TSW Healing Stages: All You Need to Know

Topical corticosteroid creams can successfully reduce inflammation and swelling; they are frequently used for eczema and other skin diseases. While these creams are easily accessible and reasonably priced, extended use may lead to a less well-known issue called Topical Steroid Withdrawal (TSW).


TSW is a complex illness. Therefore using strong steroids on sensitive regions like the face and neck might be especially concerning. Understanding the root cause and signs is essential to treating this body's response to topical steroids and making it through the TSW healing stages.
 
The following guide will walk you through TSW’s symptoms and the best solutions for healthier skin.

 

Understanding TSW (Topical Steroid)

 

Transitioning into our exploration of TSW, it is crucial to have a solid understanding of the conditions around this ailment. Being able to define the term will be essential to recognize any symptoms that could arise during this complex process.

 

Definition

 

Topical Steroid Withdrawal (TSW) is known as a medical condition that can occur when a person stops taking topical corticosteroids after a long period.


TSW is characterized by a range of symptoms brought on by the skin's steroid dependence. The skin may react with inflammation, redness, burning sensations, flaking, shedding, peeling, or spreading skin, and other painful symptoms if the medicine is suddenly stopped.


It is typically found in adults who have used moderate to high-strength steroids on sensitive regions such as the face and neck, although some cases are also spotted in children.

 

Topical Steroid Withdrawal Symptoms

 

TSW symptoms might differ greatly from person to person, and there are no predetermined criteria for their diagnosis. After stopping steroid medication, these symptoms usually show up a few days to weeks later.


TSW typically affects sensitive areas like the neck, face, groin, and underarms, often causing significant discomfort and pain. For effective treatment and recovery, it’s crucial to recognize TSW and its symptoms. Common symptoms include:

 

  • Raw skin: Oozing and flaky skin are the most frequent symptoms.
  • Redness and flushing: The skin may change from a rash to a flushed and burnt appearance, commonly spreading to previously unaffected regions.
  • Itching and burning: Most patients first experience itching, then a burning feeling.
  • Sleeve sign: A noticeable line of redness around the wrists or ankles.
  • Elephant wrinkles: Wrinkly, thick skin, especially around joints.
  • Other physical symptoms: Dry eyes, hair loss, nerve pain, extreme itching, and increased temperature sensitivity.
  • Psychological symptoms: Anxiety and depression, sleeplessness, exhaustion, mood swings, and weight issues.
 

What are The Causes of TSW? 

 

Several factors lead to TSW, and the main causes are extensive use, discontinuation, and steroid dependency. 


The primary cause of TSW syndrome is prolonged use of strong topical steroids, particularly for a duration of one year or more. Research indicates that most people with TSW have been using mid-to high-potency steroids on a regular basis for extended periods of time.


Additionally, when these steroids are abruptly stopped, especially when they are applied to sensitive areas like the face and neck, TSW often develops.
 
However, the underlying root of TSW is the skin's dependence on topical steroids. When used for an extended period, the skin may become dependent on steroids and irritated if they are suddenly stopped.


TSW symptoms typically appear a few days or weeks after treatment ends. Within just a few days, you may notice redness, itching, and a burning sensation on the affected skin. After about a week, these symptoms may intensify, leading to dry, flaky, or scaly skin and increased sensitivity. As the weeks progress, more severe symptoms can develop, including blistering, oozing, and crusting of the skin, along with systemic issues like fatigue and fever.
 
If you or someone you know is experiencing these symptoms, it's important to consult a healthcare professional for appropriate guidance and support. 

 

TSW Healing Stages

 

Now that you know what causes TSW and how this problematic reaction appears in your body, the next crucial piece of knowledge you need to know is about the healing topical steroid withdrawal stages.

Usually, there are 4 stages after your skin suffers from TSW.

 1. Inflammation

The skin's primary response to harmful stimuli is inflammation, which manifests as redness, warmth, discomfort, swelling, and fatigue. Furthermore, hives may appear in healing areas. As the skin strengthens, inflammation looks more like hives than large patches of red. This is why hives are usually seen as a sign of healing - signaling a big improvement from the inflammation you see at the start of withdrawal.

 

Among TSW healing stages, inflammation is often seen when the healing process first begins. If inflammation appears later, it might indicate a comeback, with increased blood flow supporting skin regeneration.

