What is Topical Steroid Withdrawal (TSW)?

26 Sept

TSW is the collection of symptoms someone goes through if they are addicted to steroids and stop using them. It was originally known as red skin syndrome. It’s a potentially debilitating condition, so here’s what you need to know…

Disclaimer: I am a mental health therapist, not a dermatologist or medical professional. I can’t diagnose or advise. I’m raising awareness, sharing resources and providing mental support.

TSA is topical steroid addiction. A small, unknown, proportion of topical steroid users develop some level of addiction. The body builds a tolerance to steroids, meaning higher doses are required and are less effective over time. The body becomes dependant on the medication. Lots is still unknown about TSA and TSW! Such as how often it happens and the amount of topical steroid use that causes it to occur. It’s important to be aware of, as many people end up homebound or bedbound with the condition. Loved ones turn into carers, jobs and life goals are put on hold and of course it leads to many mental health issues.

Topical corticosteroids (TCS) and hydrocortisone creams remain among the most effective, inexpensive and widely used drugs in dermatology.

Symptoms of TSA (steroid addiction):

Skin flares quickly between steroid applications (rebound effect)
Spreading to new areas that never bothered you before
A shift from itching to burning, stinging and painful skin
Failure to clear with usual steroids
Increased allergic response to environmental irritants and food (hypersensitivity)
Rashes can also appear more flushed, like a sunburn
Increased skin flaking

Symptoms of TSW (steroid withdrawal):

Extensive and excessive flaking, shedding, peeling skin
Swelling or dermatoses
A burning sensation of the skin and increased skin temperature
Erythema (redness of the skin, often over 90% of the body)
Wrinkling, thin skin
‘Red sleeves’ on lighter skin (redness on arms, ending sharply on the wrists)
Oozing, pus-filled bumps
Hypersensitivity to temperature, water and products etc
Pain, insomnia, hair loss/thinning
Shivering/lack of temperature regulation

Other symptoms include:

Eye dryness/irritation
Fatigue, shaking, nerve pain
Scaring
Depression and anxiety
Compulsive skin picking
Infections
Repetitive Strain injuries, from itching
Hormone issues and period changes
Appetite and weight changes
Difficulty sleeping
Fears and phobias developed
PTSD
Skin cycling between red, swelling, dry, shedding

How long does it take to recover from TSW - steroid withdrawal?

It’s different for everyone. It takes about 4 months for steroids to leave our system, but on average it takes 2-5 years to completely recover from TSW. Cycles of healing and flaring can happen over varying time frames, so the healing is not linear.