This is the message I want you to understand: topical steroids are one of the most effective medications used to treat skin disease, and they have been used effectively for over three decades. There can be risks if these medicines are used incorrectly; however, their safety can be assured when a dermatologist or physician who is experienced and knowledgeable with their use does the prescribing. Ironically, not using a topical steroid when prescribed appropriately can create more problems than using it, as skin disease and itch can lead to attention deficits in school, poor sleep, and disruption of the entire family dynamic.
~ Dr. Kelly Cordoro
TSW (Topical Steroid Withdrawal) is a phrase used to describe the physiological symptoms that occur as a result of quitting steroids.
As a body withdraws from topical steroids, some of the expected symptoms can include itchy skin, weeping sores from pre-existing eczema, swelling of the eyelids and face, reddened skin, bruising, spreading of existing eczema, burning red skin, swollen lymph nodes, high fever and depression.
The whole idea of TSW is based around steroid addiction – that individuals are no longer seeing the same benefits from the steroids they once took and in many cases, their skin appears to be worsened after completing a cycle of steroids.
It is important to understand that severely red skin can result from the misuse or misappropriation of prescribed steroids.
TSW has received increased attention by bloggers in the last few years – spreading by means of sensationalism and unfounded fear. Advocates of TSW defend it as the safest alternative to treating steroid addiction but factually, it poses far greater risks than tapering topical steroids – in regards to the treatment of eczema.
While the jury is still out on what constitutes steroid addiction, there is no evidence to support that complete withdrawal, and the subsequent suffering, is necessary to remedy this situation. In fact, most health care officials are adamantly opposed to steroid withdrawal that is not medically supervised, citing the many health risks – yet the majority of people going through TSW are doing so based on self-diagnosis and without doctor intervention.
Several influential websites and bloggers advocate jumping right in to TSW and immediately withdrawing from all steroids – the most popular response being that “the experts recommend quitting cold turkey”.
Who are these “experts”? Most health-care professionals advise against topical steroid withdrawal altogether but even the doctor that coined the term for red skin syndrome (another term for topical steroid addiction), Dr. Marvin Rapaport, suggests that withdrawal is a highly involved process that should be supervised.
When Dr Rapaport was asked why some individuals weren’t healed after two years of TSW, despite short-term use of steroids, he spoke on behalf of those he successfully treated, stating “the 24-7 ordeal was managed by me with many different types of medication, different soaks, compresses, sun exposure advice at the right time, psychological support, serious medications, pain meds, and a host of other necessary interventions.”
TSW is immensely painful. It can last for years and there are cases where it simply doesn’t work. Can you imagine the psychological devastation of allowing yourself to suffer for years with the hope of a better tomorrow that never comes? Even more disturbing is that many parents are choosing TSW for their infant and small children – removing the one hope of treatment that can ease their suffering and pain.
As for the website Dr. Rapaport helped to launch? He has now distanced himself from it and insists that forum members “must stop giving medical advice – that is why I am not part of it anymore. I just take care of patients and cure them.”
Even when TSW is successful, it is a process that is extremely painful with many potential severe side effects. By completely withdrawing from steroids, a body is unable to meet the demands brought on by the untreated condition.
The following side effects may occur with topical steroid withdrawal:
Septicaemia – Studies show that more than 90% of eczema sufferers are affected by the Staphylococcus aureus bacteria – a staph infection known to cause boils and sores on the skin. A staph infection can lead to blood poisoning as a result of toxins released by the bacteria and create a potentially life-threatening infection. Many individuals with TSW will allow this bacteria to actively live and reproduce on their skin for months and years. Studies have shown insufficient amounts of microbe-fighting proteins in individuals with this bacterial skin condition. A Daily Mail article reports there are 102,000 cases of sepsis each year in Britain alone and it kills 37,000 people — more than breast, bowel and prostate cancer combined. A recent news article highlighted the story of a 9-month old girl who died of septicaemia from complications brought on by eczema that was untreated.
Erythroderma – This inflammatory skin disease is often self-diagnosed as red skin syndrome but may actually be due to eczema. It is an intense generalized redness of the skin and scaling of greater than 90% of the body’s surface that can result in a defective metabolism and life-threatening conditions, as documented in a 2009 published medical study.
Suicide – The Journal of Investigative Dermatology reports that adolescents with eczema were significantly more likely to report suicidal ideation than those who did not have eczema, based on data from a population-based study of more than 3,000 adolescents. TSW only intensifies the pain of an already brutal skin condition.
The closely related skin condition of psoriasis is said to cause an estimated 150 cases of suicide a year in the UK alone. How many more deaths can be attributed to severe eczema on a world-wide scale and especially when suffering is encouraged through the withdrawal of topical steroids?