2. Exudation, Oozing, and Scab Formation

Among the stages of topical steroid withdrawal, exudation is the formation of pus after withdrawal, particularly when the skin has become dependent on topical steroids or when there is an infection.  Pus is a sign of the body’s response to infection or inflammation and is composed of dead white blood cells, bacteria, and tissue debris. Its presence indicates that the body is fighting off an infection, which can be harmful if not properly managed. Pus is made up of cellular proteins that oxidize when exposed to air, forming fibrous materials that eventually form crusts or scabs.
 
These shielding structures stop further bleeding by shielding the regenerating skin underneath. Restricting movement in these areas is essential to ensuring that scabs harden without being disturbed.

3. Proliferation and Flaking

During the proliferation stage, the skin starts to shed itself as the newly formed cells work to rebuild the basement membrane. This stage is vital to the healing process, even if it may not be visually appealing. Fresh layers are created underneath the outer layer of skin as skin cells migrate toward damaged regions.
 
Flaking is an indicator that skin regeneration is still happening. The skin may become rough in texture as the proliferation stage progressively fades, but it shows that the healing process is ongoing. So, be patient!
 
Flaking is a key sign that your skin is actively healing and regenerating. It might not look great, but it’s a positive sign that new, healthy skin is forming underneath. Patience is crucial during this stage to ensure complete and effective healing.  

4. Remodeling

​​During the last stage—the tissue remodeling phase, damaged areas contract and pull the skin taut, creating thin borders around the affected areas.
 
The formation of collagen during this phase supports the elasticity and durability recovery of the skin. The skin tone improves as the healing process continues, especially in places with natural folds like elbows and knees.
 

Topical Steroid Withdrawal Treatment

 

Here are the following ways to lessen the symptoms of Topical Steroid Withdrawal (TSW) and recover your skin faster and healthier.
 

See a doctor

With an understanding of the TSW healing stages, if you suspect your symptoms are similar to those of TSW symptoms, speak to a doctor immediately. Professionals can determine if your symptoms are a flare-up of psoriasis or eczema and guide you in gradually stopping using topical steroids.
 

Apply ice

To relieve pain and reduce inflammation, apply ice or cool compresses.
 

Use moisturizer

Use emollients and moisturizers to soothe and hydrate inflamed skin.
 

Antibiotics, if your skin becomes infected

It may be important to provide antibiotics if infection risks develop, especially with the papulopustular type of TSW.
 

Over-the-counter spot relief gel

Apply Phoilex's Active ReLeaf Spot Gel if you are looking for ReLeaf in certain spots. Designed especially for those with eczema, psoriasis, and TSW, this non-steroid solution deeply hydrates dry, irritated skin while soothing it.
 
With plant-based components reducing harsh texture and offering extreme hydration, it strengthens the skin barrier and moisturizes the skin to promote skin barrier resilience. The gel also relieves skin stress, giving it a holistic approach to your skin health as well. 
 
As you consider your skin treatment options, it’s beneficial to reflect on TSW healing stages and symptoms, as this knowledge can enhance your overall skin health approach. 
 

FAQ

Here's a closer look at some common questions people ask about TSW:
 

1. How long does TSW last?

Each person experiences Topical Steroid Withdrawal (TSW) at a different recovery pace. According to a study about Topical Corticosteroid Withdrawal featured in DermNet, before stopping the steroid, the skin often looks normal or near-normal, although patients with atopic dermatitis may experience itching or prurigo-like nodules. The onset of withdrawal after discontinuation can range from 48 hours to over 3 months.

 2. Who experiences a higher risk of TSW?

TSW (Topical Steroid Withdrawal) is reported more frequently in women, with approximately 80% of cases linked to cosmetic use of topical corticosteroids (TCS) on the face, as noted by Tan et al. However, it is unclear whether women are inherently more susceptible to TSW or if the higher incidence is due to the prevalent use of cosmetic steroids on the face. In studies examining inflammatory skin conditions, TSW affects males and females equally. 
 
The condition is uncommon in children under 3 years of age, accounting for only 0.3% of cases. The face and genital areas are most commonly affected, likely due to the higher permeability of the skin in these areas. Allergies, long-term continuous usage, and some steroid-content skin-lightening cosmetics in Asian and African countries raise the risk as well.
 

 

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