Dear Dermatologist,

Throughout your career, you will see many people with what you might call ‘severe eczema’ when in fact, what they really have is severely thin skin from topical steroid use, also known as Topical Steroid Withdrawal (TSW).

When we’ve visited you and mentioned TSW, you tend to dismiss it outright, almost implying it doesn’t exist.

Even when presented with evidence of thousands experiencing TSW, all with similar symptoms, you disregard it as a fabricated phenomenon.

After enduring TSW twice and eight years of intermittent research, I've realised why you discard the notion of TSW.

TSW isn’t a withdrawal; the name is misleading. Withdrawal from Topical Steroid Medication is akin to that of any other medication, lasting only a couple of weeks.

What we experience with TSW is actually what I’m calling “Thin Skin Syndrome.”

Extended use of topical steroids, ranging from weeks to years, causes our skin to become so thin that it can't tolerate the environment around us.

According to the International Journal of Pharmaceutics, corticosteroids (topical steroids) induce an antiproliferative effect in skin cells. This means that prolonged use slows down skin cell reproduction and even kills off our skin cells, leading to our skin regenerating slower than skin that has not come into contact with corticosteroids.

For this effect not to occur after a 7-day course of topical steroids, there needs to be a 6-12 week gap before another course can be used. This allows damaged skin to be replaced by renewed skin over approximately two skin cycles. A 2015 study by the International Journal of Pharmaceutics found that corticosteroids cause anti-proliferation through a combination of cytotoxic effects, cell cycle arrest, and apoptosis induction.

Simply put, cytotoxic effects refer to Topical Steroids poisoning our skin cells which damages them and ultimately kills them. Cell cycle arrest means that Topical Steroids halt skin cell reproduction. Finally, apoptosis induction means Topical Steroids cause our skin cells to die.

What does this mean for someone who has used Topical Steroids for an extended period of time?

Using Topical Steroids leads to skin cell death and cessation of reproduction. In contrast, undamaged skin goes through cycles every 3-6 weeks on average, with new cells replacing old ones.

Those with Topical Steroid Addiction or Withdrawal experience abnormal skin cycles which reproduce skin cells at lower and slower rates, overtime causing progressive thinning of their skin.

While recovery from TSW is possible over time, the extent of skin damage varies based on Topical Steroid potency and the amount used. Higher potency steroids lead to more severe damage, resulting in thinner skin and prolonged recovery. The same goes for the amount of Topical Steroids used (the more used, the more severe the damage) resulting in thinner skin and prolonged recovery.

Non-steroidal drugs that you often suggest to TSW patients mask inflammation rather than fixing the thin skin problem.

They also come with a long list of possible side effects that can severely impact our immune system. By taking these drugs, it’s not possible to know if my skin would be healing given the ‘band-aid’ effect, and for my future this is important to be aware of.

Without interventions like Cold Atmospheric Plasma Treatment, recovery can span from a couple of years to decades. The length of time is all dependent on the strength and amount of steroids applied to one's skin.

Currently, there's no way to measure skin thickness accurately. However, adopting measures such as eliminating environmental irritants, swimming in the ocean, avoiding allergens, providing topical nutrients to our skin cells and optimising nutrition can aid skin cell cycle normalisation and faster regeneration.

I appreciate that you have adopted this career path because you care about helping people. I’m sure you understand how much of an impact skin conditions can have on the lives of sufferers and you wish to see us gain some relief.

You’re our first line of support, and we need you. We need you to understand our condition better, and to help us cure this very preventable condition.

I hope this information can help you to provide a real difference to people like me.

Kind regards,

A TSW sufferer

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