EVERYTHING YOU NEED TO KNOW ABOUT TOPICAL STEROID WITHDRAWAL (TSW) AND ECZEMA

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One of the most prevalent ways to treat eczema is with topical steroid creams. While topical steroids are rarely harmful, in rare situations, they might produce a painful condition known as topical steroid withdrawal (TSW)

This syndrome can arise in the weeks following the discontinuation of a topical steroid. A severe rash, edema, and other symptoms may result.

TSW is poorly understood. Researchers don't know what percentage of people get it or why certain people react this way to topical steroids.

What exactly is TSW?

Topical steroid creams are frequently used to treat eczema and other skin disorders because they can alleviate symptoms such as itching and scaling.

TSW is an uncommon reaction to discontinuing topical steroid treatments. It can cause a rash that is more severe and uncomfortable than the eczema it was meant to treat. This rash can occur on the skin as patches or lumps.

The majority of documented TSW instances occur in people with eczema; but, long-term use of topical steroid creams for another skin ailment may potentially contribute to TSW.

Some research suggests that patients who have previously used topical steroids to treat eczema are more likely to develop a severe and burning rash.

People who took topical steroids for other reasons, on the other hand, are more likely to develop a rash that is bumpy and includes nodules, similar to acne.

WHAT ARE THE SYMPTOMS OF TSW?

TSW can cause a variety of symptoms. Not everyone who has TSW will exhibit the same symptoms. Because the illness is so uncommon, there are no established diagnostic criteria.

The most common symptom is irritated skin that provides a stinging or burning sensation after discontinuing topical steroid usage. This rash, known as a "red sleeve," most usually appears on your arms or legs, but it can arise elsewhere on your body.

Other TSW symptoms include:

• loss of hair

• infection

• insomnia

• nerve pain

• weeping skin (eczema with pus-filled blisters)

• skin flaking or shedding

• peeling skin

• a spreading rash

• rough lumps beneath the skin

• swelling

• deep skin wrinkles

• a rash in previously unaffected parts of the body

• under-the-skin pus-filled lumps

• skin that is temperature sensitive

• chills

• fatigue

• depression

WHAT ARE THE RISK FACTORS FOR TSW?

Researchers are baffled as to why certain persons get TSW. The illness is uncommon, and additional research is needed to help dermatologists completely comprehend it. Using mid- or high-potency topical steroids for a year or more is the greatest risk factor for TSW.

Adult women who have used topical steroids on their face or vaginal area tend to be more prone to the illness.

HOW IS TSW DIAGNOSED?

TSW can be excruciatingly painful and upsetting. Unfortunately, this illness is quite unusual and might be difficult to detect. Eczema sufferers may have difficulty recognizing TSW from an eczema flare.

There are presently no tests available to diagnose TSW. A dermatologist will instead utilize your symptoms and medical history to determine the issue.

TSW could be your diagnosis if you:

• used topical corticosteroid creams for over a year

• ceased using topical steroid creams with in past few months

• have a scorching, stinging, or unpleasant rash

• have a rash in regions where you previously did not have eczema

• have a lot of redness and swelling on your arms or legs

HOW IS TSW TREATED?

TSW is extremely rare, and there is no accepted treatment. If you are diagnosed with TSW, your dermatologist will work with you to design a treatment plan. Among the possible treatments are:

• Stopping the use of steroid creams gradually: TSW can be managed by gradually discontinuing topical steroid creams.

• Stopping the usage of steroid creams immediately: Some physicians advise halting the use of steroid creams immediately to treat TSW.

• Taking oral corticosteroids: Taking oral corticosteroids for a few weeks will help your body acclimatize to the discontinuation of topical corticosteroids and lessen TSW symptoms.

• Making use of cold compresses: Cold compresses and other skin calming therapies may also be advised.

• Antibiotics use: TSW can raise the risk of infection. Antibiotics can help with risk management.

• Getting a Dupilumab injection: According to 2018 research, an injection of the medicine dupilumab can help lessen TSW symptoms.

CONCLUSION

TSW can induce symptoms that continue for weeks, months, or even years. People with the illness recover at varying rates and respond differently to treatments. Because the illness is so uncommon, there is no average healing duration or outlook.