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5 Signs You’re Experiencing Topical Steroid Withdrawal (TSW) And What To Do About It

When most people think of drug withdrawal, images of people detoxing from powerful opioids like heroin or morphine often come to mind.

However, it’s not just illicit, recreational, or painkilling drugs that can result in withdrawal symptoms. Even mainstream medication for everyday skin conditions can have similar effects.

Topical steroid medication can result in what is known as Topical Steroid Withdrawal (TSW). Steroid withdrawal is real, and a phenomenon that can occur after using these types of medications.

Many people don’t realize the dangers of side effects when using topical steroids like hydrocortisone. Partly due to the fact that they are seemingly everywhere, their ubiquity can lead to people using them without fully understanding the risks. After all, if they are available over the counter in every pharmacy and drug store around, they can’t be that bad, right?

Wrong. 

Don’t forget you can buy cigarettes, alcohol, and other potentially harmful substances at those same exact stores. Just because a store is willing to sell you something does not mean that you should use it.

Iatrogenic conditions such as TSW syndrome occur as an unintended consequence of medical treatment.

That’s why it’s so important to contribute to raising awareness about topical steroid withdrawal.

In this article, we’re going to talk about the five most common signs that you are experiencing withdrawal from topical steroid addiction; and what you can do to address the problem.

But first, we have to understand what it is that our bodies are reacting to.

What are topical steroids?

Topical steroids are medications that are applied directly to the skin to treat a variety of conditions. They can be found in creams, ointments, lotions, gels, or solutions. Some common examples of topical steroid use include treating flare ups of atopic dermatitis, psoriasis, eczema and general redness. They can be effective in reducing inflammation and burning sensation in skin, and preventing scarring. Some people even use topical steroids to treat acne and rosacea, which can result in itchy, red skin that can sting and/or also have the sensation of burning skin.

Topical Steroid cream being dispensed

The most common form of topical steroids are creams and gels. They usually come in either a white or clear formulation. These formulations can be applied directly to the affected areas of the body, such as a pimple, rash, sunburn, or bug bite, to reduce swelling and irritation.

These steroids are called topical because they work by targeting specific receptors in your skin that are involved in natural healing processes. These substances cause a quick response by dilating blood vessels and stimulating the release of anti-inflammatory and anti-bacterial agents. The medications work on the body in all three layers of the epidermis, reaching into the dermis through superficial blood vessels. This is why these medications are particularly popular with people with eczema, which can initially seem to respond well when treated with topical corticosteroid use.

What is topical steroid withdrawal?

Topical steroid withdrawal syndrome is defined as an adverse reaction resulting from stopping the application of topical corticosteroids. When moderate to high potency topical corticosteroids are used or abused for an extended period of time, they can cause this reaction due to prolonged, inappropriate, and excessive usage.

When does topical steroid withdrawal occur?

TSW occurs when people stop the use of a topical steroid after an extended period of use, which is typically against the recommendations of the manufacturer or the patient’s dermatologist. These recommendations are made in part to help prevent topical steroid addiction and the subsequent symptoms of corticosteroid withdrawal that can accompany physical and emotional conditions relating to the long term use.

Generally, people with TSW have used topical steroid products regularly for a year or more, and have stopped using them within the past few months.

When high-potency topical corticosteroids are stopped after excessive or abused use, TSW signs and symptoms may be evident within a few days to weeks.

What are some of the symptoms of TSW?

The body is hypersensitive to topical steroids after long-term use, which can cause a wide range of symptoms when the steroids are stopped abruptly.

The unfortunate thing is that this can sometimes be difficult to detect. In some cases, a sufferer of eczema may not be able to tell the difference between a skin reaction due to TSW and an eczema flare due to their condition.

TSW is not currently able to be diagnosed by any standard test. A dermatologist or other doctor can help diagnose the condition by using the symptoms that you experience and your medical history.

A woman dermatologist examining a patient's skin

Symptoms of TSW may include:

  • Worsening skin conditions
  • Hair loss
  • Depression or mood changes
  • Insomnia or night sweats
  • Fatigue
  • Confusion or memory problems.