Growth Suppression – While growth suppression is often cited as a reason for the avoidance of steroids, it should be noted that untreated, bacterially-infected skin often creates the perfect environment for stunted growth – as noted by Dr. Kelly Cordoro, a specialist in pediatric dermatology. Ironically, there is no evidence that the use of topical steroids causes growth suppression.
I have found that one of parents’ biggest concerns with steroid use is growth suppression. Ironically, growth suppression and failure to thrive can happen if a child with severe skin disease is under-treated. Eczema in particular is a long-term chronic skin condition that, if left untreated, can create high metabolic demands on the body, leading to poor weight gain and growth. In other words, a child’s body can’t keep up with the demands their condition puts on them.
~ Dr. Kelly Cordoro
There’s a myriad of other side effects worsened by topical steroid withdrawal, including severe depression, mental anguish, social withdrawal, self-confidence and impaired immunities – just to name a few.
Topical steroid withdrawal causes physical, emotional, mental and social devastation on an alarming scale.
Why do individuals still practice TSW? Steroid phobia likely accounts for the biggest reason. Also to blame are the improper dosage and usage of steroids. Many people still struggle to understand the differences in topical steroids and oral steroids (oral steroids being far more potent and capable of side effects) and still many confuse a topical steroid treatment with the type of steroids that athletes use to build muscle.
While some may be able to endure the suffering of withdrawal and see an improvement after many months or years, it still carries the highest risk of side-effects and causes the greatest amount of suffering. Children are especially at risk by TSW and with a lower pain threshold, they stand to suffer the most.
A Better Alternative to TSW
There is an easier way. The first step is to understand steroids and realize that topical steroids, when used correctly, are a gold standard treatment for eczema.
Dr. Cordoro states that “when used incorrectly, topical steroids do pose some risk of problematic side effects. These include atrophy or thinning of the skin, stretch marks, hypopigmentation (skin turns lighter), acne-like rashes and dermatitis. Infants are most at risk because they have a high body surface-to-mass ratio. These risks increase when high-potency agents are used on large surfaces of skin. However, these risks are rare.”
Dr. Richard Aron has created a treatment for eczema sufferers that is getting far better results than any other method known today. It carries the lowest risk of side-effects, rids the body of bacterial infection in a very quick manner, provides instant relief and promotes continued healing in a way that no other method currently is able to accomplish.
By mixing a combination of topical steroid, an antibiotic and a moisturizer, Dr. Aron is able to eliminate the majority of eczema, and the associated itching and scratching, in nearly all cases. The rebounds and flares normally associated with using steroids are minimized to the greatest degree. We invite you to learn more about Dr. Aron’s approach to eczema and the healing results. Visit Dr. Aron and schedule a consultation today.
Is TSW Sometimes Necessary?
A final argument posed by proponents of TSW is that withdrawal is necessary since all other attempts to heal have been exhausted and steroids are no longer effective. The immediate rebound and red skin post cycle must certainly indicate an addiction to steroids.
While we cannot speak for the many individuals still enduring the hardships of TSW, we can recognize the many TSW converts on Dr. Aron’s Facebook page and their stories give us some rather interesting insight into what’s happening.
The experiences are all similar. Most report hearing about the symptoms of topical steroid addiction – the red, oozing sores and bright red skin that returns after completing a cycle of steroids – and on reading that these symptoms indicate they’re addicted to steroids, they make the quick decision to become anti-steroid, as they still have not found relief from their condition. At this point, some will embark on a TSW journey and some contemplate doing it but never proceed.
Many of these individuals have written Dr. Aron and supplied photographs of severe eczema and some provide photographs of bright, red skin that most TSW advocates would immediately term as red skin syndrome. Dr. Aron’s Facebook page is full of such photographs.
At this point, we need to consider that red skin syndrome is said to be unable to be healed through the use of topical steroids – which is why so many choose to ultimately give up all topical steroids in the first place, right?
Then it is especially interesting to note that nearly every person with red skin syndrome is finding both relief and healing with Dr. Aron’s methods. There are testimonials of children with “red sleeves” from top to bottom and adults with full body redness – some as bright red as any severe sunburn you can imagine. All are seeing their skin become healthier than ever before – many noting a remarkable difference in just days.
Indeed, there are many converts from TSW to Dr. Aron – and more of these individuals are turning to Dr. Aron every day.
Dr. Aron’s method of treating eczema is far superior to TSW as it provides instant relief and the healing begins immediately. It also carries the lowest risk of any treatment. It seems unfortunate, but the evidence suggests that the pain and suffering most people are being subjected to during topical steroid withdrawal is simply not necessary in the majority of cases.
There is a better way.