Table of ContentsView AllTable of ContentsSymptoms of Topical Steroid Withdrawal (TSW)What Are Examples of Topical Steroids?How Do I Know If I Have TSW?How Long Does TSW Last?TreatmentManagement and Coping StrategiesPrevention and Long-Term Outlook
Table of ContentsView All
View All
Table of Contents
Symptoms of Topical Steroid Withdrawal (TSW)
What Are Examples of Topical Steroids?
How Do I Know If I Have TSW?
How Long Does TSW Last?
Treatment
Management and Coping Strategies
Prevention and Long-Term Outlook
Topical steroid withdrawal (TSW) describes redness or discoloration and skin irritation that can occur after prolonged use of topical corticosteroids for skin conditions like eczema or psoriasis.
Also called steroid addiction or red skin syndrome,TSW remains a trending topic on social media.It’s controversial in the medical community, where some view it as a disease and others merely a myth.
Exactly how long it’s safe to use steroids on the skin depends on how strong (potent) the steroid is. As a general rule, the strongest topical steroids should not be used for more than three weeks in a row. Medium—to high-potency steroids can be used daily for up to 12 weeks.There’s no time limit for low-potency steroids,and these are unlikely to cause TSW.
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Symptoms of Topical Steroid Withdrawal
There are two main types of TSW:
Common signs and symptoms of TSW include:
Though these are associated with TSW, having them doesn’t necessarily mean you have TSW.
On the other hand, symptoms unique to TSW include:
Having either of these symptoms makes you more likely to have a confirmed case of TSW.
The general course of TSW involves different stages:
Keep in mind that the symptoms and severity of individual experiences can vary.Some people will have persistent symptoms that last for a long time, while others will experience flares alternating with periods of healthier skin.
Causes and Risk FactorsSome factors can predispose people to developing TSW. These include:Using medium or high-potency steroidsUsing steroids for at least 6 to 12 monthsUsing steroids inappropriately, such as cosmetically or without a prescriptionUsing steroids on the face or genitalsOf note, females are more likely to report symptoms of TSW.
Causes and Risk Factors
Some factors can predispose people to developing TSW. These include:Using medium or high-potency steroidsUsing steroids for at least 6 to 12 monthsUsing steroids inappropriately, such as cosmetically or without a prescriptionUsing steroids on the face or genitalsOf note, females are more likely to report symptoms of TSW.
Some factors can predispose people to developing TSW. These include:
Of note, females are more likely to report symptoms of TSW.
I Became Addicted to My Eczema Treatment
Topical steroidsare used to treat skin conditions like psoriasis and eczema.They are available in dosage forms such as:
Common topical steroids include:
Is Retinol a Topical Steroid?Retinolis another name for vitamin A. It’s classified as atopical retinoid, not a steroid.It’s commonly applied to the skin cosmetically to counter the signs of aging, such as wrinkles and dry skin.The side effects of retinol and related medicines are similar to the symptoms of TSW. The so-called “retinoid reaction” is common when people start using retinoids. It includes the following symptoms:ItchingRedness in people of light or medium skin tones and a deeper color than surrounding skin in darker skin tonesBurningSkin peeling
Is Retinol a Topical Steroid?
Retinolis another name for vitamin A. It’s classified as atopical retinoid, not a steroid.It’s commonly applied to the skin cosmetically to counter the signs of aging, such as wrinkles and dry skin.The side effects of retinol and related medicines are similar to the symptoms of TSW. The so-called “retinoid reaction” is common when people start using retinoids. It includes the following symptoms:ItchingRedness in people of light or medium skin tones and a deeper color than surrounding skin in darker skin tonesBurningSkin peeling
Retinolis another name for vitamin A. It’s classified as atopical retinoid, not a steroid.
It’s commonly applied to the skin cosmetically to counter the signs of aging, such as wrinkles and dry skin.
The side effects of retinol and related medicines are similar to the symptoms of TSW. The so-called “retinoid reaction” is common when people start using retinoids. It includes the following symptoms:
How Do I Know If I Have Topical Steroid Withdrawal?
Often, there’s no clear-cut diagnosis of TSW. It can be difficult to distinguish this condition from other things, like an exacerbation of a skin condition that was being treated with steroids.And unlike many conditions, there isn’t a specific set of criteria healthcare providers look for to consistently diagnose TSW.
If you or a loved one are experiencing symptoms consistent with TSW, seeking medical evaluation for an accurate diagnosis is very important. Your healthcare provider or adermatologistis the best resource to help you diagnose and treat this or any other skin condition.
How Long Does Steroid Withdrawal Last?
The little we know about the course of TSW comes from patient reports. These reports show that it may take months or even years for TSW to resolve fully.
