TSW is an acronym that is gaining familiarity among the severe eczema sufferers. TSW or known as topical steroid withdrawal is the skin condition symptom when one stops applying steroids entirely after a history of depending on topical steroids for a prolonged period.
In the past few years, we are getting more questions from eczema sufferers who chose to stop dependency on steroids and hope to restore their skin to pre-steroids condition.
What are the stages of TSW?
There are several stages that your skin will go through during TSW:
- Burning and inflamed
- Oozing and crusting
- Dry and flaking
- Skin shedding
“During the TSW phases, the skin is generally sensitive to almost everything – heat, most chemical, external allergen and even slight rubbing”
Thus, before trying any new skincare to find relief, you should first do a patch test on normal skin to ensure that your skin can tolerate it. Unfortunately, sometimes even after a patch test, the skin undergoing TSW may still react to the skincare, but likely only during that specific phase. Once the phase is over, you may retry again.
Tips to relieve the burning skin sensation of TSW?
This is likely the most unbearable condition where you will feel like you’re under constant sunburn; burning, hot, inflamed and perhaps swelling as well (with intense itching). One of the best remedies is to apply a cold compress on the skin. You can wrap a soft towel over a cold pack from the freezer, and lightly press on the skin that is burning. Do not bathe with hot or warm water. The best is to bathe with room temperature or slightly cool water.
“No ointment or moisturizer seems to work to relieve the burning. Sometimes, after applying, it burns and itches even more!”
For most, the burning will lead to skin breaking due to thin skin from steroids side effect. Raw and broken skin will need to be treated as wound care. Do not apply any lotion or cream directly on raw skin. You may apply antiseptic that helps to relieve some pain like Germolene Antiseptic. In the pharmacy, there may be some sunburn gels that you may try, but do read the ingredients to ensure that there are minimal ingredients to prevent reaction.
How to protect raw and burning skin?
After applying a suitable antiseptic ointment, you should only apply a natural 100% pure oil like coconut or emu oil on the skin which will not sting. Plant based oil may feel greasy and aggravate the skin further sometimes. Emu oil mimics the skin the closest and with it’s anti-inflammatory properties, it can help relief the burning while giving it the necessary barrier protection and omega/vitamins to aid healing.
Do read the labels of the emu oil – only get the 100% pure emu oil without any added essential oil (some essential oil can aggravate raw skin). Some sufferers find coconut oil, jojoba oil non-stinging but very greasy.
Y-Not Natural pure emu oil has been tried and tested by many TSW sufferers and works for most to bring some relief during this stage. It is fast absorbing because it mimics closely to the human skin and not as greasy as other oil-based skincare. It has also the added benefit of reducing inflammation, and provides the essential Omega369 and vitamins for skin repair.
How to avoid infection during the oozing and crusting phase?
Bathing during the oozing and burning phase is a dreadful affair because of the stinging and pain sensation. Contact with water will also sting most sufferers during this stage. It is not advisable to rub or apply any cleanser directly during shower/bathe. You may use cleanser that can be diluted in a tub or pail and gently soak or pour over your body. Hospigel wash and Octenisan wash are common anti-bacterial wound cleanser that can be used. QV Flareup Bath Oil can also be used if the skin is not severely wounded but has cuts and scratches. Dermaveen Shower and Bath Oil can be used once the oozing stops and it is crusty and dry.
After cleansing/bath, you will need to apply antiseptic on the wounded/scratched skin. Argasol silver gel is a good antimicrobial antiseptic which will not dry the skin further. It is also anti-fungal and anti-bacterial. It can be used for long term, and thus suitable for eczema sufferers. Some TSW suffers use Sudocrem which contains zinc oxide that helps to dry the ooze but it can also cause the skin to be very dry.
What to apply when your skin is extremely dry and flaking
When the skin starts to flake, your bedsheet will likely be covered in a “snow” of dead skin that was shed off. In general, this is a sign that the burned skin is flaking off to make way for new skin that’s forming beneath. In order to allow the skin to naturally flake off without causing too much discomfort, you may apply a light shielding lotion like Gloves in a Bottle lotion.
If there is still wounded skin, or cracks, then an ointment based like the Emu Cream may be a better relief. Some sufferers try to go through moisturizer withdrawal as well i.e. not to apply any moisturizer at all. If applying any lotion/ointment stings and the dryness can be tolerated, it may be worth a try, to allow the skin to regular it’s own natural oil.
However, if you start to scratch more, causing damaged skin, you will need to apply a small amount of ointment/moisturizer to help the skin. Some simple ointment such as shea butter,
How long will my skin take to heal from topical steroid withdrawal?
TSW flareup duration varies from person to person depending on the history of usage of topical steroids and the potency of the steroids. In general, it can takes weeks to months. Some will flareup multiple cycles and not only one cycle.
Now, there are many resources and blogs of TSW sufferers who share their experiences. ITSAN (International Topical Steroid Awareness Network) is a nonprofit charity formed to raise awareness about the Topical Steroid Withdrawal Syndrome, also known as Red Skin Syndrome or Topical Steroid Addiction.
ITSAN has grown into a thriving world-wide online community where members comfort, share, and support one another. We would strongly recommend for any caregiver or TSW sufferer to read and find useful guides at ITSAN to help emotionally. It also offers many other suggestions on how to help relief the symptoms.
TSW Assist is another useful website which was started by a TSW sufferer who personally went through TSW. This site provides crowd-sourced recommendations for managing topical steroid withdrawal. Their goal is to empower the TSW community with data and solutions to manage their topical steroid withdrawal process. There are lists of recommendations on type of products, routines and therapies are provided by the feedback from the community on what works for them, and in times that there are so many suggestions and recommendations, you can use the chart/data to decide which one to try it out for yourself.
Have a question?
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[Note : The guide above is written by Bee, who is the founder of skinshare.sg, and she herself has gone through the TSW phase for 2 years]
Does TSW go in this order?
Once you are at the skin shedding does that mean you are through it ?
Burning and inflamed
Oozing and crusting
Dry and flaking
Skin shedding
Yes, generally it’s in this sequence as you mentioned above. Skin shedding is the final phase of a cycle where the top layer of skin is peeling off to make way for new skin below. You should try to protect the bottom new layer once it’s exposed. Also, this cycle may happen several rounds until the skin stabilizes. The duration of TSW depends on how long you have been applying steroids, and the potency of the ointment.