Topical Steroid Withdrawal Syndrome

Topical Steroid Withdrawal Syndrome (TSW) is also known as Topical Corticosteroid Withdrawal or Red Skin Syndrome (RSS).

Causes or Triggers

TSW occurs as a result of prolonged and/or inappropriate use of prescription steroid creams or preparations. It usually follows moderate to high-potency topical steroid use for the treatment of atopic dermatitis (eczema).

When you regularly apply cortisone preparations to the skin the body’s production of the natural anti-inflammatory hormone ‘cortisol’ reduces over time. So that when the patient stops applying the cortisone creams, the inflammation increases as the body’s natural defences are low.

The Primary Trigger is topical steroid addiction. There are many Secondary Triggers that can impede healing or exacerbate the condition. These are common with the triggers that caused the eczema in the individual in the first place, and may be dietary or environmental allergies, chemical exposure, or lifestyle factors.

Symptoms

TSW is marked by topical corticosteroid dependence. TSW is often mistaken for severe atopic dermatitis, unfortunately leading to the prescription of more topical or oral steroid treatments.

Corticosteroid withdrawal doesn’t always lead to severe TSW syndrome. In some cases it just occurs on the face, neck and other visible areas where more steroid creams have been applied. In other cases there is whole body involvement with frequent skin infections due to impaired skin barrier function.

In TSW the skin goes through two major stages – erythematous (red, burning, stinging) and desquamation (flaking, scaly, ‘snowing’).

Redness, burning and stinging (erythema) may start on the face, neck or other treated sites on the body and then spread to the whole body, affecting areas that were never treated with topical steroids. It often spares the hands and this presentation is known as the ‘red sleeve’.

Because of severe impairment of skin barrier function both phases are marked by intense itching, temperature dysregulation, nerve pain/sensitivity and often multiple chemical and environmental sensitivities.

Our approach

Regardless of the severity of TSW, it is often a life altering and difficult course of recovery. The intensely itchy, often painful rash and temperature dysregulation can cause irritability, sleep disturbance, negative self-esteem, and a decline in health-related quality of life.

We take extra special care of our TSW patients with our Integrative Dermatology approach, which is holistic at its essence. We use safe, topical agents and body washes to help support healthy skin, while addressing nutrient deficiencies, underlying immune function, dietary, environmental and lifestyle triggers.

At Auckland Skin Clinic, we’re aware that having a chronic skin disorder can be very frustrating, embarrassing and depressing. We are also aware that it often requires some major effort on your part to change your habits and adopt a healthy lifestyle. We do our best to ensure your emotional wellbeing is supported throughout this process.