Eczema vs. Topical Steroid Withdrawal

gemmamarieayurveda
Sep 21
8 min read

Updated: Nov 6

Sadly, many of us all know someone living with a difficult health condition.

And unfortunately, too many of us also know someone who’s suffered from the wrong use of pharmaceuticals.

One story close to my heart is a client, who experienced Topical Steroid Withdrawal (TSW) — an unrecognised but increasingly common condition.

"TSW, also known as Red Skin Syndrome, most often happens from either prolonged use of high potency topical steroids, using them on thinner skinned parts of your body such as your face, or using them incorrectly. We say mostly, but there are many cases of people getting TSW from a hydrocortisone (lowest potency cream). The risk is much higher in children who have much thinner and more delicate skin. They estimate now, that 12% of people who use steroids long-term (more that the four weeks) will go on to develop TSW."

“I would give anything to go back to having eczema. The damage and the pain that topical steroids have caused me internally and externally has been debilitating, emotionally traumatising and unable to recognise myself for long periods of time. If I knew that steroids could cause this much damage, I would never have taken my GP's advice. I want to use my story to encourage others to heal their body naturally without the use of pharmaceuticals," Says a Chikitsa client, Jordan.

TSW is a name given to an iatrogenic condition caused by the use of corticosteroids (and also protopics) on the skin. An iatrogenic condition is defined as an illness, condition or adverse reaction caused by a pharmaceutical treatment or medical intervention. Some may come from medical neglect, misuse, or ill advice, but they can also be caused even when following standard protocols.

Hydrocortisone 1%, 1.5% and 2.5% (a class 7 steroid – the weakest class available over the counter) was first approved by the FDA in 1953. They were only tested on skin for four weeks before approval and the NDA did not require extensive clinical trials so they were introduced based on small open clinical observations not long-term trials.

Clobetasol, which is a class 1 steroid, the highest potency available was approved by the FDA in 1968 before first being used in medical settings in 1978. Trial details for this are not publically available so there is no knowing how many people were in the clinical study or anything about the dose, duration or safety outcome for the trial. This was standard procedure for clinical trials prior to 2007, and yet, topical corticosteroids have never been retested for safety and adverse reactions in clinical trials since then.

“Doctors and dermatologists still work by the book, and I can understand, it’s all they know and have been taught, but at what point should they think – this treatment is causing more harm than good in some patients. Maybe the fact that it was approved in the sixties with no trial record should flag up a warning sign?” says Jordan.

What exactly happens to the body when TSW occurs?

Due to the suppression of the blood vessels to calm the inflammation, when stopping steroids, these open causing the skin to flush red. This, known as the first stage in the cycle can last anywhere between weeks and months and can happen over and over again. Patients describe it as feeling like their skin is on fire.

“I’d sleep with icepacks in bed to try and stop the burning. I didn’t know it was possible to constantly feel so hot externally but have my body quiver relentlessly due to being unable to regulate my temperature. Your body feels like it's covered in a million cuts. You can’t shower, walk or even lie down without pain or discomfort and it felt like my skin would tear with any movement”, says Jordan.

The second stage of the cycle is when the skin has become so thin it oozes plasma. This is really painful for patients and involves a lot of management as well as coming with a large and frequent risk of infection.

“My skin would just come off under my nails or from being rubbed with fabric. The open sores all over my body would weep and leak fluid – a smell and feeling that will forever haunt me. These patches would itch so relentlessly but you were rubbing what felt like raw flesh. It was torture. I would have to spray hypochlorous acid spray on to avoid infection (it felt like acid). I would gear myself up ready for a screaming fit post-spray. I would cover myself in sudacrem, but constantly having to peel the dried ooze and cream from when it got stuck to my clothing - it was painful and demoralising”, Jordan continues.

The third stage of the TSW cycle is the skin proliferation before the final stage which is re-modeling and the skin rebuilding itself. They say this is due to the fact that the steroids stop the skin cells from naturally turning over, this continues until the skin has caught back up. The problem with TSW is that even after the skin has gone full circle, the cycle can start again. Most often, the skin cycles between the first three stages over and over again, some patients rarely seeing the healed skin stage.

“The itching I can only describe as pure torture. Hours and hours a day, and you just can't stop, it's like being covered in fire ants 24/7. Some itch attacks could be 12+ hours long to the point my fingers and nails hurt as much as my body. The flaking was also relentless, with my face and arms being the worst. I had to hoover my house and bed multiple times a day. It was so demoralising to look and feel this way. I wouldn’t leave the house, I felt like I was trapped in a body that wasn't mine. I suffered multiple other symptoms such as hair loss, weight loss and insomnia. This condition does not just affect the skin, the steroids have done so much damage internally and externally and 2.5 years down the line, I am still flaring and still dealing with the damaged nerve itching", Jordan continues.

