Topical Steroid Withdrawal (TSW)

Topical Steroid Withdrawal (TSW), also called Topical Steroid Addiction or Red Skin Syndrome, is a serious and often long-lasting reaction that can follow long-term use of steroid creams and ointments, most commonly prescribed for eczema. In 2021 the UK medicines regulator, the MHRA, published a national review confirming that severe withdrawal reactions can occur after long-term continual use, and announced that steroid product information would be updated with warnings. Even so, TSW is still not widely recognised in everyday practice, and many people find themselves researching it alone.

We're proud sponsors of ITSAN, the charity raising awareness of TSW, and this page draws on their guidance and published medical sources rather than our own opinion. We don't claim that any of our products treat TSW.

A crucial safety note first: if you're thinking of stopping topical steroids, please involve your doctor. Long-term steroid use can suppress the adrenal glands, and stopping when they're severely affected can be dangerous. Your doctor can check for this and support you. The MHRA also advises anyone with redness or burning after stopping to speak to a healthcare professional before using steroid creams again. ITSAN's Doctor's Guide can help if you're struggling to find a doctor who understands TSW.

TSW Isn't "Just Eczema"

Many people going through TSW say they were told it was "just eczema" flaring up, which is why you'll see the hashtag #ThisIsNotEczema in TSW communities. The two can look alike at first, but they tend to behave differently over time.

What tends to point towards TSW (from ITSAN's guidance for doctors and the medical literature it cites):

A history of using topical steroids regularly for a long time, often needing stronger creams, more often or on larger areas, with the creams working less and less well.
Redness that spreads beyond the original eczema patches, including to areas where steroids were never used. A "red sleeve" on the arms or legs is a classic sign. It typically spares the palms and soles, though severe cases can affect them.
Burning and stinging as the main sensation, alongside an intense, deep itch, rather than itch alone.
Redness and flares returning within days of stopping or missing steroid doses, getting worse each time, with little or no real period of remission.
Widespread, constant shedding of skin flakes, plus oozing and swelling, often cycling through phases.
Symptoms beyond the skin: swollen lymph glands, swelling, feeling too hot or too cold, nerve pain ("zingers"), hair loss, exhaustion, disturbed sleep and appetite changes.
Skin that suddenly can't tolerate moisturisers it used to.

What tends to point towards eczema:

Itch is the main sensation, with patches in the usual places, such as the creases of the elbows and knees, neck and hands.
Patches that flare, settle and clear, with periods of remission, and flares that link to a trigger.
Symptoms limited to the skin itself, such as discomfort, disturbed sleep and self-consciousness.

Worth knowing:

Redness can look pink, red or purple, or show as a darkening of your natural skin tone, so don't rule TSW out because your skin doesn't look "red".
There's no test for TSW. It's recognised from your history and how your skin behaves over time, and even the MHRA acknowledges these reactions can be hard to tell apart from the original condition.
Other things can look similar, including allergy to an ingredient in a cream (patch testing can identify this), infection, or eczema that is simply severe.
TSW isn't only for people with eczema. It has been reported after steroids used for acne or skin lightening, after oral or injected steroids, and in carers who apply steroid creams to someone else without washing their hands afterwards.
Get medical help promptly if your skin looks infected, for example weeping yellow crusts, fever, or painful clusters of blisters. Open skin is vulnerable to infection.

If this sounds familiar: write down every steroid you've used, including creams, ointments, inhalers, nasal sprays and tablets, with dates, strengths and the areas treated. ITSAN points out that doctors often don't have the full picture, and this record can help. ITSAN also maintains a collection of medical resources to share with your doctor, including a downloadable Doctor's Guide to TSW, the MHRA review, and published studies, so you don't have to build the case alone.

Every Person's Skin Is Different

If there's one consistent message from ITSAN's community of thousands of people going through TSW, it's that there's no single product or routine that works for everyone. Some people can't tolerate anything on their skin at all, especially during a flare, and that's completely normal, not something you're doing wrong. If a moisturiser helps, use it. If it doesn't, or it makes things worse, stop. Introduce one new thing at a time and patch test first. TSW skin can accept something for weeks and then suddenly react to it.

Why Simple Ingredients Tend to Be Better Tolerated

ITSAN's research into what their community finds helpful points consistently towards simple, short-ingredient balms and oils. Shea butter, jojoba oil, coconut oil, olive oil and zinc oxide all feature. That's the category our products sit in.

If your skin is rejecting almost everything, our Pure Baby Balm is worth knowing about. It's made from just three ingredients (shea butter, sunflower oil and vitamin E), it's unfragranced, and it's free from declarable allergens.

Beyond that, some of our customers going through TSW tell us they've found comfort with our Unfragranced Beauty Balm, Calendula and Marshmallow Balm and Zinc and Calendula Cream. We're not claiming these help TSW. Nobody can honestly claim that for any product. Their simplicity is simply the kind of thing worth trying, cautiously, one at a time.

A few things to know first:

Choose unfragranced. Essential oils are active plant compounds, and TSW skin is often hypersensitive.
Calendula: our calendula products aren't suitable for anyone with a known sensitivity to the daisy family, and should be patch tested first like everything else.
Broken, oozing or open skin: our products contain no antimicrobial preservatives, which is a benefit for irritation, but it means extra care is needed if skin is broken or infection is suspected. That needs a doctor's eye, not a skincare product.

Cleansing

If you use our Oil Cleansing Method, one adjustment matters for TSW. Use cool or lukewarm water, not hot. Many people find heat aggravates burning and itching, though a few find it soothing, so listen to your own skin. A gentle wipe with a soft, damp cloth is enough.

One Person's Journey

Ruth Holroyd, a long-standing allergy and eczema advocate and judge for the FreeFrom Skincare Awards, wrote about her own experience of TSW on our blog, including how she found her way to using our unfragranced calendula balms during her recovery. It's an honest, detailed account: Topical Steroid Withdrawal and Skincare: Ruth's Story.

Finding Support

TSW affects far more than the skin. It's exhausting, isolating and hard on mental health. ITSAN's Facebook support community connects you with thousands of people who understand, and their Coping with TSW guide covers itch, sleep and day-to-day advice in far more depth than we can here. If you're feeling low or overwhelmed, please reach out to a doctor or counsellor. That support matters as much as anything you put on your skin.