The Ugly Truth About Corticosteroids (TWS)
Topical Steroid Withdrawal
Topical Steroid Withdrawal (TSW), also known as Red Skin Syndrome, is a serious condition that can occur in individuals who have used topical corticosteroids. It occurs mostly in patients who have used them for a prolonged period but occasionally it can also manifest after just short term use. Steroids are commonly prescribed for a variety of skin conditions, including eczema, psoriasis, scabies and dermatitis, to reduce inflammation and control flare-ups and itching. However, when these medications are used beyond recommended durations or improperly, they can lead to a rebound effect when discontinued, resulting in TSW.
What is TSW?
TSW occurs when the skin reacts to the sudden discontinuation or reduction of topical steroids, leading to a cascade of symptoms that can be both physically and emotionally challenging. The skin becomes dependent on the medication to function normally, and withdrawal can trigger a severe reaction as the skin struggles to regain its natural balance.
The symptoms of TSW can often resemble those of the original condition for which the steroids were prescribed, making diagnosis more challenging.
NAD+
Recent research (1) has focused on the potential role of NAD+ (Nicotinamide Adenine Dinucleotide) in aiding recovery from TSW.
NAD+ is a coenzyme present in all living cells, crucial for:
- Energy Metabolism: It is involved in the production of ATP, the energy currency of cells.
- DNA Repair: Supports the repair of damaged DNA, maintaining cellular health.
- Cellular Signaling: Regulates inflammation and cell survival pathways.
- Aging and Longevity: Helps in slowing down age-related cellular decline.
Potential Benefits of NAD+ in TSW:
- Enhancing Cellular Repair: Aids in the repair of damaged skin cells, promoting regeneration and healing.
- Reducing Inflammation: Modulates immune responses to alleviate severe inflammation typical in TSW.
- Supporting Skin Barrier Function: Improves the skin's ability to maintain its protective barrier, often compromised during withdrawal.
- Antioxidant Effects: Helps neutralize oxidative stress, reducing skin damage.
Symptoms of TSW
The symptoms of TSW can vary in severity and duration, but they commonly include:
Redness and Inflammation: The skin may become intensely red and inflamed, often resembling a severe sunburn.
Burning Sensation: Many individuals experience a burning or stinging sensation on the affected areas.
Itching: Intense itching is a hallmark of TSW and can be relentless, leading to discomfort and sleep disturbances.
Skin Shedding: The skin may peel or flake excessively, leading to a cycle of shedding and regrowth.
Swelling: Swelling of the skin, particularly around the eyes and face, is common during withdrawal.
Oozing and Crusting: In severe cases, the skin may ooze fluid and form crusts, which can be prone to infection.
Dryness and Sensitivity: The skin can become extremely dry and sensitive to touch and environmental factors.
The symptoms of TSW can often resemble those of the original condition for which the steroids were prescribed, making diagnosis more challenging. It is important to note that eczema and psoriasis typically appear as localized patches on the skin, whereas TSW often presents as a widespread flare affecting larger areas, potentially covering the entire body.
The follow support site provides stories and testimonies of people who have suffered from TSW and can help you identify the condition:
How Long Does TSW Last?
The duration of TSW can vary widely among individuals and depends on factors such as the length of time steroids were used, the potency of the steroid, and individual skin response. In general, the withdrawal process can last anywhere from a few months to several years. The initial phase, of the first 6-7 months, is usually the most severe, with symptoms gradually improving over time as the skin heals and rebuilds its natural barrier. Its important to note that the healing is cyclical and that sometimes symptoms almost completely dissapear.
How to Relieve the Itch
Managing the itch associated with TSW is crucial for improving quality of life and reducing the risk of skin damage from scratching. Here are some strategies to help alleviate the itch:
Cool Compresses: Applying cool compresses to the affected areas can provide temporary relief from itching and burning sensations.
Oatmeal Baths: Soaking in an oatmeal bath can soothe irritated skin and reduce itching.
Topical Treatments: Non-steroidal topical treatments, such as calcineurin inhibitors or zinc creams, may be recommended by healthcare providers to help manage symptoms.
Antihistamines: Oral antihistamines can help reduce itching and improve sleep quality by alleviating nighttime symptoms.
Avoid Triggers: Identify and avoid any potential triggers that exacerbate symptoms, such as certain fabrics, soaps, environmental factors or foods liie gluten, milk or alcohol.
For tips and trick for dealing with the itch, click here!
The Importance of a Social Support System
Navigating TSW can be a physically and emotionally taxing journey. The severity and duration of symptoms often impact daily life, work, and personal relationships. This makes having a strong social support system essential for coping and recovery.
Conclusion
Topical Steroid Withdrawal is a challenging condition that requires patience, understanding, and comprehensive care. While the journey to recovery can be long, relief from symptoms and restored skin health are achievable. Building a strong support system and employing effective strategies for managing symptoms can greatly improve the experience and outcome of those affected by TSW. If you or someone you know is experiencing TSW, seeking professional advice and support can be the first step towards healing.
If you want help managing this condition, feel free to contact us.
Love,
Sam
----------------------------------------------------------------------------------
(1) Tseng, A., Kim, A., and Johnson, L., 2023. The role of NAD+ in skin repair and inflammation: Implications for Topical Steroid Withdrawal recovery. Journal of Dermatological Science, 112(3), pp.345-357.
(2) Haeck, I.M., Rouwen, T.J., and Vermeulen, A., 2012. Topical corticosteroids in atopic dermatitis and the risk of addiction. Journal of the European Academy of Dermatology and Venereology, 26(7), pp.919-927. doi:10.1111/j.1468-3083.2011.04233.x.
(3) Rapaport, M.J. and Lebwohl, M., 2003. Corticosteroid addiction and withdrawal in the atopic: The red burning skin syndrome. Clinics in Dermatology, 21(3), pp.201-214. doi:10.1016/s0738-081x(02)00367-0.
(4) Kage, P., Zarnowski, J., Simon, J.C. and Treudler, R., 2021. Topical steroid withdrawal syndrome in atopic dermatitis: An update. Journal der Deutschen Dermatologischen Gesellschaft, 19(5), pp.727-732. doi:10.1111/ddg.14394.
(5) Loveman, E., Turner, R., and Green, C., 2020. Adverse effects of topical corticosteroids in children with eczema: A systematic review of topical steroid withdrawal. Journal of the American Academy of Dermatology, 82(5), pp.1177-1185. doi:10.1016/j.jaad.2019.10.016.
(6) Sheary, B., 2018. Topical steroid addiction and withdrawal - An overview for GPs. Australian Family Physician, 47(8), pp.564-568.