Because of the wide range of symptoms, it could be easy to mistake the conditions as unrelated to TSW. That’s why if you’re experiencing topical steroid withdrawal, it’s important to know what it is, how to spot it, and what to do about it.

Here are five signs you’re experiencing the symptoms of topical steroid withdrawal and what to do about them.

1. You’re experiencing skin irritation and blistering.

Skin irritation from topical steroid withdrawal

When your body becomes accustomed to the effects of topical steroids over months or years, it may start to experience skin irritation and blistering as its primary means of regulating skin function once the steroids are removed from the system.

Once the medication is stopped, symptoms include significant discomfort and even pain in areas where you’ve been using topical steroids for a long time. Furthermore, it can make skin conditions like psoriasis or acne worse.

Inflammation of the skin, accompanied by a burning or painful sensation, is usually a telltale symptom after stopping topical steroid use. Known as a “red sleeve,” this rash commonly occurs on the arms or legs, but it can also occur anywhere on the body.

Experiencing TSW can also cause the following skin symptoms:

  • Pus-filled blisters on the skin 
  • Shedding or flaking of the skin
  • Peeling of the skin
  • A spreading rash
  • Eczema-like rashes in areas that were previously unaffected
  • Under-the-skin bumps that contain pus
  • Hard bumps under the skin
  • Inflammation
  • Developing deep wrinkles
  • Temperature-sensitive skin

2. You feel feverish and have achiness.

Symptoms of fever from TSW

Topical steroid withdrawal can also lead to elevated body temperatures and achiness – both of which are common side effects of the medications in general, not just topical steroid withdrawal.

If you find yourself suffering from a fever soon after quitting your topical steroids, it’s worth considering if TSW might be the culprit.

Regardless if you think it’s TSW or not; if you’re feeling really sick, please seek medical help as soon as possible!

3. You have trouble sleeping or concentrating.

TSW can cause trouble sleeping

As the body’s natural response to an abnormal imbalance in hormones, topical steroid withdrawal can cause disrupted sleep patterns and difficulty concentrating, both of which are common during any kind of drug detoxification process – including topical steroid withdrawal.

Getting enough sleep is important as it is, but even more so if you are experiencing insomnia or other sleep issues caused by TSW. Make sure you schedule in enough rest so that you don’t suffer any long-term negative consequences from this process.

And it should go without saying that if you are feeling particularly tired or foggy, do not drive! Uber is your friend, here.

4. You experience flu-like symptoms such as sore throat, headache, and fatigue.

Topical Steroid Withdrawal can result in fatigue and headaches

Many people who use topical steroids develop some degree of immunity over time – meaning that if they stop taking their medication suddenly, they may experience some degree of inflammation or infection related to their old skin regimen (even if they stopped taking the medication specifically for this purpose).

During hot weather months or times when viral infections are more prevalent (such as during fall/winter), this type of inflammation can be particularly troublesome – making flu-like symptoms one sign that you might be experiencing topical steroid withdrawal symptomatically before it spreads to other areas.

As with any sore throat, headache and fatigue associated with a flu, proper hydration is key. Make sure to drink plenty of fluids and avoid caffeine and alcohol if you can.

Getting enough rest is also critical for restoring your energy levels and overall well-being. Make sure to give yourself plenty of time to catch up on those Z’s. Even if it means putting a pause in your streaming binge session to hit the hay early!

If you notice any of these signs and they persist, be sure to consult with your doctor.

5. Mood swings or depression.

Depression resulting from TSW

You’d be forgiven for not being in the best of moods if you’re starting to suffer from the symptoms of TSW, even if you didn’t know it. However, it’s worth considering that the way you are feeling is a direct side effect of the condition itself, and not just a reaction to feeling unwell.

Things to keep an eye out for are increased irritability and an overall decrease in happiness. If you’re feeling particularly down, it might be a good idea to reach out to a friend or family member for support or talk to your doctor about potential treatments to help identify the root cause of your mood swings, as well as how best to manage them directly.

