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  • Writer's pictureImogen Tingay

Understanding the Differences: Eczema vs. Topical Steroid Withdrawal

Two of my favourite topics to talk about; Eczema and TSW. I’ll be honest, I’ve hated them both equally, especially when they were happening to me. But I now see them as a way to connect better with your body and take control of your health. While they share some similarities in symptoms and skin involvement and that you rarely experience TSW without experiencing Eczema first, it is crucial to understand their differences for accurate diagnosis (normally a diagnosis made by you at home) and appropriate treatment.


Eczema and Topical Steroid Withdrawal (TSW) are two distinct conditions that can affect the skin. While they share some similarities in symptoms and skin involvement, it is crucial to understand their differences for accurate diagnosis and appropriate treatment. I’ll attempt to highlight the characteristics, causes, symptom patterns, and durations of both eczema and TSW to shed light on their unique features and differences. By gaining a better understanding of these conditions, we can stop treating TSW like it is just severe eczema and get to the bottom of proper management.

 

Eczema: The Chronic Inflammatory Skin Condition


Firstly, let’s have a refresher of what eczema is. Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition characterized by redness, itching, dryness, and inflammation of the skin. It affects people of all ages, with many individuals developing symptoms during childhood. Eczema is believed to arise from a combination of genetic factors, immune system dysfunction, environmental triggers, and allergies. Bear in mind that these last two won’t cause eczema but will exacerbate it.


The symptoms of eczema can vary in severity, with periodic flare-ups and remissions. It commonly affects areas such as the face, hands, elbows, and knees, but it can occur on any part of the body. The skin barrier in individuals with eczema is compromised, allowing irritants and allergens to penetrate easily, triggering an immune response, and resulting in inflammation. Common triggers for eczema include dry weather, certain fabrics, soaps, detergents, stress, and food allergens. A dysfunctional immune system, whether caused by illness or poor gut health and gut inflammation can also make eczema symptoms worse.


Living with eczema can be challenging, as the constant itching and discomfort can impact one's quality of life. Additionally, the visible red, scaly patches may lead to self-consciousness and affect a person's self-esteem. Treatment for eczema focuses on managing symptoms, reducing inflammation, and improving the skin barrier. It often involves the use of moisturizers to keep the skin hydrated, topical corticosteroids to alleviate inflammation, topical calcineurin inhibitors (helps control stress response), and antihistamines to control itching. In severe cases, systemic medications like oral corticosteroids or immunosuppressants may be prescribed. Additionally, lifestyle changes like avoiding triggers, practicing good skincare habits, and maintaining a healthy diet can help manage eczema effectively.

 

Topical Steroid Withdrawal (TSW): A Consequence of Excessive Corticosteroid Use


Topical Steroid Withdrawal (TSW) is a condition that occurs as a result of prolonged or excessive use of topical corticosteroids to treat various skin conditions, including eczema. Corticosteroids are potent anti-inflammatory medications that can provide rapid relief for various skin issues. However, when used for an extended period, the body can become dependent on them, leading to a rebound effect upon discontinuation. This is a generalisation as some find they experience TSW even after a short usage, plus you can start to experience symptoms of TSW even whilst using the steroids. This was the case with me and happened when my body had adapted to the steroid’s potency, thus making it useless. I’d apply the creams in the morning and experience a couple of hours relief before symptoms severe inflammation would flare up.


TSW manifests as a severe and widespread flare-up of the skin, often beyond the original affected site. The symptoms include intense redness, burning, itching, and flaking of the skin. Individuals may also experience systemic symptoms such as fatigue, insomnia, mood changes, weight loss, immune dysfunction, swollen lymph nodes and many more. The severity and duration of TSW can vary depending on the strength and duration of prior topical corticosteroid use…..and also seemingly randomly.


The key difference between eczema and TSW lies in their causes and symptom patterns. Eczema is primarily an inflammatory skin condition triggered by various factors, while TSW is a consequence of prolonged corticosteroid use. Eczema follows a pattern of periodic flare-ups and remissions, typically localized to specific areas affected by the condition. In contrast, TSW presents as a widespread and severe flare-up that occurs upon discontinuing the use of topical corticosteroids.


Living with TSW can be extremely challenging, both physically and emotionally. The severe symptoms and the lack of immediate relief from corticosteroids can be distressing for individuals experiencing TSW. It is essential for those undergoing TSW to seek support to manage the condition effectively. I would recommend working with a healthcare professional however I know how difficult that is. If you can find a medical professional you understands TSW and can help support you in any way, I recommend keeping hold of them!


Treatment for TSW varies hugely on the individual but can involve the gradual tapering of topical corticosteroids under medical supervision or going ‘cold turkey’ which is what most people do, me included. In theory, this tapering process should be beneficial to avoid exacerbating withdrawal symptoms and allow the body to adjust gradually to reduced corticosteroid levels however most individuals don’t find that it makes much of a difference and TSW will be severe either way. Additionally, symptomatic relief measures such as moisturizers or no moisture treatment, wet wrap therapy to soothe the skin, promoting gut health and immune function, and supportive care for systemic symptoms such as supporting your natural cortisol cycle may be recommended. The healing process for TSW can be lengthy, ranging from several months to years, depending on the individual's situation.

 

In conclusion, eczema and Topical Steroid Withdrawal (TSW) are distinct skin conditions with different causes, symptom patterns, and durations. When managing these conditions, the focus has to be on the individual whilst bearing in mind the different mechanisms of the conditions. It is important to seek professional medical advice when you can for appropriate treatment strategies for both conditions. With the right guidance and management, individuals can hopefully find relief!


I hope you enjoyed this blog post! On another note and a definite personal plug, my bookings are now open and I am ready to go with seeing clients! I am officially a registered dietitian and am certified by the British Dietetic Association. For more information about wh

at conditions I treat, see my services page

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