Some of the symptoms are extreme edema (swelling), elephant skin (hardening of the skin), collagen depletion, eye problems, swollen lymph nodes, hair loss, temperature dysregulation, hormone changes, insomnia, depleted energy, digestive issues, mental health problems and of course the excessive itching that they deal with on a daily basis.

Gaslighting from medical professionals

For people living with TSW they are often gas lit by the medical professionals who cease to admit that their reactions are caused by steroids. This leads to a patient-led community where people are using trial and error and the recommendation of others to try and heal. This in itself can be dangerous. Especially with the cocktail of supplements that patients are experimenting with all in an attempt to find some relief.

“This could have been preventable. People have known for a long time about the adverse reactions but the pharmaceutical industry puts profit over people, so nothing has ever been done”, say’s Jordan.

In 2017 a dermatology book edited by Dr Koushik Lahiri called ‘A Treatise on Topical Corticosteroids in Dermatology: Use, Misuse and Abuse’ was made available.

The book quotes:

“Topical steroid addiction was recognised about a decade after the introduction of the molecule. It is manifested as psychological distress due to continuous and unsupervised use … and rebound phenomenon occurring when the drug is stopped.”

“Known medically as Topical Corticosteroid Withdrawal (TCW), Topical Steroid Addiction (TSA) or Red Skin Syndrome – characterised by intense rebound erythema and burning after prolonged use of moderate-high potency steroids on the skin, especially on the face or genital area. TSA is defined as skin developing worse symptoms on withdrawal that before steroid use, often triggering repeat usage.”

Some doctors and dermatologists do know about the adverse reactions, yet, it is still prescribed without a thought to anyone with a skin condition with no interest or consideration to the root cause or the allergen or irritant that might be causing the initial rash or complaint.

Granted there are many medical professionals who are ignorant to it as they have never connected the dots. Others see it but will not change as they only preach what they have been taught rather than to look at their patient as an individual. Many refuse to believe the reaction is caused by the steroids they prescribed and often use the diagnosis, “worsening eczema”.

“I for one fell into the trap of convenience - how quickly a steroid cream could get rid of the issue. But although a steroid cream externally seemed to bring down the inflammation, numb the itching and clear up any sign of my eczema, this cream was slowly damaging my largest organ”,

--- Chikitsa client continues.

Healing the body naturally before turning to pharmaceuticals...

A holistic approach considers you as a whole person, not simply as a rash that can be instantly erased with a quick fix. It looks at your diet, lifestyle, emotional wellbeing, energy, sleep, stress, and mental state—seeking to understand where imbalance has developed within your body.

True holistic healing is not a shortcut. It requires patience, strength, and commitment. This is the way humans were always meant to heal. Yet today, our world is filled with challenges: toxins and chemicals in our homes, cleaning products, artificial fragrances, a food industry that promotes addictive ultra-processed products, pesticides sprayed on fresh produce, and even metals contaminating our water. While we cannot completely escape these influences, we can realign ourselves through conscious choices—nourishing the body with real food and cultivating a balanced lifestyle.

The importance of Ayurveda;

Ayurveda, one of the world’s oldest healing systems, focuses on addressing the root cause of illness, while also removing accumulated toxins and repairing cellular damage, including that which may arise from steroid use or other stressors. Central to Ayurveda is Agni (digestive fire), which has been revered for thousands of years as the foundation of health. In modern terms, this corresponds to what western medicine now calls the “gut microbiome.”

Unlike trendy “detoxes” such as juice cleanses or coffee enemas, Ayurveda is not a passing fad. It is a time-tested medical system, and it invites us to choose carefully and avoid extreme methods that may do more harm than good.

The power of Ayurveda lies in its ability to heal at a cellular level, bringing about side benefits rather than side effects. Over time, as your body comes back into alignment, you may notice improved energy, deeper sleep, better appetite, and a more stable mood—subtle yet powerful signs of restored balance. By strengthening Agni, Ayurveda gently releases toxins through the body’s natural pathways—stools, urine, and sweat—while enhancing nutrient absorption. This ensures that every tissue in the body receives what it needs for optimal function and vitality.

Currently there are very few proven ways to ease symptoms of TSW. For most patients, time is the biggest healer.

Although she has made significant progress, my client’s healing journey continues as she recovers from the lasting effects of steroid misuse. If her story resonates with you and you are navigating TSW, feeling isolated or dismissed by the conventional medical system, please know you’re not alone. We’re here to support you and help guide you in the right direction.

If you feel an Ayurvedic Consultation would support you please use this link to book with Gemma.