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What are topical steroids? -

Topical steroids are medications applied directly to the skin to alleviate symptoms that arise from various skin conditions, including eczema and psoriasis. The way they work is that they suppress the body’s immune system and its response in the skin, so that reactions are minimized.

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Types -

There are different types of topical steroids, ranging from mild to very potent. Mild steroids are often used for sensitive areas and for children, while more potent steroids are used for severe conditions but are limited to short-term use due to their stronger effects.

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Side effects -

Common side effects of using topical steroids include stretch marks and increased susceptibility to skin infections. But while short-term use is typically uneventful, it is long-term use that can lead to more serious issues, like the skin’s inability to naturally produce steroids.

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Withdrawal -

Topical steroid withdrawal (TSW), also known as red skin syndrome, occurs when patients stop using topical steroids and then experience adverse skin reactions. These reactions are often worse than the initial condition treated by the steroids.

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Fear -

The fear of topical steroids has been so widespread due to TSW that it has actually been given an official name: corticophobia. Distrust toward topical steroids has grown over the years, especially as medical professionals have not properly addressed the symptoms arising from withdrawal.

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Symptoms -

The primary symptoms of TSW include severe redness, burning, itching, peeling, and oozing skin. These symptoms often appear in areas where topical steroids were applied, but can spread to other parts of the body as well.

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Duration -

The duration of topical steroid withdrawal can vary significantly, lasting from several months to years. The timeline depends on how long the topical steroids were used, as well as where on the skin they were applied.

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Diagnosis -

Unfortunately, there are no specific tests that can be conducted to diagnose TSW. A diagnosis is primarily clinical, based on a patient’s history of topical steroid use and the characteristic symptoms that tend to follow discontinuation.

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Risks -

Aside from long-term use, there are a number of risk factors that can cause patients to potentially experience topical steroid withdrawal. These include frequent application, as well as use on sensitive skin areas such as the face or genital region. Even preexisting skin conditions like eczema can make some people predisposed to TSW.

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Pathophysiology -

Sadly, there is still a lot of research that needs to be done on topical steroid withdrawal, and so this condition is not fully understood. It is hypothesized that long-term steroid use suppresses the skin’s normal functions, which leads to a dependency. When steroid use is abruptly stopped, the skin rebounds aggressively and this causes severe symptoms.

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Other skin conditions -

It is important for people to understand the difference between TSW and other underlying skin conditions. This differentiation is crucial to avoid unnecessary continuation of steroids.

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Quality of life -

TSW can severely impact a person’s quality of life. Patients often experience physical discomfort, emotional distress, and social withdrawal due to the visibility and severity of symptoms.

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Psychological impact -

The psychological impact of TSW can be profound. Patients may experience anxiety, depression, and frustration due to the chronic and visible nature of the symptoms and the often slow recovery process.

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Long-term -

The long-term outcomes of topical steroid withdrawal vary. Some patients experience full recovery and a return to healthy skin, while others may have ongoing issues with sensitivity and flare-ups.

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Other withdrawals -

TSW is often compared to other withdrawal syndromes, such as those from other medications. Truthfully, there are many similarities, and understanding these parallels can help inform how TSW is treated.

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Management -

Any attempts to manage topical steroid withdrawal includes supportive skin care and the treatment of symptoms by medical professionals. Even using moisturizers, antihistamines, and pain relief medications can help.

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Alternative therapies -

There are many alternative treatments that can be used instead of topical steroids. Indeed, some patients explore therapies such as acupuncture or herbal remedies. But these methods should only be explored with the advisement of a medical professional.

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Natural remedies -

Natural remedies or complementary therapies can help manage the symptoms caused by topical steroid withdrawal. But you should be warned that they are not cures. While they can provide relief, it’s important to discuss any alternative treatments with a healthcare provider.

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Research and evidence -

More research is needed to understand TSW fully. Not only is current evidence largely anecdotal, but limited studies have shown that many people are also not even aware of the dosage for topical steroids. It’s always important to read the fine print of any medication you obtain.

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International Classification of Diseases -

Shockingly, TSW isn’t officially recognized by the International Classification of Diseases, which is another reason why it has been so difficult to establish a clear outline of the condition’s symptoms and diagnostics.

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Patient stories - If you’re wondering about the signs and symptoms of TSW without the desire to consult your healthcare provider, you can always turn to the internet. Many patients with TSW share their experiences online through blogs and social media in the hopes of creating greater medical awareness.

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Healthcare providers -

Many researchers and medical practitioners have been trying their best to increase awareness and education among healthcare providers about TSW. It is important that medical professionals are able to recognize the symptoms of this condition and assist people as needed.

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Avoiding TSW -

If you use topical steroids, the best way to avoid withdrawal afterward is by using the steroids appropriately and under the guidance of a healthcare provider. This includes using the lowest effective dose for the shortest duration possible.

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Gradual tapering -

It would also be a good idea to gradually taper the use of topical steroids, instead of abruptly terminating the usage. This approach allows the skin to adjust slowly, potentially reducing the severity of TSW.

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Barrier repair -

Supporting skin barrier repair is a critical aspect of managing TSW. Using products that restore the skin’s natural barrier function can help alleviate symptoms and promote healing.

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Moisturizers -

Using moisturizers regularly can help maintain your skin’s barrier and reduce the need for topical steroids. Moisturizers keep the skin hydrated, which is essential for managing chronic skin conditions and preventing flare-ups.

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Phototherapy -

In some cases, phototherapy (light therapy) can be used to manage symptoms of TSW. This treatment involves exposing the skin to controlled amounts of natural or artificial light to reduce inflammation and improve symptoms.

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Guidelines -

If you are ever recommended to take topical steroids to treat a skin condition, we highly recommend that you consult the guidelines and policies regarding the steroid before using it. This can truly help provide a clear outline on how it should be used to avoid problems.

Sources: (TSW Assist) (WebMD) (National Eczema Association) (National Geographic)

See also: Techniques to make your skin glow naturally

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