What is Topical Steroid Withdrawal Syndrome?
Topical steroids are often a first line of defense for treating the itching and inflammation associated with skin conditions like eczema and psoriasis. Patients like topical steroids because they work quickly, and doctors recommend them because they can count on them to effectively resolve bothersome symptoms.
Topical steroids work by suppressing the body’s production of inflammatory chemical messengers that prompt itching and inflammation in the skin. They also cause blood vessels in the skin to constrict, which reduces redness and swelling. When used to treat psoriasis, topical steroids also help normalize the skin’s cellular turnover process to reduce scaling and improve skin appearance.
“However, the challenge with topical steroids is that they come with potentially serious side effects. And, over time, they can stop working, which means patients need to increase their dose. As a frontline clinician, we definitely want to avoid that,” explains Dr. John Papastergiou, BScPhm, PhD, RPh and Assistant Professor at both the University of Toronto’s Leslie Dan Faculty of Pharmacy and the University of Waterloo’s School of Pharmacy.
Among the side effects associated with prolonged or inappropriate topical steroid use is thinning of the skin and shrinking of the skin’s sebaceous glands (which can lead to increased dryness and loss of elasticity). Changes in pigmentation, stretch marks and increased likelihood of bruising are potential side effects as well.
If a patient stops using topical steroids abruptly, they can experience Topical Steroid Withdrawal (TSW) Syndrome, which presents as a “rebound effect” and other withdrawal symptoms that can be very difficult to resolve.
A key symptom of TSW Syndrome is a worsening of the skin condition despite ongoing or increased use of topical steroids. Most patients experience a rebound effect of redness, burning, stinging, swelling, dryness, peeling, and intense itching that develops shortly after discontinuing steroid use. It is believed that overuse of topical steroids leads to changes in the skin’s structure and function, and that TSW Syndrome occurs once the skin becomes dependent on topical steroids.
The duration of TSW Syndrome varies from patient to patient and can range from weeks to months or even over a year. When a patient is diagnosed with TSW Syndrome, the first treatment step is generally discontinuing the use of topical steroids. Non-steroidal treatments may be recommended to manage eczema or psoriasis symptoms during this time. Doctors often suggest patients seek psychological support due to the impact that symptoms of TSW Syndrome can have on quality of life.
The good news is, TSW Syndrome can be avoided. If your doctor prescribes a topical steroid to relieve itching and inflammation, use it as directed. Most importantly, do not exceed the suggested application frequency. You can also eliminate the risk of TSW Syndrome completely by taking a steroid-free approach to managing eczema and psoriasis symptoms.
Phoilex takes a proven-effective, plant-based approach to managing skin affected by these conditions—without the use of steroids. Instead, our topical Active ReLeaf Spot Gel feature a proprietary Phyto-Active Blend™ of seven botanicals to provide the skin with powerful antioxidant and anti-inflammatory benefits that help restore balance to the skin.
Consider these clinical results for Phoilex Active ReLeaf Spot Gel:
- 83% of participants felt immediate relief after application
- More than 73% reported immediate relief upon application after the first week of use
- 93% noticed relief from the feeling of itchiness in just 2 weeks
- 93% of users felt itch- and irritation-free in the affected area for 4 hours after application
- 74% of participants saw an overall decline in flare-ups after using Active ReLeaf Spot Gel for 8 weeks
- 100% of participants said they would continue to use Phoilex in the future
Another Phoilex advantage is the products’ versatility, since they are designed to keep the skin calm during asymptomatic periods, and to quell symptoms during a flare-up. (Phoilex can also be used if you need extra relief between topical steroid doses.)
Phoilex understands that TSW Syndrome is a global problem, which is why we support the International Topical Steroid Awareness Network (ITSAN). This organization is taking on TSW Syndrome through education, advocacy and support, while providing a wonderful resource for patients who are concerned about the side effects of topical steroids, thinking about stopping them or living with TSW Syndrome.
We hope you’ll join us on our journey to provide effective, steroid-free relief for symptoms of eczema and psoriasis—without the worry of TSW Syndrome.
