If you suffer from eczema and start using a topical steroid to treat it, will you end up with topical steroid withdrawal?
How do you know if you are suffering from topical steroid withdrawal or if it is your eczema getting worse?
A recent Healthline article states: “Topical steroid creams are one of the most common methods to manage eczema. While they do not usually cause harm, in rare cases, topical steroids may lead to a painful condition called topical steroid withdrawal (TSW)”.
Long-term or overuse of topical steroids causes the skin to become dependent on the medication. When topical steroid use is suddenly stopped, the skin reacts with severe withdrawal symptoms, such as burning, redness, peeling, and inflammation that far exceed the original eczema symptoms. Proper management of steroid use, tapering off gradually, and using non-steroidal treatments can help prevent TSW from occurring.
So, what is the difference between eczema and topical steroid withdrawal?
What Is Eczema?
Eczema is a chronic inflammatory skin condition characterised by itchy, red, and dry skin. It is one of the most common skin conditions in children, but it can also affect adults. Children with eczema may outgrow the condition as they get older, but for others, it can persist into adulthood.
Eczema occurs due to a combination of genetic, immune, and environmental factors that cause the skin to lose moisture and become more sensitive to irritants.
Many people with eczema experience periods of remission, where their symptoms are mild or absent, but flare-ups still occur, particularly in response to triggers. There is no complete cure for eczema but there are ways to help live with the skin condition more comfortably.
Eczema Symptoms
- Dry, scaly skin
- Red or inflamed patches
- Intense itching, which can lead to further skin damage
- Blisters or oozing in severe cases
- Thickened, rough skin in chronic cases
Skin Appearance in Eczema
- Red, itchy, and dry patches of skin, often with scaling or flaking.
- Affected areas may ooze, crust, or develop thickened skin over time due to chronic scratching.
- Eczema typically occurs in localised areas, such as the hands, face, neck, or inside the elbows and knees.
What Is Topical Steroid Withdrawal?
Topical Steroid Withdrawal (TSW), also known as Red Skin Syndrome occurs as a reaction when someone who has used topical steroids for an extended period suddenly stops.
When topical steroid use is suddenly discontinued, the skin can go into withdrawal mode, resulting in a host of uncomfortable and severe symptoms. These symptoms are likened to eczema, but on steroids.
@ampernaskin Send this to someone who is using steroids for their skin! Our Founder Kiri explains the onset of topical steroid withdrawal. If you need skin support, please DM or email us at info@amperna.com 💙 #topicalsteroidwithdrawal #tsw #steroids #tswawareness @tsw ♬ original sound - Amperna® Skincare
TSW Symptoms
- Red, burning, dry and flaky skin
- Oozing and crusting
- Swelling
- Severe itching and burning
- Skin thinning or cracking
- "Steroid Face" or "Elephant Skin" (A swollen, puffy appearance)
Skin Appearance in TSW
- Widespread redness that may extend beyond the areas where the steroid medication was originally applied. The skin can look inflamed, swollen, and may have intense burning and stinging sensations, unlike the typical eczema itch.
- Peeling and shedding of large patches of skin is common.
- There may also be thickening and wrinkling of the skin in severe cases.
- The affected areas are usually more widespread compared to eczema and may affect the entire body, particularly where steroids were used.
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How to Prevent Topical Steroid Withdrawal
- Do your research: Ensure you understand the potential risks and understand how topical steroid use works.
- Know your alternate options: There are ways you can help treat your eczema flares without using topical steroids.
- Use topical steroids cautiously: Always follow your healthcare provider’s instructions for correct topical steroid use.
- Avoid long-term or overuse: Only use topical steroids during flare-ups and avoid prolonged use of high-potency steroids unless medically necessary.
- Consult your doctor regularly: Regular check-ins with a dermatologist can help ensure you are using the right treatments for your condition.
Topical steroids can be effective for controlling eczema flare-ups in the short term, but improper use or long-term reliance can make eczema worse overall. By using steroids cautiously and exploring alternative treatments, you can better manage eczema without the risk of long-term complications.
TSW can last anywhere from months to years, depending on the duration and potency of the topical steroids used. It is important to be prepared for a potentially long recovery process, and patience is key.
If you are currently suffering from topical steroid withdrawal you can use these AMPERNA® products to help ease your symptoms:
@ampernaskin Are you currently experiencing Topical Steroid Withdrawal? Kiri can help you. #tsw #topicalsteroidwithdrawal #steroidwithdrawal #tswwarrior #topicalsteroidaddiction #topicalsteroidawareness ♬ vlog, chill out, calm daily life(1370843) - SUNNY HOOD STUDIO
How Topical Steroids Can Affect Eczema Long-Term
Long-term use of topical steroids can have several effects on both living with eczema itself and your overall skin in general. These can include:
Skin Thinning
Prolonged use of potent topical steroids, especially on sensitive areas like the face or neck, can cause the skin to thin. A condition called skin atrophy, thin skin is more susceptible to injury, infection, and irritation, which can worsen eczema symptoms. The skin's natural barrier is compromised, making it harder for the skin to retain moisture and protect itself from irritants.
