What is Topical Steroid Withdrawal 

  • Topical Steroid Withdrawal (TSW), also known as Topical Steroid Addiction (TSA) or Red Skin Syndrome (RSS), is a debilitating and painful condition that can develop from the use of topical corticosteroids (steroid creams or ointments) to treat various skin problems, most commonly eczema. It is classified as an iatrogenic condition, meaning it is caused inadvertently by medical treatment.

  • TSW occurs when the body develops a tolerance to topical steroids, requiring progressively more frequent or potent applications to achieve the same effect. Upon reducing or stopping the medication, the skin and body experience a severe withdrawal reaction. This condition is often mistakenly diagnosed as a "worsening" of the original skin issue, like eczema.

  • Topical Steroid Addiction is the state where the body and skin have become physically dependent on topical steroids and the person is still applying them. Topical Steroid Withdrawal refers to the rebound symptoms that occur once application has ceased. 

Topical Steroid Addiction Symptoms

  • Tolerance: The steroid stops working as effectively as it once did.
  • Spreading rashes: Rashes appear in areas the original condition did not present and often in places steroids were not applied.
  • Need to Escalate: The user is forced to apply the cream more frequently or prescribed a stronger (more potent) steroid to manage the symptoms.
  • Rebound: The original skin condition flares up more intensely, and very quickly, if the next application is delayed.
  • Allergies: Allergies and sensitivities become more severe or the user becomes sensitive to things they never used to have a problem with.
  • Thinning of the skin: Skin appears thinner, most noticeable on the face around the eyes, or under eye darkness. 

Topical Steroid Withdrawal Symptoms

  • Intense redness: In darker skin tones, this may appear as darker brown, purple, or grey discoloration.
  • Red Sleeves: Specific patterns of redness. The Red Sleeve is inflammation on the arms/legs that stops abruptly at the hands/feet (sparing the palms and soles).
  • White Nose: Bright redness on the face, sparing the nose and area around the mouth (perioral area).
  • Burning: The skin feels hot, for the person, and also to the touch.
  • Stinging: The skin feels painful and stingy.
  • Swelling (Edema): Fluid retention causing puffiness, particularly in the face (especially around the eyes), hands, and feet.
  • Flaking and Shedding: Excessive, visible and continuous, shedding of large or small skin flakes (often described as "snowing").
  • Oozing (Exudate): The skin produces clear or yellowish fluid, often followed by crusting.
  • Cracking and Fissures: Deep, painful cracks and fissures, particularly in skin folds or around joints.
  • Skin Atrophy: Thinning and fragility of the skin.
  • Elephant Skin: Thickened skin with diminished elasticity that forms deep folds or wrinkles, often seen on the extensor surfaces (knees, elbows).
  • Telangiectasia: Visible, broken capillaries or spider veins due to chronic vasodilation.
  • Eye Sensitivity: Dry eyes and sensitivity to light.
  • Altered Thermoregulation: Difficulty controlling body temperature, often cycling rapidly between feeling intensely hot, flushing, or having uncontrollable chills/shivering.
  • Severe Nerve Pain: Shooting, sharp, or prickling pains, sometimes called "zingers".
  • Enlarged Lymph Nodes: Swollen glands, often in the neck, armpits, or groin.
  • Adrenal Suppression: In severe cases of prolonged potent steroid use, the body's natural production of cortisol may be suppressed, leading to severe fatigue and weakness.
  • Insomnia and Sleep Disturbance: Often due to intense itching, burning, and discomfort. 
  • Extreme Fatigue: Debilitating, persistent tiredness that can leave sufferers bedridden or housebound.
  • Hair Loss (Alopecia): Hair loss from the scalp and/or body.
  • Hypersensitivity: The skin becomes intensely sensitive to environmental factors like water, movement, clothing fabric, temperature, and moisturisers.
  • Mood Alterations: Significant psychological impact including anxiety, depression, and mood swings.
  • Appetite and Weight Changes: Loss of appetite or unexpected weight loss.