A few weeks ago I had a patient come to see me because she was experiencing red, inflamed skin on her cheeks and forehead that she was worried may be rosacea. As we went through her medical history as well as the products she was regularly using on her skin, I noted that she was applying a corticosteroid cream daily as a moisturizer and has been using it for a number of weeks. After a thorough assessment and images with the Observ520, I determined that the redness and irritation was most likely Topical Steroid Withdrawal.
What is Topical Steroid Withdrawal?
Topical Steroid Withdrawal occurs due to an elevation in blood nitric oxide levels. Nitric oxide widens your blood vessels, increasing blood flow to the skin causing the skin to appear red, itchy and irritated. Topical Steroid Withdrawal occurs when topical corticosteroids are inappropriately used or overused and then discontinued. The classic signs and symptoms tend to occur within days to weeks after discontinuation of the topical steroids.
Signs of Topical Steroid Withdrawal:
- Worsening of your rash and increased redness as your skin is no longer responding to topical steroids and other prescription topical treatments.
- Severe burning sensation of the skin. The redness and burning sensation are due to continuous vasodilation, which is often accompanied by intercellular and extracellular fluid retention.
- Skin is red, dry and crinkles easily. You may also start to see underlying blood vessels.
- Skin depigmentation or dark hyperpigmentation – seen as either white patches on the skin or dark brown/grey areas of the skin, commonly seen near the knees, elbows and on the face, but can occur anywhere topical steroids are used.
- Visible stretch marks on the skin (aka. atrophic striae) – these can look like stripes across the skin and they are a sign your skin is low in zinc and other minerals.
- Skin swelling – your skin can look puffy and swollen, and it can be tender to touch.
- Pimple-like bumps (papules), nodules and pustules – bumps appear and look like acne. Also known as ‘steroid acne’ or ‘pustular psoriasis’.
- Extensive wrinkling of skin (premature skin ageing) – some patients call this ‘elephant skin’.
- Loss/thinning of hair and/or loss of eyebrows – your hair may fall out in clumps. This is more common with long term use of topical steroids.
- Cracked skin – especially on the corners of the mouth, lips and hands.
- Frequent skin infections – requiring antibiotic treatment.
- Increased and persistent itch – the itching continues to get worse and there seems to be no relief in sight.
Preventing Topical Steroid Withdrawal:
- Explore alternatives
There are a number of natural products that can take the place of topical corticosteroid creams or ointments and while there may be times where steroids are your best option, it helps to have a few options to try first. Rather than just experimenting, I would highly recommend speaking with a Naturopathic Doctor with experience in skincare who can properly diagnose your concern and provide a plan tailored to your particular needs. This will also help to prevent wasting money and time on things that don’t work for you or may aggravate your concern. I have a number of products I recommend depending on the concern and the patient’s personal history: MediHoney, St Francis Herb Farm Red Clover Plus Salve, From the Meadow Chirpy Chickweed Cream.
- Don’t go cold turkey
While it may seem like a good idea to just stop the use of your topical corticosteroid, that may make you more vulnerable to Topical Steroid Withdrawal symptoms. Slowly cutting back on your applications is recommended. For example, decrease the strength of your steroid by mixing it with another cream or ointment and gradually reduce the frequency of applications over a period of about 6-8 weeks.
- Nourish your skin
As you discontinue steroid use, it is helpful to nourish your skin from the inside out. Because topical steroids cause hormonal imbalance within the skin, nutritional support can help to reduce the severity and duration of symptoms. Proper nutrition also reduces the risk of hair loss, eyebrow loss and premature wrinkling of the skin from topical steroid use. It also reduces the likelihood of the patient developing sensitivities to a variety of chemicals such as salicylates, preservatives, food additives, and MSG after steroid use.
During the gradual discontinuation of steroid use I often recommend dietary modifications to reduce inflammation throughout the body and to provide the skin with key nutrients that assist with cellular regeneration and metabolism. I also often recommend a customized supplement protocol to assist with liver detoxification and reduction of inflammation. This often includes a combination of magnesium, zinc, omega 3’s, choline, glycine and vitamin C.