Steroid Dependence and Tolerance
Over time, the skin can become dependent on topical steroids to maintain its normal function. This means that the same dose of steroids becomes less effective in managing eczema flare-ups, leading people to use stronger steroids or apply them more frequently. When this happens, eczema symptoms may seem to worsen because the underlying inflammation is no longer controlled effectively by the steroid. When the steroids are stopped, eczema symptoms may return more severely, leading to what is known as rebound flare-ups.
Steroid Rebound or Topical Steroid Withdrawal (TSW)
Long-term use of topical steroids, especially in high doses, can lead to TSW or steroid rebound. When the steroids are discontinued, the skin may experience severe inflammation, redness, burning, peeling of the skin and a worsening of eczema-like symptoms.
Steroids suppress the immune response, temporarily reducing inflammation. However, when their use is reduced or stopped, the body may overcompensate by producing an exaggerated inflammatory response, leading to a rebound flare of eczema.
Skin Barrier Interference
Using topical steroids incorrectly increases the risk of side effects like permanent skin damage or infection. Overuse can also worsen eczema overall by damaging the skin barrier. Eczema occurs partly due to a compromised skin barrier that allows moisture to escape and irritants to penetrate. Long-term use of steroids can exacerbate this problem by further weakening the skin’s ability to repair itself, making the skin drier and more prone to inflammation.
Masking Underlying Skin Conditions
Steroids suppress inflammation, which is the body’s natural response to harmful stimuli like allergens or irritants. By continually suppressing this reaction, topical steroids can mask the true severity of eczema, leading to under-treatment or an incomplete understanding of what triggers the flare-ups. When the steroids are stopped, the full extent of the eczema may appear more intense.
Non-Steroidal Alternatives to Help Live with Eczema
Although there is no cure, if you suffer from Eczema there are ways you can help manage your symptoms without resorting to using topical steroids and potentially risk being caught in a chronic cycle. Non-steroidal treatments aim to reduce inflammation, restore the skin barrier, and control the immune response, offering safer, long-term options for managing eczema. Combining these treatments with lifestyle adjustments, such as stress management and a skin-friendly diet, can help keep eczema under control and improve the quality of life for those living with the chronic nature of the condition.
Emollients (Moisturisers)
Moisturisers are crucial in treating eczema because they help maintain and repair the skin barrier, prevent moisture loss and protect against irritants.
AMPERNA®'s range is full of humectants like glycerine, urea and hyaluronic acid as well as skin barrier repair ingredients like ceramides and fatty acids. *For extra relief from dry itchy eczema patches, apply a wet layer of muslin bandage wrap over moisturiser to lock in hydration and soothe inflammation.
Diet Modifications
Some people with eczema may benefit from eating an anti-inflammatory diet rich in omega-3 fatty acids (found in fish, flaxseed, and walnuts) to help reduce inflammation.
Identifying and avoiding food allergens, like dairy, eggs, or nuts, may help control eczema in people who have specific food-related triggers.
Incorporating probiotics in your diet can help balance and support the immune system and improve skin health.
Phototherapy (UVB Light Therapy)
Exposing the skin to controlled amounts of ultraviolet light can help reduce eczema symptoms by slowing down the inflammatory process. Recommended for people with moderate to severe eczema who have not responded well to topical treatments. It is done under medical supervision to avoid skin damage.
Stress Management and Mental Health Support
Stress can exacerbate eczema flare-ups, so managing stress through techniques like meditation, deep breathing, yoga, or cognitive behavioural therapy (CBT) can help reduce flare-ups. Stress management improves overall well-being and helps manage the emotional aspects of living with eczema, which can reduce stress-related flares.
Lifestyle Changes and Self-Care
Identifying and avoiding triggers like allergens, irritants (soaps, chemicals), and extreme temperatures can help manage eczema.
Short, lukewarm baths followed by immediate application of moisturisers (the “soak and seal” method) are recommended.
Using fragrance-free cleansers, soaps and avoiding harsh scrubs helps to prevent irritation.
The Cycle of Eczema and Topical Steroids Conclusion
The key difference between eczema and Topical Steroid Withdrawal (TSW) lies in their cause and symptoms. Eczema is a chronic skin condition driven by genetics and environmental triggers, while TSW can occur after prolonged and incorrect use of topical steroids which manifests with more severe, widespread, and unpredictable symptoms.
TSW also involves burning, redness, and large-scale skin peeling, whereas eczema primarily causes itching and localised dry or scaly patches. Managing both conditions requires different approaches, with TSW often needing steroid discontinuation and alternative therapies.
There are other options out there so ensure you are doing your research before starting any topical steroid medication treatment.
If you need any more information, you can contact Kiri (AMPERNA® founder and owner) at info@amperna.com.
