TSW

Topical Steroid Withdrawal

When corticosteroids that used to help stop working

For years, you used corticosteroid ointment for your eczema, and it worked reliably until suddenly it wasn't as effective as before, or until you decided to stop using it and your skin reacted much worse than you expected.

Severe burning, intense redness even in areas where you never had eczema, peeling, swelling. This condition is professionally referred to as topical steroid withdrawal (TSW), also known as "red skin syndrome."

Finally, it's being talked about openly

TSW is not new; it was first described in 1969, and in the 1970s, Japanese dermatologists began to refer to it as "steroid addiction." For years, however, it remained on the periphery of interest, mentioned only in isolated case reports, while patients experiencing it often met with distrust from their own doctors.

This has changed in recent years. The British drug agency MHRA formally recognized the existence of TSW reactions in September 2021, and in May 2024, it introduced mandatory labeling of the potency of corticosteroid preparations on the packaging, along with a warning about the risk of TSW with long-term use. Similar official recognition has gradually been issued by other organizations, including the American National Eczema Association, the Canadian Eczema Society of Canada, the British Association of Dermatologists, and the British National Eczema Society.

However, it is also important to be fair: consensus across the medical community is still not 100%, and some dermatologists (in one survey of British and Dutch doctors over 15%, in another survey of Australian dermatologists even 59%) still do not consider TSW to be a separate diagnosis distinct from an eczema flare-up. So, the discussion still has a long way to go, but it is certainly no longer true that doctors are silent on this topic.

What science says about it

• TSW is primarily described after prolonged use of medium to highly potent corticosteroid ointments – typically after approximately 6 months of regular use in adults, and after 2 months in children.
• It most commonly affects more sensitive skin areas: according to one clinical analysis, over 99% of cases involve the face, neck, or intimate areas.
• In the adult population, TSW is described significantly more often in women than in men (around 81% of reported cases).
• Typical manifestations include intense redness, burning, peeling skin, swelling, and the so-called "red sleeve" – sharply demarcated redness of the arms ending at the wrist.
• Recovery time is highly individual – full recovery is reported in approximately 28% of adults, and 44% of children, with some individuals experiencing persistent problems for more than 5 years.
• Because there are no unified diagnostic criteria, TSW is sometimes confused with a flare-up of underlying eczema or contact allergy – therefore, it is crucial for a dermatologist to confirm the diagnosis.

What to do about it – and where the line of cosmetics is drawn

TSW is not something you should try to resolve on your own. Discontinuation or adjustment of corticosteroid treatment always belongs in the hands of a dermatologist, as incorrect procedures can worsen the condition. If you suspect your skin is going through this, the first step is always a professional consultation, not a change in home care.

It must also be stated frankly: in TSW, the exact opposite of intensive care is often recommended in practice, i.e., temporarily not applying anything to the skin at all, so that it can "learn" to regulate its own barrier and sebum production again, instead of continuing to rely on an external layer, whether it be steroids or cream. This approach (sometimes called moisturizer withdrawal) is indeed used in TSW, and it is a decision that should always be made by a dermatologist based on the patient's specific condition, not a cosmetic brand.

Bioidentical lipids from beef tallow could thus have their place during the period when the dermatologist recommends barrier restoration with regular care, not as a treatment for TSW, which they do not replace, but as support for skin barrier renewal.

If you are dealing with TSW: first consult a dermatologist about the next steps. As supportive care for barrier renewal in the meantime, you might consider Bohemian Balm.

Bohemian Balm is not a medicinal product, it does not treat or prevent TSW, and it does not replace medical care. We do not have a clinical study specifically on TSW – the recommendation is based on general skin barrier support, which the product has clinically verified for atopic eczema.

Sources: review of topical steroid withdrawal, StatPearls/NCBI 2024; MHRA Drug Safety Update, May 2024 and records from 2021; systematic review of topical steroid addiction and withdrawal, Frontiers in Allergy 2025; review of "Topical steroid withdrawal: dissecting the controversy", Frontiers in Medicine 2026; clinical data on TSW demographics and localization, Banner Health 2025; Swedish questionnaire study of TSW in atopic dermatitis, 2025.