Below are some additional tips that may help you deal with topical steroid withdrawal in a comfortable and successful manner:

– Seek out professional support. Many people find that talking to a therapist or counselor who specializes in TSW can be incredibly helpful – not only for emotional support, but also for providing practical advice on how to best manage the symptoms of TSW. Alternatively, sufferers of TSW often find they can support one another, and share their experiences. This type of support group has proven beneficial to atopic dermatitis patients, patients with eczema, and even younger patients with childhood eczema.

– Establishing healthy coping mechanisms can be vitally helpful – whether that means journaling, spending time outdoors in nature, practicing yoga or meditation, or engaging in another form of self-care.

– Take care of yourself physically and emotionally. Remember: Taking care of yourself if you develop TSW is crucial for ensuring a speedy and successful recovery – of both the withdrawal as well as the underlying skin disease!

What Should I Do If I Notice These Signs of Topical Steroid Withdrawal?

If you are experiencing any of the above signs of topical steroid withdrawal, it is important to contact your doctor as soon as possible so you can get the proper treatment started immediately.

A dermatologist can help diagnose TSW

In the event that you meet the diagnostic criteria for TSW, your dermatologist will assist you with developing a plan for treating it. There are a number of possible treatment options, including:

  • Stopping the use of steroid cream slowly over a period of time. A gradual reduction in the use of topical steroid creams can aid in the management of TSW and act as a way to avoid the worse symptoms for weeks after stopping. Eventually the skin should readjust to being without the mid- or high-potency topical steroids.
  • Stopping the use of topical steroids immediately. In order to manage TSW, some dermatologists recommend to stop using topical steroids and creams immediately.
  • The use of oral corticosteroids. The body can adjust to the absence of topical corticosteroids by taking oral corticosteroids for a few weeks.
  • Applying a cold compress. You might also be advised to apply cold compresses on your skin and to use other skin soothing treatments.
  • The use of antibiotics. There is an increased risk of infection associated with TSW. This risk can be managed with antibiotics.
  • Injection of dupilumab. Dupilumab injections may reduce symptoms of TSW, according to research from 2018.

Prevention

As with any other disease, prevention is always better than treatment.

Both patients and doctors need to be aware of the risks of frequent and prolonged use of topical corticosteroids of moderate potency or higher. There is a strong correlation between the higher the potency, the longer the period of application (e.g. more than one year), and the more frequent the use of the topical corticosteroid (more than once a day), with the likelihood that a withdrawal reaction will occur.

The best way to prevent a case of TSW is to not use topical steroids at all! Luckily, there have been some huge advancements in the field of non-steroidal topical treatment for skin conditions, including eczema, psoriasis, and many more. 

Dermeleve® is one of the most effective anti-itch medications on the market- and uses no steroids at all! Instead, Dermeleve® is composed of all natural healing ingredients, including ceramides, hyaluronic acid, vitamin C & E, and shea butter.

All the natural ingredients in the world don’t matter if the product is not effective, right?

Right!

Dermeleve®

Dermeleve® starts working to relieve itching immediately upon application, with results in as little as 5 MINUTES! Compared to the days and weeks needed for a corticosteroid based cream to work, it’s no contest.

Box of Dermelev

But wait; there’s more! Not only does Dermeleve® work in as little as 5 minutes, that same single application can last up to 5 HOURS! If that’s not enough, Dermeleve® offers a satisfaction guarantee!

With a safer, faster working, longer lasting alternative like Dermeleve® available, there’s no reason to worry about topical steroid withdrawal at all, as there’s no reason to use them in the first place!

Conclusion

Topical steroid withdrawal is something that is not commonly known, but that doesn’t make it any less real. As with all things in life, there are risks and benefits, and having the knowledge to make an informed decision is critical. 

We hope that this article has given you some insight into the causes, symptoms, treatments and prevention methods of topical steroids withdrawal. If you feel you might be suffering from this condition, it is important to speak with your doctor as soon as possible so you can get started on the road to recovery, and get some relief from your discomfort!

In the meantime, we suggest giving Dermeleve® a try!

Dermeleve® is an all natural topical anti itch product that is effective, fast acting, and long lasting. It is available through physicians’ offices, and directly from the Dermeleve® website.