In recent months, growing numbers of patients have come forward describing severe skin symptoms they believe are linked to long-term use of topical steroid creams, a reaction often referred to as Topical Steroid Withdrawal (TSW).
At the same time, doctors are not in agreement with next steps.
So where does that leave patients?
What is TSW?
Topical steroid creams have been a cornerstone of eczema treatment for decades. For most people, they are safe, effective, and can be life-changing.
However, a subset of patients report a different experience:
- Worsening redness and inflammation
- Skin that feels “burning” or hypersensitive
- Symptoms that don’t respond to standard treatment
Some describe cycles where symptoms return quickly after stopping steroids, or worsen despite continued use.
Currently, there is no universally agreed definition or diagnostic criteria for TSW. This makes it a challenging and sometimes controversial area of dermatology.
Why is there so much confusion?
There are two key reasons:
1. Overlap with eczema
Many symptoms reported in TSW e.g. redness, itching, flaking, also occur in severe eczema. This makes it difficult to distinguish between the two.
2. Lack of clear research and guidelines
While reactions to long-term steroid use are recognised, there is limited high-quality evidence defining who is at risk, how to diagnose it reliably and the best way to manage it. As a result, different clinicians may interpret the same symptoms in different ways.
The real issue: when patients don’t feel heard
One of the most consistent themes is not just the symptoms, but the experience of care.
Many patients report:
- Feeling dismissed or not believed
- Being prescribed repeated treatments without reassessment
- A lack of clear explanation when things aren’t improving
This can lead to frustration, anxiety, and loss of trust.
A more balanced approach to care
When skin conditions don’t behave as expected, the answer isn’t always to simply continue the same treatment.
A good dermatology assessment should include:
- A detailed review of treatment history
- Consideration of alternative diagnoses
- A clear explanation of risks and benefits of each option
- A plan that can be adjusted based on response
Importantly, this should be a collaborative process, where patients feel informed and involved. In an unhurried appointment where you are listened to.
What should you do if your skin isn’t improving?
If you’re concerned that your treatment isn’t working as expected, it’s worth booking a medical review.
This doesn’t necessarily mean stopping treatments, but it does mean:
- Re-evaluating what’s happening
- Exploring all appropriate options
- Making an individualised plan that suits your needs
What should I do next?
Topical steroid withdrawal remains an evolving and debated topic.
But one thing is clear:
When a condition isn’t improving, patients deserve more than repetition, they deserve careful assessment, clear communication, and a plan that makes sense for them.
If your skin isn’t responding the way it should, getting a second opinion can provide clarity, and often, reassurance.
Book your consultation with one of our experienced dermatologists.