To speed up the recovery of the skin and prevent the reoccurance of symptoms I recommend working with a Naturopathic Doctor to create a personalized protocol. To book a free 15 minute consultation with me at Connected Health and Skin or send me a message here.
Have a beautiful day!
I’m going through TSW and I want to make this process speed up as fast as possible.
Hi, unfortunately there is no fast or easy solution for TSW. I have seen it take 12-24 months to completely resolve in some more extreme cases. I strongly recommend that you consult with a professional to support you through the process as that can speed up the results.
Hi! Do you take in new patients? My son is going through TSW and would like a ND to takeover his medical condition replacing our GP. We live in Ajax, Ontario
Hi Christina,
I am accepting new patients at Connected Health & Skin. However, I never recommend that someone replace their medical doctor with a Naturopathic Doctor as each has limitations on what we are able to offer. It is best to have both on your healthcare team (ideally there would be collaboration but this isn’t always the case). Rather than replacing the GP, I find it best to add in the support of a Naturopathic Doctor and explore other avenues of care.
I’ve been using a corticosteroid for severe acne and it first cleared up,but when I tried to quite,after one week I got rashes all over the place where I applied it,it still responds well it again cleared up but only when I use it,how can I stop it how can I get rid of the existing rashes?pls help…
I would strongly recommend that you consult with a professional to help support you through the process of discontinuing the corticosteroids. The longer you use them the more challenging it may become to discontinue them without this reaction. I have found that in cases of topical steroid withdrawal the rashes and redness are often part of the process and the best we can do is alleviate the discomfort. Also, topical steroids can’t fully treat acne as all they do is reduce inflammation. I encourage you to speak with a dermatologist or qualified Naturopathic Doctor.
HI …i used topical steroids for about 8 months then went to a doc who gave me lower stength cream but due to some misunderstanding… i used clobetasol for 10 days then i went to doc so he gave me fluticanate( fluticasone propionate) which i used for 10 days then he gave a lower strenght cream which was clobetasone butyrate n told me to use it twice for 7 days n then once for the next 7 days then he asked me to stop them completely …it has been 7 days since my last appointment but i have used it 3 times in these 7 days because tiny bumps appear on my face when i dont apply it..so i thought that i should gradually taper the use rather than going cold turkey…please help me…i had a normal face…but these steroids ruined it all…i want my skin back pls help me please???
You may benefit from a more gradual taper protocol as well as further topical and internal support to ease the process.
Would taking a supplement of L. L-lysine inhibit the NO production and ease the redness?
It may. Though I have never been able to find any studies illustrating its effectiveness for this. I would definitely suggest putting a plan together with a Naturopathic Doctor with experience working with topical steroid withdrawal.
Hello, I was prescribed various TS over 9 months for a small rash on my face and not given proper guidance. After not being able to taper off and decreased effectiveness, I read about TSW online and with another doctor’s guidance I stopped them, began a course of doxycycline and metrogel, and three weeks in started a short course of prednisone to finally get rid of the rash and itch! I was wondering if there is any timeline for the hair loss to start and stop (if it’s going to happen)? I have also sent for a supplement called Skin Friend (am &pm) to help my skin recover! Thank you for all of the information!
Hi Angelina,
Unfortunately there is no standard timeline for hair loss associated with steroid use as it is variable depending on the person, the dose used and the duration. My recommendation would be to connect to a local Naturopath to help support the healing process from the inside out if possible.
All the best in the healing process and journey.
Hi Dr Newell, after much online research I believe my daughter has been suffering from TSW for many years now on and off. She has been using topical steroids, never more than 2 weeks at a time for almost 10 years now. I want to wean her off of the steroid creams in the most natural and gradual way possible so as not to disturb her social life (she is in grade 10). We live in Richmond Hill, Ontario. Do you know of any Naturopathic Doctors who have experience with TSW in the Richmond Hill Area or the GTA?
Hi,
I am so happy you reached out. I practice at Connected Health & Skin in Toronto and unfortunately I don’t know of any other practitioners with a ton of experience in this area.
We do offer virtual visits as well as in-person at Connected so encourage you to reach out – http://www.connectedhealthandskin.com