If you’re in the middle of Topical Steroid Withdrawal (TSW), first of all—you’re not imagining things, and what you’re going through is incredibly real. For many, it’s one of the most physically and emotionally challenging experiences of their life. So if you’re just getting through each day, that’s already a huge accomplishment.
But if you’ve found yourself wondering,
“Why is my skin still flaring?”
“Is this TSW, or is my eczema back?”
“Shouldn’t things be improving by now?”
You’re not alone—and more importantly, you’re asking the right questions.
Because here’s something most people aren’t told: TSW and eczema are not the same thing. And they can absolutely happen at the same time.
Steroid Withdrawal Doesn’t Mean Your Eczema Is Gone
Let’s go back to the beginning.
Topical steroids are designed to suppress inflammation, which is why they’re often prescribed for eczema. They can reduce redness, itching, and swelling quickly—but they don’t cure eczema. Instead, they temporarily turn down the volume on your immune system’s response.
Eczema, or atopic dermatitis, is a chronic condition. It’s influenced by genetic factors, immune dysregulation, a damaged skin barrier, and environmental triggers. Steroids can hide the symptoms, but they don’t fix the root causes.
So what happens when you stop using steroids?
Two things may hit you at once:
- TSW begins—your body rebounds from the long-term suppression, causing intense symptoms like burning, redness, flaking, oozing, and swelling.
- Your eczema comes back—because the underlying condition was never resolved.
It’s a double hit. And it’s why many people are confused when they expect their skin to eventually improve during TSW, but instead it seems to keep flaring.
TSW Adds a Layer of Complexity to Eczema
Think of it like this:
Your original eczema is a small fire that’s been smouldering for years. Steroid creams throw a blanket over it—suppressing the smoke, but not putting it out.
Then one day, you remove the blanket (you stop steroids). And suddenly not only is the fire still there, but now it’s flaring bigger, with smoke, sparks, and even some collateral damage from the blanket itself—that’s TSW.
So when people say, “This is just TSW,” that might only be half the truth.
But How Can You Tell What’s What?
Honestly? It’s not easy to separate them—because the symptoms overlap.
Both eczema and TSW can cause:
- Red, inflamed skin
- Severe itching or burning
- Oozing or weeping
- Cracking, flaking, and peeling
- Pain, sensitivity, and emotional distress
And in many cases, they can feed off each other. For example, ongoing inflammation from eczema can worsen TSW symptoms, and the skin barrier damage from TSW can make eczema harder to manage.
What About the Skin Barrier?
If you’ve lived with eczema, you probably already had a compromised skin barrier before ever using steroids. This natural barrier is your skin’s first line of defence—keeping moisture in and irritants out. In eczema, this barrier is often genetically weaker and more prone to inflammation.
TSW can further disrupt this barrier, making your skin hypersensitive and slow to repair. But even after TSW symptoms settle, the underlying barrier weakness often remains. If it’s not supported through the right care and lifestyle strategies, flares can continue.A Holistic Path Forward
If you’re navigating the confusion between TSW and eczema, it’s important to work with a practitioner or clinic that understands both.
At our Eczema and Psoriasis Clinic, we often meet patients who think they’re only dealing with TSW—when in reality, there’s still underlying eczema that needs to be supported and managed long term.
That’s why our approach is holistic and individualised. We combine:
Acupuncture to regulate the nervous system and reduce inflammation
Herbal medicine to support internal imbalances and improve skin resilience
Skin barrier support using natural, gentle products suited for sensitive skin
Targeted dietary adjustments to identify foods that may be slowing down the healing process
Lifestyle education to help reduce stress and prevent flare-ups
We don’t rely on steroids or suppressive therapies. Instead, we support the skin’s ability to heal by treating the whole person—not just the symptoms.
Final Thoughts: It’s Not Either-Or
If your symptoms feel layered, confusing, or like they never end—it’s probably because they are layered. TSW doesn’t erase eczema. And eczema doesn’t disappear just because you’ve stopped steroids.
But this doesn’t mean healing is impossible.
It just means we need to zoom out, listen to your body, and support it on all levels—not just the surface.
Your skin might be saying:
“I’m not just reacting to the past—I’m still asking for support in the present.”
That message is worth listening to.
You’re not alone in this. And no matter where you are on your journey—whether you’re mid-TSW, struggling with long-standing eczema, or just starting to explore alternatives—there are ways forward. Real, gentle, lasting ways.
Because healing isn’t just about what you stop doing—it’s about what you start giving your skin, your body, and yourself.
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