What is TSW

Important Disclaimer

• We are not advising anyone to stop, reduce, or change prescribed topical steroids or medications. Any changes to medical treatment should always be discussed with and guided by your prescribing practitioner. Topical Steroid Withdrawal is a complex and still evolving area of research, and individual experiences can vary widely. Our role is to offer education, support, and skin barrier focused care alongside appropriate medical guidance.

Topical Steroid Withdrawal, often called TSW, is a condition that is becoming increasingly recognised yet remains one of the most emotionally challenging skin journeys people face. It is something very close to my heart. I lived with eczema for more than twenty years and relied on topical steroids for about ten of those years. When I stopped using them, I was lucky. I did not experience severe TSW.

Many of my patients, however, have not been as fortunate.

As a Dermal Nurse and founder of The Functional Skin care line and Studio, I meet people who are exhausted, in pain, and feeling misunderstood. Their skin burns, stings, flakes, and flushes unpredictably. They are looking for answers that are not easily found in mainstream Dermatology because research is still limited. My goal with this article is not only to provide education, compassion, and clarity for those already experiencing TSW, but also to raise awareness about eczema care long before someone reaches this stage. Although TSW is something we can only support gently and cautiously, my hope is that by understanding eczema more deeply, people feel empowered to seek help earlier and protect their skin barrier before withdrawal symptoms ever begin.

What Topical Steroids Are:

Topical steroids are synthetic versions of cortisol, a hormone your body naturally produces in the adrenal glands. Cortisol helps regulate inflammation, immune responses, and swelling.

When applied to the skin, topical steroids
• Calm redness, itching, and swelling
• Suppress overactive immune signalling in the skin
• Reduce inflammatory chemicals like cytokines and prostaglandins
• Temporarily tighten leaky blood vessels that contribute to redness and oozing

They do not heal the underlying cause of eczema. They suppress symptoms.

What Is Topical Steroid Withdrawal?

Topical Steroid Withdrawal refers to a group of symptoms that may appear when topical corticosteroids are reduced or stopped after long term or frequent use. Reported symptoms include burning, stinging, intense redness, warmth, swelling, oozing, and cycles of flares followed by dryness and peeling over the entire body (not just the steroid treated areas). These symptoms can fluctuate in waves. For some people, the cycles continue for months, and for others, years.

TSW can be difficult to diagnose because the current evidence is based mostly on patient surveys and case reports, not large controlled studies. This means the true prevalence is unknown and many health professionals approach it cautiously due to the lack of formal diagnostic criteria.

Despite these limitations, patient experiences are valid and deserve acknowledgement.

Why Does TSW Happen?

Although the exact cause is not fully understood, the research we do have suggests several contributing factors:

• Changes to the Skin Barrier

Long term steroid use can alter keratinocyte turnover, lipid production, and epidermal thickness. This may weaken the barrier, increase transepidermal water loss, and lead to reactive, sensitive skin that struggles to self regulate

• Neuroimmune and Hormonal Effects

Some steroids can be absorbed systemically. With frequent use this may influence the hypothalamic pituitary adrenal axis, nerve signalling, and vascular responses ). These changes may contribute to the burning, flushing, and hypersensitivity that many people describe.

• Rebound Inflammation

Steroids may become less effective over time, a process known as tachyphylaxis. When they are stopped, some patients experience rebound inflammation that is more widespread than the original eczema.

Why My Studio Business Became Interested In TSW Support?

Because eczema and topical steroid use are such a significant part of my personal history, I have always felt drawn to this area. Over time, more and more patients began presenting with symptoms that aligned with TSW. Many felt overwhelmed or unsupported. I realised the best contribution I could make was to document what I see and advocate for more research.

In our next blog post, I will share an in house case study of a patient in current withdrawals and share how we made significant improvements to her skin health and quality of life in just a few short months.

Madilyn, RN