More research is needed regarding the treatment of TSW. The available data is considered low quality.
Other treatment modalities for managing TSW include topical and systemic (acting on the whole body) therapies and supportive measures to alleviate symptoms and promote skin healing.
Pharmacological treatments that may provide a benefit, depending on your symptoms, include:
For optimal results, discuss your treatment regimen with your healthcare provider rather than self-treating your TSW symptoms.
Lifestyle modifications like the following may help with symptom relief and minimize the discomfort associated with TSW:
Skin disorders are often associated with a decline in self-esteem and mental health.
Coping mechanisms that can help chronic skin conditions include:
TSW is most likely to happen if you use strong topical steroids for an extended period or, in a way, they aren’t meant to be used.
To prevent TSW or reduce the risk of recurrence, consider these recommendations:
Summary
Topical steroids are a cornerstone of treatment for skin conditions like eczema and psoriasis. But keep in mind that these are strong medications, and they shouldn’t be used indefinitely.
Topical steroid withdrawal may occur in people who have used strong steroids for a prolonged period. Symptoms may vary and can include redness or discoloration, burning, and skin flaking. These symptoms can easily be confused with the worsening of an existing skin condition.
Treatment often consists of stopping or gradually decreasing the steroid, along with managing the symptoms. Lifestyle changes and social support are essential during the healing process, which can take months or even years.
If you are experiencing symptoms of TSW, remember that you’re not alone. Discuss your concerns with a healthcare provider who can help you develop a treatment plan.
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Brookes TS, Barlow R, Mohandas P, et al.Topical steroid withdrawal: an emerging clinical problem.Clin Exp Dermatol. 2023;48(9):1007-1011. doi:10.1093/ced/llad161Marshall HF, Leung DYM, Lack G, et al.Topical steroid withdrawal and atopic dermatitis.Ann Allergy Asthma Immunol. 2024;132(4):423-425. doi:10.1016/j.anai.2023.12.022Tan SY, Chandran NS, Choi EC.Steroid phobia: Is there a basis? A review of topical steroid safety, addiction and withdrawal.Clin Drug Investig. 2021;41(10):835-842. doi:10.1007/s40261-021-01072-zFinnegan P, Murphy M, O’Connor C.#corticophobia: a review on online misinformation related to topical steroids.Clin Exp Dermatol. 2023;48(2):112-115. doi:10.1093/ced/llac019Stacey SK, McEleney M.Topical corticosteroids: choice and application.Am Fam Physician. 2021;103(6):337-343.Sheary B.Topical corticosteroid addiction and withdrawal - an overview for GPs.Aust Fam Physician. 2016;45(6):386-388.Sheary B.Steroid withdrawal effects following long-term topical corticosteroid use.Dermatitis. 2018;29(4):213-218. doi:10.1097/DER.0000000000000387Hwang J, Lio PA.Topical corticosteroid withdrawal (‘steroid addiction’): an update of a systematic review.J Dermatolog Treat. 2022;33(3):1293-1298. doi:10.1080/09546634.2021.1882659Tan S, Phan P, Law JY, et al.Qualitative analysis of topical corticosteroid concerns, topical steroid addiction and withdrawal in dermatological patients.BMJ Open. 2022;12(3):e060867. doi:10.1136/bmjopen-2022-060867Zasada M, Budzisz E.Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments.Postepy Dermatol Alergol. 2019;36(4):392-397. doi:10.5114/ada.2019.87443Motamedi M, Chehade A, Sanghera R, et al.A clinician’s guide to topical retinoids.J Cutan Med Surg. 2022;26(1):71-78. doi:10.1177/12034754211035091Mukherjee S, Date A, Patravale V, et al.Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety.Clin Interv Aging. 2006;1(4):327-348. doi:10.2147/ciia.2006.1.4.327Pena J, Zameza PA, Pixley JN, et al.A comparison of topical corticosteroids and topical calcineurin inhibitors for the treatment of atopic dermatitis.J Allergy Clin Immunol Pract. 2023;11(5):1347-1359. doi:10.1016/j.jaip.2023.03.022Kowalewska B, Krajewska-Kułak E, Sobolewski M.The impact of stress-coping strategies and the severity of psoriasis on self-esteem, illness acceptance and life satisfaction.Dermatol Ther (Heidelb). 2022;12(2):529-543. doi:10.1007/s13555-021-00669-8Clarke EN, Norman P, Thompson AR.How does self-compassion help people adjust to chronic skin conditions? A template analysis study.Front Med (Lausanne). 2022;9:974816. doi:10.3389/fmed.2022.974816
