Severe Eczema? Or is it TSW...
Written by Laura Wheeler
If you’ve been living with chronic eczema, you know how relentless and life-disrupting it can be — the red, itchy, irritated skin that keeps you up at night, flares with the slightest trigger, and the overwhelming fatigue from trying countless treatments without lasting relief.
You may have been using topical or oral steroids to control the flare-ups, but they’re starting to lose their effectiveness. You notice your eczema is spreading to areas you never had it before, turning into a deep, burning flush with nerve pain and intense itching. Your skin may weep, swell, or become hot and hypersensitive to touch. The creams that once calmed things down now seem to make it worse — or stop working altogether.
Your worsening eczema may not be eczema at all…but Topical Steroid Withdrawal (TSW).
Topical Steroid Withdrawal (TSW), also known as Red Skin Syndrome, is a condition that may develop after discontinuing the use of topical or oral corticosteroids, particularly when these have been used frequently over an extended period of time.
The mechanism behind TSW
Topical corticosteroids reduce inflammation by suppressing the immune response in the skin. Prolonged or frequent use can cause the skin and body to become reliant on these medications.
When steroid treatment is stopped or reduced, the skin can experience a rebound effect characterized by intense inflammation. This occurs because the body’s natural ability to regulate immune responses and inflammation has been impaired.
Key factors involved include:
Hormonal suppression: Long-term steroid use can suppress the hypothalamic-pituitary-adrenal (HPA) axis, reducing the body’s natural production of cortisol. This suppression delays the skin’s ability to control inflammation effectively once steroids are withdrawn and may result in severe exhaustion and adrenal fatigue.
Immune system overactivation: With steroids removed, the immune system can become overactive, leading to widespread skin redness, swelling, and burning sensations.
Vascular changes: Steroid use can cause blood vessels in the skin to dilate excessively due to nitric oxide release. After stopping steroids, this results in persistent flushing, burning, and redness of the skin.
Nerve sensitization: Nerve endings in the skin may become hypersensitive, causing burning, stinging and nerve pain.
Skin barrier impairment: Chronic steroid use thins the skin and disrupts its protective barrier, increasing susceptibility to dryness, cracking, and infection.
These symptoms typically appear within days to weeks of reducing or stopping steroid use and can persist for several months or longer, depending on the duration and strength of previous treatment.
How Naturopathy Can Support TSW Recovery
Naturopathic care offers a holistic approach to TSW by addressing the deeper systems involved in skin repair, immune function, and inflammation regulation. Treatment plans are tailored individually, but may include:
Nutritional support to reduce systemic inflammation and promote skin barrier repair
Herbal medicine to calm the nervous system, balance cortisol, support the liver, and reduce infection
Gut health optimisation, including microbiome and digestive support to reduce systemic inflammation
Immune system regulation to reduce hypersensitivity to environmental triggers
Topical and lifestyle strategies to soothe and repair the skin without suppressing it
TSW recovery can be a long and emotionally taxing journey — but with the right support, it is possible to restore the skin barrier, reduce systemic inflammation and regain quality of life.
If you suspect you may be experiencing TSW, I invite you to book a free 15-minute discovery call to explore your symptoms and discuss whether naturopathic care may be the right path forward for you.