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What is Topical Steroid Withdrawal?

What is Topical Steroid Withdrawal?

Topical Steroid withdrawal is a subject close to our hearts.

The TSW community has been reaching out to us for the past 10 years, letting us know how our salts have helped them through their journeys.

We therefore feel it’s our duty to help answer the commonly asked question: “What is Topical Steroid Withdrawal?”

Our aim is to help prevent future generations from having to go through the devastating effects of TSW, either themselves or as a parent of a TSW child, by raising awareness of how to avoid addiction to topical steroids.

What are Topical Steroids?

Topical corticosteroids are a type of steroid medicine you apply directly to the skin to reduce inflammation and irritation. You commonly use these for children and adults to treat the symptoms of eczema and psoriasis.

If used correctly for short periods of time such as 1-2 weeks then they rarely have serious side-effects.

What is Topical Steroid Addiction? (TSA)

Although corticosteroids are not addictive in themselves, if you use them continuously over long periods the skin can suffer with a withdrawal reaction. (This is thought to be around 12 months for adults, but as little as a few months in children).

The skin can show an increase in tolerance due to the addiction. Which leads to higher doses and escalating potency prescriptions.

What is Topical Steroid Withdrawal? (TSW)

TSW refers to the symptoms which occur when a patient reduces or ceases use of topical steroids.

The more common Topical Steroid Withdrawal symptoms include burning, swelling, itching, flaking and oozing of the skin. Other symptoms can include nerve pain, altered thermoregulation, atrophy and hair loss.

It is an extremely painful, debilitating condition which affects all aspects of the patient’s life and can lead to depression, insomnia, anxiety and even PTSD.

What is Red Skin Syndrome? (RSS)

Withdrawal often accompanies painful redness of the skin. Which is why TSW is also referred to as ‘Red Skin Syndrome’ (RSS).

This redness is very distinct and often presents in the form of ‘sleeves’ or a ‘mask’. It looks and feels like sunburn with the accompanying burning sensation.

The story so far:

January 2012
The International Topical Steroid Awareness Network (ITSAN), is formed by parents and patients who suffer first-hand devastating effects of TSW. This non-profit organisation has since been advocating, educating, raising awareness and providing essential support for the global TSW community.

September 2021
The MHRA  (UK Medicines & Healthcare products Regulatory Agency) recognised the effects of Topical Steroid Withdrawal as a result of a yellow card campaign spearheaded by UK charity Scratch That.

The Review ruling resulted in information about Topical Steroids Withdrawal now being included in the patient information leaflets provided for all packs of topical corticosteroids.

August 2022
The National Eczema Association announced their commitment to raising awareness about the subject of what is Topical Steroid Withdrawal.

November 2022
The British Journal of Dermatology published the article Topical steroid withdrawal syndrome: time to bridge the gap’, with contribution from the National Eczema Society.

The current crisis

  • Most prescribing medical professionals are still unaware of the risks that long-term topical steroid misuse can pose to their patients.
  • Patients and parents are not being educated about the dangers of long-term misuse of topical corticosteroids.
  • Anyone can purchase ‘over the counter’ mild corticosteroids such as hydrocortisone. However, pharmacists aren’t yet aware of the importance of highlighting the correct care advice to prevent accidental long-term misuse.
  • The lack of research into this subject means that current NHS guidelines have no clear route for diagnosis or treatment. Doctors can’t follow advice for what is Topical Steroid Withdrawal as it simply doesn’t exist yet in their guidelines.
  • Patients and parents feel unsupported and desperate - not knowing how to manage their TSA symptoms effectively. They feel forced to ‘go it alone’ with TSW, which means they’re not receiving the essential care needed to keep them safe both physically and emotionally.

If you think you may have TSA

  • If you’re in the UK then take a look at the Scratch That It’s lots of very handy info.
  • Also head over to Itsan who are the world’s leading TSW charity, providing amazing support for the international community.
  • Watch ‘Preventable’. Briana Banos charts her journey going through TSW, speaking to fellow sufferers and medics, while on her mission to find answers and raise awareness.

  • is a UK TSW advocate who now co-owns a clinic providing treatment and advice in the UK for patients going through Topical Steroid Withdrawal.

If you’re already going through TSW

You may find that our Dead Sea Bath Salts for eczema can help. Dead Sea Salt can help soothe the symptoms during TSW, providing some comfort and relief, helping your skin to feel calmer and more comfortable.

You may worry that bathing in salt might sting the skin, but Dead Sea Salt is mainly made of Magnesium Chloride. This was used during both World Wars to clean wounds effectively without irritating the skin tissues. Dead Sea Salt also contains other essential minerals for skin hydration and renewal, including Potassium and Calcium.

Bathing in Dead Sea Salt helps protect and restore the skin’s natural barrier and Westlab Dead Sea Salt has been tested and approved to be skin microbiome-friendly, supporting the good bacteria to help keep skin healthy.

Our Dead Sea Bath & Shower Gel for eczema has been formulated to protect and maintain the skin barrier without causing dryness or irritation. Free from SLS/SLES and infused with Dead Sea Salt, it also gently moisturises the skin and supports the skin barrier.

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