How To Overcome Topical Steroid Withdrawal (TSW)/Red Skin Syndrome

By Dr. Chris Reynolds. M.B.,B.S.

INTRODUCTION

"Every time I see a doctor or dermatologist they don't know what I am talking about - they say steroids just thin the skin. The most recent derm who I was told was one of the best in Sydney started off by saying that TSW is a "load of s**t" and doesn't really exist. I was so upset when she told me to just go back on steroids."  Bev. Australia

Does that sound familiar? But many doctors, including dermatologists, don't believe there is such a thing as topical steroid withdrawal or "red skin syndrome"! 

"It's just the eczema playing up again. Let's try something a little stronger."

In other words, ALL the symptoms of TSW must be due to "eczema", NOT topical steroids (TS) or other similar drugs prescribed for this condition. If there's cracking, weeping, pain, infection etc. keep applying steroids and if it doesn't improve, we'll use a stronger, "more powerful" drug to keep the "eczema" under control. For example, cyclosporin, tacrolimus (Protopic - which should be avoided at all costs) and other potent drugs that not only suppress the immune system, sometimes severely, but cause marked atrophy (thinning) of the skin as well.

This is simply not true.

Most eczema sufferers outgrow the condition by the age of 20, so why do symptoms of the condition frequently persist, even into old age? 

Because the skin damage is caused by topical steroids, not eczema! I know this because I have successfully weaned numerous patients off TS in their 70's who were still being treated for "eczema"! But they didn't have eczema, because once they were weaned off TS using wheatgrass extract, their skin returned to normal.

Having helped numerous patients recover from TSW/RSS over the past 20 years or so, (View some examples) it seems that overuse/abuse of TS has been the prime cause of needless patient suffering since the early 1950's when they were first introduced. Ironically, these drugs revolutionised the treatment of numerous skin conditions and eased much suffering - but at the high price of skin atrophy or thinning. Damage occurs to the 'microcirculation' i.e. the tiny blood vessels and nerves that control the skin's blood flow. This then slows the healing process.  Also, pain-sensing nerve receptors (nociceptors) are confined mainly to the upper layers of the skin. As the skin gradually atrophies or thins out, these nerve endings are exposed which can result in severe pain.

Also, damage by TS to immune system cells in the upper layer of the skin further reduces the skin's ability to protect the body from infection by bacteria. 

So, the TS-dependent patient seems to have only two choices: 

1. Go 'cold turkey' and stop using TS, or, 
2. Continue using TS but suffer longer term consequences.

The first choice could take 3 to 5 years for recovery, but the suffering can be, and often is, severe. Or, continue with TS, endlessly thinning and damaging the structure and function of the skin, going from bad to worse and becoming increasingly dependent on these drugs.

But it's not just the skin that's adversely affected. There is a "whole body" effect as well because TS penetrate the skin which often results in long term damage to the immune system. In turn, this compromises one's ability to recover from TSW, and even when the skin has recovered, skin eruptions can continue for several years due to these "whole body" negative effects. View this article for more information. 

After continued TS use, "flares" or "rebound" effects can occur not long after ceasing the drugs. The reaction can be severe, distressful and difficult to control. Burning pain, weeping skin, constant itching, scratching, dryness, recurrent bacterial infections, patchy discoloration, disfigurement, cracking and tightening of the skin may occur. Urgent admission to hospital for treatment of blood-poisoning with intravenous antibiotics is not uncommon and the severe stress involved and unsightliness of one's skin can lead to adverse psychological effects such as depression.

In many cases, rebound "flares" come to control the patient's life who is often referred to as being "steroid-addicted", which I think is unfair. Instead, perhaps we should ask why these drugs were prescribed in the first place. After all, topical steroids are standard drugs for the treatment of eczema, both infantile and adult. (Please note, for infantile eczema I recommend wheatgrass extract INSTEAD of TS.) (See how wheatgrass can control infantile eczema without resorting to TS).