What if some of your persistent skin inflammation isn't solely due to Topical Steroid Withdrawal?
TSW can involve intense redness, burning, itching and weeping. However, when symptoms persist or unexpectedly worsen, it's worth considering whether another condition is contributing to the inflammation.
Two areas I frequently consider in clinical practice are bacterial and fungal skin infections.
Staphylococcus aureus: Fuel for Inflammation?
Staphylococcus aureus is a bacterium commonly found on eczema-prone skin.
When the skin barrier becomes compromised, this bacterium can contribute to inflammation through the production of toxins known as superantigens, which stimulate immune activity.
This may aggravate itching, redness and skin damage.
Signs that warrant investigation include increasing pain, warmth, swelling, pustules and yellow crusting.
Malassezia: The Overlooked Yeast
If you're experiencing persistent inflammation around your face, scalp, ears or neck, Malassezia may be worth investigating.
This yeast naturally lives on our skin, but in some individuals it can trigger inflammatory immune responses.
Research has linked Malassezia to head and neck dermatitis, particularly in people with atopic eczema.
Not every red facial rash is TSW, and identifying coexisting conditions can help guide more targeted treatment.
What About Mould Exposure?
Environmental mould is another consideration, particularly for individuals with allergies, asthma or eczema.
Damp environments may aggravate existing inflammatory conditions, although research has not established mould as a cause of TSW.
A thorough clinical history, including environmental exposures and symptom patterns, can help determine whether further investigation is appropriate.
Why This Matters
Not every flare is necessarily caused by withdrawal alone.
TSW can coexist with bacterial infections, fungal dermatitis, allergic reactions and underlying eczema.
Identifying these additional conditions may help reduce unnecessary inflammation and improve symptom management.
My approach to TSW involves considering the skin microbiome, immune health, environmental exposures and other relevant factors to provide personalised support.
Feel free to book a FREE discovery call via the booking link to learn more.
Research & Further Reading
Head and Neck Dermatitis in Atopic Dermatitis: A Narrative Review.
Nakatsuji & Gallo (2019). The Role of Staphylococcus aureus in Atopic Dermatitis.
Shobnam et al. (2025). Topical Steroid Withdrawal Is a Targetable Excess of Mitochondrial NAD+.