflet, and any revision to the above joint statement, as appropriate.

The MHRA acknowledges that more high-quality research would enhance the understanding of TSW reactions, including what causes them and how to accurately diagnose and manage them. To make good decisions about what research to fund, the National Institute of Health and Care Research (NIHR) needs a balanced picture about which questions most urgently need answering. To achieve this, they ask patients, carers, clinicians, healthcare workers, service managers, and researchers for research topics. Any member of the public can submit suggestions via the NIHR website at the following link:

https://www.nihr.ac.uk/get-involved/suggest-a-research-topic

In the meantime, the MHRA continues to monitor reports of TSW reactions via the Yellow Card Scheme, which encourages anyone to report if they suspect an adverse reaction to a medical product or products. Access to the Yellow Card reporting site can be found at the following link:

https://yellowcard.mhra.gov.uk/

In addition to Yellow Card Scheme, the MHRA receives adverse event reports from pharmaceutical companies who collect data from healthcare professionals and patients, as well as cases from published literature and other sources.

The Medicines and Healthcare products Regulatory Agency (MHRA) has reviewed topical steroid withdrawal (TSW) reactions, and first communicated about these reactions in September 2021 through our Drug Safety Update, which is widely disseminated among health care professionals. This communication is available at the following link:

www.gov.uk/drug-safety-update/topical-corticosteroids-information-on-the-risk-of-topical-steroid-withdrawal-reactions.

The MHRA has continued to monitor reports of TSW and undertook an additional review in 2024, which can be found at the following link:

www.gov.uk/drug-safety-update/topical-steroids-introduction-of-new-labelling-and-a-reminder-of-the-possibility-of-severe-side-effects-including-topical-steroid-withdrawal-reactions.

During this review, further advice was sought from dermatologists, the National Eczema Society, and the Commission on Human Medicines. Consequently, the MHRA took forward a number of actions, including ensuring that there are updated warnings in the product information that is supplied with the creams, and the inclusion of information regarding the potency of topical steroids on the packaging. The British National Formulary (BNF) has updated their topical steroids potency information in line with the outcomes of the MHRA’s review. The BNF’s treatment summary for topical corticosteroids is available at the following link:

https://bnf.nice.org.uk/treatment-summaries/topical-corticosteroids/

Furthermore, the MHRA engaged with the British Association of Dermatologists who have released an updated statement that is available at the following link:

https://cdn.bad.org.uk/uploads/2024/02/22095550/Topical-Steroid-Withdrawal-Joint-Statement.pdf

Following these discussions, the British Association of Dermatologists has formed a Topical Steroid Withdrawal Working Party Group (TSW WP) in collaboration with National Eczema Society, Scratch That, the Primary Care Dermatology Society, and the British Dermatological Nursing Group. The objective of the TSW WPG is to develop expert consensus guidance on supporting people with concerns about TSW, including a Patient Information Leaflet, and any revision to the above joint statement, as appropriate. Further information on the TSW Working Party Group is available at the following link:

https://www.bad.org.uk/topical-steroid-withdrawal-joint-statement/

The Pharmacy First service allows for referrals from NHS111, general practitioners and accident and emergency for advice on a minor illness, which includes a number of skin conditions and may also include the sale of over-the-counter medicines.

Currently the clinical pathways element of the service that allows for the supply of prescription-only medicines covers seven common health conditions, including sinusitis, sore throat, earache, impetigo, shingles, infected insect bites and uncomplicated urinary tract infections in women aged between 16 and 64 years old. NHS England is keeping the clinical scope of this part of the service under review.

The Department’s National Institute for Health Research (NIHR) welcomes funding applications for research into any aspect of human health, including topic steroid withdrawal. It is not usual practice to ring-fence funds for particular topics or conditions. Applications are subject to peer review and judged in open competition, with awards being made on the basis of the importance of the topic to patients and health and care services, value for money, and scientific quality.

The NIHR expects patient and public involvement in the research it supports. Applicants for NIHR funding are required to set out plans for involving the patients and the public in funding applications, which are assessed by funding committees.

General practitioners are responsible for ensuring their own clinical knowledge, including of topical steroid withdrawal, remains up-to-date, and for identifying learning needs as part of their continuing professional development. This activity should include taking account of new research and developments in guidance, such as that produced by the National Institute for Health and Care Excellence, to ensure that they can continue to provide high quality care to all patients. All United Kingdom registered doctors are expected to meet the professional standards set out in the General Medical Council’s (GMC) Good Medical Practice.

In 2012 the GMC introduced revalidation, which supports doctors in regularly reflecting on how they can develop or improve their practice, gives patients confidence doctors are up to date with their practice, and promotes improved quality of care by driving improvements in clinical governance. The training curricula for postgraduate trainee doctors is set by the Royal College of General Practitioners and must meet the standards set by the GMC.

