Topical steroid creams and ointments are commonly prescribed to people with eczema and other skin conditions in order to reduce irritation and inflammation. . Also called topical corticosteroids, these creams are available over-the-counter and through a prescription from your doctor. T
Because of their low price, wide availability, and popularity, most people don’t think twice about applying topical steroids to their skin. While many people will use these creams without any noticeable adverse side effects, others will experience what is called Topical Steroid Withdrawal after stopping treatment.
What Is Topical Steroid Withdrawal (TSW)?
Topical steroid withdrawal (TSW), also referred to as Red Skin Syndrome, is an iatrogenic condition that occurs after recurrent steroid use. Topical steroid withdrawal is most prominent in cases where patients have used high-potency steroids frequently for a prolonged period of time, or used steroids on the face Women who blush easily seem to be at higher risk as well, whereas very few cases have been reported in children.
Many healthcare providers have not heard of TSW, and others do not recognize it as an iatrogenic condition because it does not have a formal diagnostic criteria. There has been little clinical research into TSW to date, although some recent literature reviews, articles, and op-eds by dermatologists call for more research and clearer diagnostic criteria.
TSW symptoms can vary from person to person, and there is no formal diagnostic criteria. Raw, red skin with blisters or flaking, with very fine scale described as “snow,” are the most prominent symptom of TSW, but other possible topical steroid withdrawal symptoms include:
- “Red sleeve” (Redness that ends abruptly in a noticeable line at the wrist or ankles)
- “Elephant wrinkles” (Thickened, wrinkly skin, particularly around the knees)
- fluid oozing from your skin
- swelling (edema)
- swollen lymph nodes
- increased sensitivity to heat and cold
- nerve pain described as “zingers”
- dry, red, irritated eyes
- hair loss
- trouble sleeping and fatigue
- weight loss or gain
- depression and/or anxiety
What Does TSW Look Like?
There are two subtypes of TSW: erythematoedematous and papulopustular.
According to a 2015 TSW literature review,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. It has a defined border and may or may not involve red bumps.
Papulopustular TSW more often occurs in patients who’ve 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 skin won’t peel, and the swelling will be less prominent than with an erythematoedematous TSW.
Ashley P., a young mom and inspiring member of the Gladskin community, described her heart-wrenching experience with TSW, saying it caused “a breakdown of the skin, oozing lymphatic fluid, skin that's hot to the touch, nerve pain to the extreme, [and the] skin's inability to ward off antigens, making me highly susceptible to bacterial and viral infections. Pain is an understatement: Itchiness to the extreme, cracked, open, bleeding skin, hair falling out, insomnia... and the inability to regulate my core temperature — all at once!”
Does Topical Steroid Withdrawal Go Away on Its Own?
Time does seem to heal topical steroid withdrawal. However, managing the long-term symptoms may be uncomfortable, itchy, or just plain painful. So, how long does topical steroid withdrawal last? The answer to this question isn’t straight forward and will vary from person-to-person, depending on the severity of their reaction as well as duration of topical steroid use. In severe cases, people have battled TSW symptoms for years. Others only struggle for a much shorter duration of time. So that may make you wonder…
How Do You Treat Topical Steroid Withdrawal?
Prevention is the best option when it comes to TSW… but we understand it may already be too late for that! If you’re dealing with inflamed, red skin after stopping your topical steroid, be sure to visit your dermatologist. Treatment recommendations for TSW typically vary based on your personal situation. Some doctors will recommend you immediately stop your steroid at once, while others recommend tapering off to help minimize your skin’s reaction. Other doctors do not recognize TSW as a legitimate iatrogenic condition in part because there is no formal diagnostic criteria. Visit your doctor to hear their recommendation based on the symptoms you are currently experiencing as well as your history with topical corticosteroids.
For the most part, treating topical steroid withdrawal means managing symptoms. Yes, you need to get off the medication, and ideally in the most comfortable way possible. Some people find that ice or a cool compress will help with some of the itching, stinging, or burning you may be experiencing.
Topical Steroid Withdrawal Healing Stages
TSW usually goes through the following four stages as someone goes through the healing process: 1. inflammation, 2. exudation, oozing and scab formation, 3. proliferation and flaking, and 4. Remodeling. As mentioned above, though, each person has their own unique healing journey with TSW. For instance, a person could have one stage of topical steroid withdrawal in one part of their body and another stage in another part. A person could also have two different stages on the same part of their body. It is important to work with your dermatologist throughout the TSW healing journey.
Skin inflammation is the body’s natural and beneficial way of protecting itself. When inflammation is present, your immune system has sent out inflammatory cells and cytokines in an attempt to heal the body and minimize a perceived threat. Skin inflammation is characterized by redness of the skin in lighter complexion, warmth to touch, pain, swelling, and feelings of general weakness. Inflammation is common for someone at the beginning of the withdrawal journey. If you have been on your withdrawal journey for some time and you experience this, it means you are having a flare-up as this inflammatory process occurs at the beginning of every flare-up.
Exudation, Oozing, and Scab Formation Stage
Exudation is the body’s formation of pus. It occurs when the body has become addicted to topical steroids and is in withdrawal. When exposed to air, cellular components of the pus undergo oxidation to form a crust or scab. The formation of crusts or scabs prevents more bleeding from the wound and protects the wound to allow new skin to form underneath. Crusts and scabs can repeatedly break to release more pus and appear to ‘ooze’. This is because they are very weak structures prone to breakage.
Proliferation and Flaking Stage
The proliferation stage is the skin flaking stage. It can be considered cosmetically unappealing, but very necessary for the healing of the skin. At this stage, the cells of the skin are trying to rebuild the basement membrane of the skin. As such, they migrate to the sites of the wounds and proliferate there.
The remodeling stage is the stage at which wounds begin to contract, pulling the skin towards itself. This is noticeable by thin lines surrounding the wound. At this stage, collagen is being formed in an effort to strengthen the skin and return it to its normal strength and elasticity.
Eczema-Related Topical Steroid Withdrawal Success
Patients like Ashley P. who’ve dealt with severe pain and skin damage from topical steroids have found relief through the help of our Gladskin Eczema Cream. As Ashley told us, “The chronically prescribed topical steroids damaged the integrity of all three of my skin’s layers, muting my body's ability to ward off antigens, and opening me up for unguarded attacks by viruses and bacteria. I researched Gladskin and the ingredients, and I was impressed — ingredients that are compatible with broken, sensitive skin! I loved how it felt when I put it on my skin. It absorbs quickly without feeling greasy, and it has been so instrumental in keeping my skin infections at bay since steroids have ruined the integrity of my skin. It has been a big tool in my healing process as I go through TSW."
Gladskin Can Help Guide Your TSW Journey
Topical steroid withdrawal can be a frustrating and debilitating condition to live with — affecting all aspects of life, not just your skin appearance. If you’re struggling to cope with TSW, consider seeking counseling for support or sharing with trustworthy friends and family.
When dealing with TSW, prevention is always the best option. To avoid unwanted withdrawal side effects, be sure to monitor how long and how often you’re applying topical corticosteroids — especially if you’ve been using a higher strength cream. Always consult with your healthcare provider before quitting or tapering off of topical steroid creams and ointments.
And remember that if you’re facing TSW from eczema our Gladskin Eczema Cream uses Micreobalance® (our patented smart protein) that works with your skin to restore balance to the skin microbiome gently and effectively while moisturizing at the same time. Four out of five users experience reduced itch and redness! Try it today!