What is topical steroid withdrawal (TSW) symptoms
What It Is and How to Treat It
One of the most commonly prescribed treatments for eczema are topical steroid creams, also known as topical corticosteroids. For some, usage of these treatments leads to a condition known as topical steroid withdrawal (TSW), also known colloquially as red skin syndrome. Because TSW has the potential to massively disrupt your life, we want to talk about topical ways to soothe the skin in the case that you have TSW, and also give you an overview of what’s involved in the healing process.
There are two subtypes of TSW: erythematoedematous and papulopustular. Erythematoedematous TSW is more common in patients using topical steroids to treat skin conditions like eczema or seborrheic dermatitis. It involves redness and swelling of the skin where the topical steroid was applied, along with scaly or peeling skin. Papulopustular TSW more often occurs in patients who have used topical steroids for acne. This type of rash also involves redness, but red and pus-filled bumps will also be prominent at the area where the topical steroid was applied.
The syndrome can feel like:
- A burning sensation
- Extreme flaking, shedding, peeling, or spreading skin
- Swelling or dermatoses in affected areas
- Erythema, or redness of the skin
- Wrinkling, thin skin
- Oozing, pus-filled bumps
- Steroid dermatitis, which can cause nodules and papules to form on the skin
One of the challenges of TSW is a shortage of clear clinical solutions to the condition. Just as eczema expresses uniquely in every individual, so does TSW. Apart from the physical suffering that comes alongside TSW, its stress on the body also often leads to all manner of disruptions to life. The condition weighs heavily on the morale, and disrupts daily routines. Apart from visible skin symptoms, TSW can look like:
- Hair loss
- Depression and disability, if withdrawal persists for a longer period of time
Any or all of these symptoms can manifest individually. Unbearably, they can also pile on all at the same time, creating a living nightmare that challenges one to the core.
Healing Stages of TSW
The confusing thing about TSW is individuals afflicted can struggle to find a consistent treatment protocol from dermatologists. Additionally, symptoms widely vary. For some, time away from steroid creams alone helps to ease the skin. Symptoms can range from merely uncomfortable to life-disruptiving. Since so many variables are at play, how can TSW be healed?
Understanding the stages of TSW helps you identify where you can start to help yourself. There are four stages of healing from TSW.
Some people can progress through all four stages quickly, others may spend a long time in one stage, and some people may be at different stages on different parts of their body.
Visible skin inflammation results when your immune system begins to react to perceived threats. Without steroids to suppress the immune functions of the skin, inflammatory cells and cytokines go forth. Warmth, pain, and swelling (edema) can occur.
The skin exudates, oozes or weeps fluid. As the ooze dries, it forms a crust or a scab, which may re-open and ooze again. This is not the body “detoxing” but a leakage from the blood vessels due to their dilation.
The proliferation stage is the skin flaking stage. TSW flakes are often very small and fine and are sometimes called "snow." Many people with TSW report significant flaking that requires them to sweep and change their sheets daily.
In this stage, the skin begins to heal, strength, regain its elasticity, and restore its ability to protect your body from pathogens.
We’re here to support your skin’s healing
As you deal with the frustrating effects of TSW, be forgiving of yourself. Your body is doing what it was genetically programmed to do: heal from trauma. But the process will take time. Healing from TSW can happen over weeks, months or seasons. During these phases, your skin’s integrity is compromised, reducing its ability to protect the rest of your body from unwanted virus and bacteria.
When withdrawing from steroids, switch to products that won’t incite the same inflammatory side effects. Total withdrawal from all treatments can be tempting, but it can also leave your skin solely without support, making it that much harder for your body to complete the phases of healing.
Listen to your body. Products that will help you will feel good at first contact, and you’ll notice that your road to recovery is smooth and steady.
Caring for broken skin requires special precautions. Our specially formulated Eczema Care Set is fragrance-free, vegan and gentle. The products help restore necessary moisture to the skin, assist in countering inflammation, and essential fatty acids into the skin. The cream absorbs deeply into the skin’s layers, fortifying it naturally, while providing much needed cellular support.
Coping with TSW Syndrome – ITSAN. (n.d.). ITSAN. Retrieved April 18, 2023, from https://www.itsan.org/coping-with-tsw/