Topical Steroid Withdrawal (TSW)
Over the last few years, there has been growing awareness of what many patients describe as Topical Steroid Withdrawal (TSW) — sometimes also called Topical Steroid Addiction or Red Skin Syndrome. The condition is said to occur when the skin reacts badly after stopping topical corticosteroids, with symptoms such as burning, redness, oozing, and intense itching.
On social media, there are now millions of posts, videos, and shared stories from people who believe they have experienced TSW. These accounts are often very moving and highlight the physical and emotional distress that can occur. Despite the sheer volume of these reports, there has been very little formal scientific research into this area. At present, the medical community does not yet have a clear understanding of what causes these reactions, how common they are, or how best to diagnose and manage them.
Having attended dermatology meetings in both the UK and the US this year, it’s clear to me that this is a subject that warrants much more attention. While topical corticosteroids remain a cornerstone of eczema management and are usually both safe and effective when used appropriately, there is undoubtedly a small group of patients who experience something quite different and much more difficult when they stop treatment.
In my own practice, I have treated thousands of babies and children with eczema since 2000. Most have needed some form of medical therapy to improve, and only a very small number have cleared completely without treatment. That said, I recognise that for some, the experience after discontinuing steroids can be extremely distressing — both for the patient and their family. I still feel that the term withdrawal may not be entirely accurate from a medical standpoint, but I fully agree that this is an area that is poorly understood and urgently needs more research.
I am hoping to help coordinate a national study to explore this further — to properly characterise what patients are experiencing, identify possible risk factors, and understand the biological and psychological impact. Only through careful, open-minded research can we begin to give patients and clinicians clear, evidence-based answers.
The positive news is that we now have a new generation of non-steroidal treatments for eczema that are transforming care. Dupilumab, which blocks the IL-4 and IL-13 pathways, has already been life-changing for many children and adults with severe eczema, reducing inflammation, itch, and the need for topical steroids. Nemolizumab, targeting the IL-31 receptor pathway, is another promising treatment showing excellent results in reducing itch and improving quality of life. Several other targeted and small-molecule treatments are also on the horizon, giving us more options than ever before.
Eczema remains a complex and variable condition — no two children or adults are quite the same. My hope is that through better research, open dialogue, and more personalised treatments, we can continue to improve care and rebuild trust between patients and clinicians. Listening to patients’ lived experiences while maintaining scientific integrity is key to moving forward.