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Brookes TS, Barlow R, Mohandas P, et al.Topical steroid withdrawal: an emerging clinical problem.Clin Exp Dermatol. 2023;48(9):1007-1011. doi:10.1093/ced/llad161Marshall HF, Leung DYM, Lack G, et al.Topical steroid withdrawal and atopic dermatitis.Ann Allergy Asthma Immunol. 2024;132(4):423-425. doi:10.1016/j.anai.2023.12.022Tan SY, Chandran NS, Choi EC.Steroid phobia: Is there a basis? A review of topical steroid safety, addiction and withdrawal.Clin Drug Investig. 2021;41(10):835-842. doi:10.1007/s40261-021-01072-zFinnegan P, Murphy M, O’Connor C.#corticophobia: a review on online misinformation related to topical steroids.Clin Exp Dermatol. 2023;48(2):112-115. doi:10.1093/ced/llac019Stacey SK, McEleney M.Topical corticosteroids: choice and application.Am Fam Physician. 2021;103(6):337-343.Sheary B.Topical corticosteroid addiction and withdrawal - an overview for GPs.Aust Fam Physician. 2016;45(6):386-388.Sheary B.Steroid withdrawal effects following long-term topical corticosteroid use.Dermatitis. 2018;29(4):213-218. doi:10.1097/DER.0000000000000387Hwang J, Lio PA.Topical corticosteroid withdrawal (‘steroid addiction’): an update of a systematic review.J Dermatolog Treat. 2022;33(3):1293-1298. doi:10.1080/09546634.2021.1882659Tan S, Phan P, Law JY, et al.Qualitative analysis of topical corticosteroid concerns, topical steroid addiction and withdrawal in dermatological patients.BMJ Open. 2022;12(3):e060867. doi:10.1136/bmjopen-2022-060867Zasada M, Budzisz E.Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments.Postepy Dermatol Alergol. 2019;36(4):392-397. doi:10.5114/ada.2019.87443Motamedi M, Chehade A, Sanghera R, et al.A clinician’s guide to topical retinoids.J Cutan Med Surg. 2022;26(1):71-78. doi:10.1177/12034754211035091Mukherjee S, Date A, Patravale V, et al.Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety.Clin Interv Aging. 2006;1(4):327-348. doi:10.2147/ciia.2006.1.4.327Pena J, Zameza PA, Pixley JN, et al.A comparison of topical corticosteroids and topical calcineurin inhibitors for the treatment of atopic dermatitis.J Allergy Clin Immunol Pract. 2023;11(5):1347-1359. doi:10.1016/j.jaip.2023.03.022Kowalewska B, Krajewska-Kułak E, Sobolewski M.The impact of stress-coping strategies and the severity of psoriasis on self-esteem, illness acceptance and life satisfaction.Dermatol Ther (Heidelb). 2022;12(2):529-543. doi:10.1007/s13555-021-00669-8Clarke EN, Norman P, Thompson AR.How does self-compassion help people adjust to chronic skin conditions? A template analysis study.Front Med (Lausanne). 2022;9:974816. doi:10.3389/fmed.2022.974816
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Brookes TS, Barlow R, Mohandas P, et al.Topical steroid withdrawal: an emerging clinical problem.Clin Exp Dermatol. 2023;48(9):1007-1011. doi:10.1093/ced/llad161Marshall HF, Leung DYM, Lack G, et al.Topical steroid withdrawal and atopic dermatitis.Ann Allergy Asthma Immunol. 2024;132(4):423-425. doi:10.1016/j.anai.2023.12.022Tan SY, Chandran NS, Choi EC.Steroid phobia: Is there a basis? A review of topical steroid safety, addiction and withdrawal.Clin Drug Investig. 2021;41(10):835-842. doi:10.1007/s40261-021-01072-zFinnegan P, Murphy M, O’Connor C.#corticophobia: a review on online misinformation related to topical steroids.Clin Exp Dermatol. 2023;48(2):112-115. doi:10.1093/ced/llac019Stacey SK, McEleney M.Topical corticosteroids: choice and application.Am Fam Physician. 2021;103(6):337-343.Sheary B.Topical corticosteroid addiction and withdrawal - an overview for GPs.Aust Fam Physician. 2016;45(6):386-388.Sheary B.Steroid withdrawal effects following long-term topical corticosteroid use.Dermatitis. 2018;29(4):213-218. doi:10.1097/DER.0000000000000387Hwang J, Lio PA.Topical corticosteroid withdrawal (‘steroid addiction’): an update of a systematic review.J Dermatolog Treat. 