Topical steroid withdrawal can happen after you stop the use of topical corticosteroids. Learn how you can reduce your chance of this condition and help ease your symptoms.

Topical steroid withdrawal syndrome (TSWS) can develop when you stop long-term or frequent use of topical corticosteroids, especially on sensitive skin areas.

It’s sometimes called “red skin syndrome” or “steroid cream addiction.”

Symptoms of TSWS may even be more severe than the original skin concern and can significantly impact quality of life.

Signs and symptoms of topical steroid withdrawal can include:

  • skin redness (erythema) or other color changes that spread beyond treated areas
  • swelling (edema) and puffiness
  • skin flaking, scaling, or peeling
  • papules (bumps) and pustules (blisters)
  • burning or stinging sensation
  • intense itching disrupting sleep and daily life
  • severe dryness, tightness, or sensitivity
  • pain and discomfort

In addition to physical symptoms, you may find that you feel affected emotionally and mentally. Possible effects can include:

  • insomnia
  • anxiety
  • depression
  • social withdrawal

  • Erythematoedematous TSWS: This involves widespread redness, heat, swelling, and burning.
  • Papulopustular TSWS: Characterized by bumps and pustules, typically on the face or trunk.

Key risk factors for TSWS include:

  • long-term or frequent topical steroid use
  • use of high-potency steroids
  • application to thin-skinned or sensitive areas (face, neck, genitals)
  • history of atopic dermatitis or chronic skin conditions
  • use in children

People of all genders can be affected. Some studies suggest a higher prevalence in women and certain age groups.

Diagnosis of TSWS may include:

  • a review of your medical history (duration, potency, and area of steroid use)
  • examination and discussion around the onset and pattern of symptoms after stopping steroids
  • exclusion of other skin conditions (eczema, contact dermatitis, infection)

Currently, there are no standardized diagnostic criteria for this condition. Diagnosis often relies on clinical judgment by your doctor.

Any information you can remember can help with your diagnosis. It may be helpful to keep a diary of notes when symptoms arise and take pictures of any skin changes.

Discontinuation

Discontinuation of topical steroids should be done under the guidance of a healthcare professional. You can do this either by:

  • complete cessation (“cold turkey”), where you stop right away
  • gradual tapering, where you slowly decrease the frequency or potency of your steroid

You should discuss each option with your doctor to determine which is the best for you.

Supportive care

Stopping topical steroids can be a big change for your body and skin. You can help prevent any side effects from stopping your medication by making sure your skin is additionally supported during the process.

Here are some things you can try:

  • moisturizing with gentle, fragrance-free emollients
  • cool compresses for relief
  • pain management (topical or oral, as advised)
  • prevention of skin infections: by being aware of the signs and by keeping areas of skin clean and protected. It may be necessary to use an antimicrobial emollient if you have breaks in your skin.
  • psychological support (counseling, peer groups): this can help give you emotional support and someone to talk to if you need.
  • emerging treatments (e.g., dupilumab injections) may help some individuals. Speak with a dermatologist who can advise if these may be suitable for you.

Recovery timeline

Recovery from TSWS will vary for each person, but typically follows this timeline:

  • Acute phase: Weeks to months of intense symptoms
  • Improvement phase: Symptoms gradually lessen (months)
  • Resolution phase: Full recovery can take 1 to 3+ years.

During this time, people may experience cycles of flares and improvement.

To reduce your chance of developing TSWS, you can try the following tips:

  • Use the lowest effective steroid potency for the shortest time.
  • Avoid long-term use on sensitive areas.
  • Discuss plans for discontinuation with a healthcare professional.
  • Recognize early warning signs and seek guidance promptly.

TSWS is a real, but often misunderstood, condition. Early recognition, proper support, and collaborative care are key to recovery. Recovery is possible, though it can take time.

Remember, you’re not alone. Seek out patient support groups and forums to find others going through the same thing. They may be able to share their experiences, which can help you on your way to recovery.

FAQ

Yes. TSWS is increasingly recognized by dermatology organizations and regulatory agencies, though it lacks standardized diagnostic criteria.

Recovery varies widely. Most people see improvement within months, but full recovery can take 1–3+ years.

Prevention focuses on using steroids as directed, avoiding long-term or high-potency use, and regular check-ins with a healthcare professional.

TSWS often causes new, more severe symptoms (burning, redness) beyond the original area and persists after stopping steroids, unlike typical eczema flares or short-term rebound.

No, never stop abruptly on your own. Talk with a healthcare professional about the best approach for you.

There is no single proven cure. Symptom management (moisturizers, infection prevention, psychological support) is key. Some people may benefit from newer therapies. A dermatologist can help advise you whether this is an option for you.

Yes, especially with prolonged or high-potency steroid use. TSWS in children is less common but does occur.

No. A rebound is a short-term flare of the original condition after stopping steroids. TSWS is a longer, more severe syndrome.

Oral steroids may provide temporary relief but can prolong withdrawal or cause dependency. If a doctor suggests this, they will monitor you closely.

You can look for dermatologists who treat eczema drug reactions, ask in support groups, or seek telemedicine with TSWS-experienced clinicians.