What is TSW (Topical Steroid Withdrawal)

TSW, or sometimes referred to Red Skin Syndrome, is a debilitating condition linked to the prolonged use, or sudden discontinuation, of topical steroid creams. It has recently been recognised as a medical condition, but it is complex and often difficult to diagnose due to its similarity to chronic eczema.

While it produces symptoms that resemble chronic eczema, they are often more severe than typical flares. TSW is characterised by painful burning, oozing, pus formation, extreme flaking, and shedding of the skin. In lighter skin tones, the well-known ‘red sleeve’ pattern may appear as bright or dull red patches. On darker skin tones, inflammation may look different - appearing purple, dark brown, grey, or even ashen — and redness may not be visible at all. In both cases, the skin can become thickened, raw, and extremely sensitive.

In some individuals, TSW can also trigger secondary complications, such as fungal rashes or widespread hyperpigmentation and hypopigmentation, where the skin heals with darker or lighter patches. Symptoms may appear suddenly and spread to areas of the body that were not previously affected by eczema, with recovery sometimes taking months or even years.