2022;33(3):1293-1298. doi:10.1080/09546634.2021.1882659Tan S, Phan P, Law JY, et al.Qualitative analysis of topical corticosteroid concerns, topical steroid addiction and withdrawal in dermatological patients.BMJ Open. 2022;12(3):e060867. doi:10.1136/bmjopen-2022-060867Zasada M, Budzisz E.Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments.Postepy Dermatol Alergol. 2019;36(4):392-397. doi:10.5114/ada.2019.87443Motamedi M, Chehade A, Sanghera R, et al.A clinician’s guide to topical retinoids.J Cutan Med Surg. 2022;26(1):71-78. doi:10.1177/12034754211035091Mukherjee S, Date A, Patravale V, et al.Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety.Clin Interv Aging. 2006;1(4):327-348. doi:10.2147/ciia.2006.1.4.327Pena J, Zameza PA, Pixley JN, et al.A comparison of topical corticosteroids and topical calcineurin inhibitors for the treatment of atopic dermatitis.J Allergy Clin Immunol Pract. 2023;11(5):1347-1359. doi:10.1016/j.jaip.2023.03.022Kowalewska B, Krajewska-Kułak E, Sobolewski M.The impact of stress-coping strategies and the severity of psoriasis on self-esteem, illness acceptance and life satisfaction.Dermatol Ther (Heidelb). 2022;12(2):529-543. doi:10.1007/s13555-021-00669-8Clarke EN, Norman P, Thompson AR.How does self-compassion help people adjust to chronic skin conditions? A template analysis study.Front Med (Lausanne). 2022;9:974816. doi:10.3389/fmed.2022.974816
Brookes TS, Barlow R, Mohandas P, et al.Topical steroid withdrawal: an emerging clinical problem.Clin Exp Dermatol. 2023;48(9):1007-1011. doi:10.1093/ced/llad161
Marshall HF, Leung DYM, Lack G, et al.Topical steroid withdrawal and atopic dermatitis.Ann Allergy Asthma Immunol. 2024;132(4):423-425. doi:10.1016/j.anai.2023.12.022
Tan SY, Chandran NS, Choi EC.Steroid phobia: Is there a basis? A review of topical steroid safety, addiction and withdrawal.Clin Drug Investig. 2021;41(10):835-842. doi:10.1007/s40261-021-01072-z
Finnegan P, Murphy M, O’Connor C.#corticophobia: a review on online misinformation related to topical steroids.Clin Exp Dermatol. 2023;48(2):112-115. doi:10.1093/ced/llac019
Stacey SK, McEleney M.Topical corticosteroids: choice and application.Am Fam Physician. 2021;103(6):337-343.
Sheary B.Topical corticosteroid addiction and withdrawal - an overview for GPs.Aust Fam Physician. 2016;45(6):386-388.
Sheary B.Steroid withdrawal effects following long-term topical corticosteroid use.Dermatitis. 2018;29(4):213-218. doi:10.1097/DER.0000000000000387
Hwang J, Lio PA.Topical corticosteroid withdrawal (‘steroid addiction’): an update of a systematic review.J Dermatolog Treat. 2022;33(3):1293-1298. doi:10.1080/09546634.2021.1882659
Tan S, Phan P, Law JY, et al.Qualitative analysis of topical corticosteroid concerns, topical steroid addiction and withdrawal in dermatological patients.BMJ Open. 2022;12(3):e060867. doi:10.1136/bmjopen-2022-060867
Zasada M, Budzisz E.Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments.Postepy Dermatol Alergol. 2019;36(4):392-397. doi:10.5114/ada.2019.87443
Motamedi M, Chehade A, Sanghera R, et al.A clinician’s guide to topical retinoids.J Cutan Med Surg. 2022;26(1):71-78. doi:10.1177/12034754211035091
Mukherjee S, Date A, Patravale V, et al.Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety.Clin Interv Aging. 2006;1(4):327-348. doi:10.2147/ciia.2006.1.4.327
Pena J, Zameza PA, Pixley JN, et al.A comparison of topical corticosteroids and topical calcineurin inhibitors for the treatment of atopic dermatitis.J Allergy Clin Immunol Pract. 2023;11(5):1347-1359. doi:10.1016/j.jaip.2023.03.022
Kowalewska B, Krajewska-Kułak E, Sobolewski M.The impact of stress-coping strategies and the severity of psoriasis on self-esteem, illness acceptance and life satisfaction.Dermatol Ther (Heidelb). 2022;12(2):529-543. doi:10.1007/s13555-021-00669-8
Clarke EN, Norman P, Thompson AR.How does self-compassion help people adjust to chronic skin conditions? A template analysis study.Front Med (Lausanne). 2022;9:974816. doi:10.3389/fmed.2022.974816
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