Topical Steroid Withdrawal

Whether you've heard of it referred to as topical steroid addiction, steroid dermatitis or red skin syndrome, the anecdotal evidence for this condition is overwhelming. You only need to flick through the #TSW hashtag on Instagram or do a quick google search to see pictures and headlines shared by people suffering from this painful condition.  

What are Topical Steroids? 

Topical corticosteroids are a type of steroid medicine applied directly to the skin intended to reduce inflammation and irritation. Usually prescribed as a cream, gel, lotion or ointment, they remain one of the most widely used topical drugs of the past fifty years. Mild corticosteroids, in the form of hydrocortisone, can often be bought over the counter at your local pharmacy. However, stronger forms are usually available on prescription. If you're battling psoriasis, eczema or dermatitis, chances are your doctor will have offered you a steroid cream at some stage of your treatment. 

Initially such a simple, topical application can seem very tempting. After all, wouldn't we love to massage something into our skin that's purportedly going to take the pain, itching and redness away fast? Unfortunately steroid creams do not work for everyone and, as with many other medicines, they tend to come with a myriad of potential side effects. If they do work successfully, it's also important to consider how they work. Unfortunately steroid creams are not designed to treat the underlying root cause of a skin complaint. Instead these creams suppress what we see on the skin's surface, but as soon as we stop using them, the condition can flare back twice as badly.   

Acknowledging Topical Steroid Withdrawal

First described in a dermatology journal in 1979, Topical Steroid Withdrawal is now recognised by a number of dermatological associations. Last month marked a significant statement from the National Eczema Society and British Association of Dermatologists. These respected organisations issued a joint position report on Topical Steroid Withdrawal and here's what they said. If you think you're suffering from TSW, you might also like to connect with a support network known as ITSAN. They aim to raise awareness of the condition and can offer valuable resources.

For me, the most powerful part of the joint statement issued by the BAD and Eczema Society is section 5, which states that 'Concern over the use of TCS leads some people to try to manage their eczema without them. At first, the eczema is likely to get worse, but some people find that after a while it settles and can be managed with simple emollients or non-pharmacological therapies, and by making lifestyle changes to minimise triggers like stress.' It's such a positive to see non-pharma and lifestyle changes recommended by such powerful organisations. 

What are the Other Side Effects of Steroid Creams?

Topical Steroid Withdrawal is just one of the many side effects associated with ceasing the use of steroid creams. Skin thinning, bruising, stretch marks, spots, prominent blood vessels and localised hair growth are some of the other most commonly reported adverse effects. 

In addition, extra care should be taken using medicated lotions around areas such as beneath the eyes or on the eyelids, where prolonged use can in some cases lead to glaucoma or cataracts. If topical steroids are massaged in to large areas of the skin or applied for an extended period of time, there is a risk of absorption into the bloodstream. This can lead to further complications including raised blood sugar levels and blood pressure problems. 

How to Come off Steroid Treatments

My advice would be to wean off steroid treatments slowly. When people come to me keen to make holistic changes, there can be a very real temptation to instantly ditch their cupboard full of pharmaceuticals in favour of a natural approach. It doesn't have to be this drastic, and transitioning gradually whilst implementing positive lifestyle changes can actually reduce the chances of Topical Steroid Withdrawal. 

TSW tends to arise as the result of prolonged, frequent, and inappropriate use of moderate to high potency topical corticosteroids. The National Eczema Association recommends steroid creams should not be used continuously for longer than four weeks. Thereafter usage should be gradually tapered off to twice per week. If you're not sure how slowly or quickly to wean off your medicated cream, discuss your decision with a doctor or dermatologist who can help you decide on an appropriate plan.

Natural Alternatives to Steroid Creams

It might be that you're looking to wean off your corticosteroids using a natural alternative, or you might be wanting to avoid having to use steroid creams altogether. Choosing naturally soothing botanicals can help to alleviate the irritating symptoms of a chronic skin condition. Whilst you focus on long term healing from within.  

Chamomile

Designed to soothe irritated skin, chamomile can be effective when it comes to soothing insect bites, skin rashes and wounds. Commonly used in the natural treatment of psoriasis and eczema, it should always be patch tested as allergies are possible. 

A 1985 clinical trial in Germany found that chamomile was nearly as effective as 0.25-percent hydrocortisone cream, according to the University of Michigan Health System.

Rather than choosing a chamomile cream, which often contain petroleum and other potentially problematic ingredients, chamomile oil can be applied directly on to skin or used in the bath. You might alternatively like to make a compress by brewing chamomile tea and soaking a flannel to apply to the area affected. 

Skin Soothing Spray

A powerful combination of sunflower, ballon and blackcurrant oils, my natural Skin Soothing Spray is designed to offer relief from itchy and irritated skin. Store in the fridge for extra cooling power when applied. 

Oatmeal Bath Soak

Colloidal oatmeal baths can help relieve dry, itchy and irritated skin. You can buy colloidal oatmeal in health stores or online, or you can make your own soak using regular oatmeal in a recipe such as this one. Unless your child has an intolerance or allergy, oatmeal bath soaks can be an excellent option for soothing children's insect bites and eczema too. 

 

 

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