Written by: Isabella Sukh
Medically reviewed by: Dr. Lohi Pratti
Topical steroids (topical corticosteroids) have been used for treating eczema for over 70 years. Topical steroids are used to reduce inflammation and speed up the healing of eczema. Additionally, they are also used to make the skin less hot, itchy, and sore. However, topical corticosteroids are not a cure for eczema. Topical Steroid Withdrawal (TSW) is a serious potential side effect of the usage of topical steroids for eczema. A significant pharmaco-dependence on the TC as well as damage to the skin of the face are the outcomes of abuse, misuse, or overuse of topical steroids. TSW is likely to occur after quitting long-term usage of topical steroids. People undergoing TSW reactions experience symptoms worse than their original condition. Much is still unknown about TSW, especially on how frequently it occurs and how much topical steroid use is responsible for it.
Potential symptoms of TSW include:
Flaking, shedding, peeling, or spreading skin
Women (99.3%) reported experiencing the majority of TCS (Topical corticosteroids) withdrawal symptoms in the face and vaginal region (81.0%), typically following prolonged, improper usage of powerful TCS.
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
Insomnia
Hair loss
Shivering
Fatigue
Depression and disability, if withdrawal persists for a longer period of time
Those dealing with TSW may experience constant discomfort and agony. Unfortunately, this condition is very rare and there is no standard treatment.
Potential treatment options include:
Slowly stop the use of steroid creams. Gradually stopping topical steroid creams can help manage TSW.
Immediately stop the use of steroid creams. Some dermatologists recommend immediately stopping the use of steroid creams to manage TSW.
Take oral corticosteroids. Taking oral corticosteroids for a few weeks can help your body adjust to stopping topical corticosteroids and reduce symptoms of TSW.
Using cold compresses. Cold compresses and other skin-soothing treatments might also be recommended.
Take antibiotics. TSW can cause an increased risk of infection. Antibiotics can help manage this risk.
Receiving a dupilumab injection. Research from 2018 suggests that an injection of the medication dupilumab can help reduce symptoms of TSW.
Notes: Red face syndrome is a condition in which any attempt to stop using TC to the face after a protracted period of usage results in rebound erythema, burning, and scaling.
TSW takes just as much a mental and emotional toll as a physical one. Those suffering from TSW often may experience anxiety, depression, and suicidal thoughts. Additionally, some people experiencing TSW wind up homebound and have to pause their social and professional life. TSW is an unbelievable burden for individuals who experience it.
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References:
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Hewett, Lauren. “TSW: What the Eczema Community Needs to Know.” National Eczema Association, 31 Aug. 2022, nationaleczema.org/blog/tsw-need-to-know.
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Srakocic, S. “Understanding Topical Steroid Withdrawal (TSW) and Eczema.” Healthline, 31 Aug. 2021, www.healthline.com/health/eczema/tsw-eczema#diagnosis.
“7 Stages of Grief in TSW.” Decoding Topical Steroid Withdrawal,
decodingtopicalsteroidwithdrawal.com/7-stages-grief-tsw.
“Topical Steroid Withdrawal Healing Stages and TSW Skin: TSW Assist: TSW Skin.” TSW Assist | Topical Steroid Assistance & Solutions, 28 Sept. 2022, tswassist.com/topical-steroid-withdrawal-healing-stages/.
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