The Medicines and Healthcare products Regulatory Agency has reviewed topical steroid withdrawal reactions, and first communicated about these reactions in September 2021 in its Drug Safety Update. It produced a further review this year. The British Association of Dermatologists has formed a Topical Steroid Withdrawal Working Party Group, which aims to produce an expert consensus and guidance on supporting people with concerns about topical steroid withdrawal.

The Medicines and Healthcare products Regulatory Agency (MHRA) has reviewed topical steroid withdrawal reactions, and first communicated about these reactions in September 2021 via our Drug Safety Update, which is read by a wide range of health care professionals. This communication is available at the following link:

www.gov.uk/drug-safety-update/topical-corticosteroids-information-on-the-risk-of-topical-steroid-withdrawal-reactions

The MHRA has continued to monitor reports of topical steroid withdrawal, and in 2024 it undertook a further review, which is available at the following link:

www.gov.uk/drug-safety-update/topical-steroids-introduction-of-new-labelling-and-a-reminder-of-the-possibility-of-severe-side-effects-including-topical-steroid-withdrawal-reactions.

During this review, further advice was sought from dermatologists, the National Eczema Society, and the Commission on Human Medicines. Consequently, the MHRA is taking forward a number of actions, including updated warnings in the product information, and the inclusion of information regarding the potency of topical steroids on the packaging. The MHRA is also engaging with the British Association of Dermatologist, who have released an updated statement, which is available at the following link:

https://cdn.bad.org.uk/uploads/2024/02/22095550/Topical-Steroid-Withdrawal-Joint-Statement.pdf

Following this engagement, the British Association of Dermatologists has formed a Topical Steroid Withdrawal Working Party Group (TSW WP), in collaboration with the National Eczema Society, Scratch That, the Primary Care Dermatology Society, and the British Dermatological Nursing Group. The aim of the TSW WPG is to produce an expert consensus and guidance on supporting people with concerns about topical steroid withdrawal, including a Patient Information Leaflet, and any revision to the joint statement, as appropriate. The joint statement is available at the following link:

https://www.bad.org.uk/topical-steroid-withdrawal-joint-statement/

The decision to prescribe a particular drug is a clinical one, and should be based on the patient’s medical needs. Decisions about what medicines to prescribe are made by the doctor or healthcare professional responsible for that part of the patient’s care, and prescribers are accountable for their prescribing decisions, both professionally and to their service commissioners. It is for the general practitioner or other responsible clinician to work with their patient and decide on the course of treatment, with the provision of the most clinically appropriate care for the individual always being the primary consideration.

The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for continually monitoring the safety of medicines and taking action to minimise risks to patients where necessary. The MHRA has reviewed topical steroid withdrawal reactions, and first communicated about these reactions in September 2021. This communication is available at the following link:

www.gov.uk/drug-safety-update/topical-corticosteroids-information-on-the-risk-of-topical-steroid-withdrawal-reactions.

Since then, the MHRA has continued to monitor reports of topical steroid withdrawal reactions and has undertaken a further review, which was published in May 2024. This review is available at the following link:

www.gov.uk/drug-safety-update/topical-steroids-introduction-of-new-labelling-and-a-reminder-of-the-possibility-of-severe-side-effects-including-topical-steroid-withdrawal-reactions.

Further advice has been sought from dermatologists, the National Eczema Society, and the Commission on Human Medicines, and the MHRA is taking forward a number of actions, including updated warnings in the product information and the inclusion of information regarding the potency of topical steroids on the packaging. The MHRA is engaging with the British Association of Dermatologists who have released an updated statement. The statement is available at the following link:

https://cdn.bad.org.uk/uploads/2024/02/22095550/Topical-Steroid-Withdrawal-Joint-Statement.pdf.

Topical corticosteroid product information contains the following warnings about the dangers of long-term use: ‘Long-term use of topical steroids can result in the development of rebound flares after stopping treatment (topical steroid withdrawal syndrome). A severe form of rebound flare can develop which takes the form of a dermatitis with intense redness, stinging and burning that can spread beyond the initial treatment area. It is more likely to occur when delicate skin sites such as the face and flexures are treated. Should there be a reoccurrence of the condition within days to weeks after successful treatment a withdrawal reaction should be suspected. Reapplication should be with caution and specialist advise is recommended in these cases or other treatment options should be considered’.

The Government is committed to supporting everyone’s mental health and wellbeing, and ensuring that the right support is in place, including for those with long term physical health conditions such as inflammatory skin conditions. This is why, between 2018/19 and 2023/24, National Health Service spending on mental health has increased by £4.7 billion, as part of the NHS Long Term Plan.

The NHS continues to develop the NHS Talking Therapies Long Term Conditions services to ensure that people with a long-term physical health condition, such as an inflammatory skin condition, have access to National Institute for Health and Care Excellence recommended psychological therapies.