September 14, 2025

Lucy Nguyen

Irvine High School

12th Grade

According to the Cleveland Clinic, eczema affects upwards of 31 million people in the United States, making it one of the most common chronic skin conditions. This incurable form of dermatitis is characterized by dry and itchy, textured patches of skin that can range from mild red spots to more severe bleeding cracks. Together these symptoms weaken the skin barrier and can lower quality of life. As there is currently no cure for the chronic condition, people living with eczema turn to a variety of treatment options—one being topical steroids. 

Although a common condition, the widely used topical steroids that treat it come with a major risk factor. In the form of ointments and creams, steroidal medications can be applied directly to the skin of the affected area to reduce the dry, itchy feeling. While topical steroids have been a life-changing solution for many for over 40 years, in some cases, the prolonged use of topical steroids can cause a severe cluster of symptoms labeled as topical steroid withdrawal (TSW) as a result of the body’s growing dependence on the medication.

Corticosteroids are a classification of topical steroids frequently relied upon to treat the symptoms of eczema. According to the National Library of Medicine, they work by involving “anti-inflammatory, anti-mitotic, and immunosuppressive properties” (Maskey et al.). These chemical messengers start by inhibiting necessary regulatory proteins for the transcription of the genes that cause inflammation. Additionally, they constrict the blood vessels and block proteins that cause swelling and redness. Meanwhile, the anti-mitotic characteristic of corticosteroids works to target a key symptom of the condition—the thick, dry skin. By preventing cells from dividing, the reproduction rate of the outermost skin cells slows, resulting in a more typical, thinner layer of skin. 

Those with eczema also have a hyperactive immune system, causing their skin to be “overly stimulated by small allergens or irritants” (Nebraska Medicine). With these immunosuppressive medications, flare-ups and redness will be less easily triggered. Through these effective and fast-working properties, topical steroids have been able to help millions of people with eczema. However, with the repeated use of this treatment, there come risks—one being topical steroid withdrawal.

Before TSW, the body first becomes dependent on the medication, later leading to symptoms such as stinging sensations, fatigue, extremely flaky skin, and prevalent erythema, a condition where redness is caused by the dilation of the blood vessels. As topical steroids treat inflammation through the constriction of blood vessels, with TSW, vasodilation takes place, meaning the vessels widen, causing intense inflammation and a visible red color of the skin. Due to corticosteroid treatment plans typically consisting of a brief period of steroid use, usually a few weeks, followed by a dead period of no usage to avoid long-term side effects, this back-and-forth constriction and dilation causes hyperdilation of the blood vessels, contributing to the variety of symptoms in TSW. 

Furthermore, topical steroidal medications have been known to reduce “steroidogenesis of epidermal lipids such as ceramides, cholesterol, and fatty acids” (Maskey et al.), meaning that, while using treatment, the corticosteroids will produce the necessary organic compounds that regulate the skin barrier and keep it healthy. However, this means that during TSW, the body loses a major producer of these healthy lipids, causing it to lack the molecules it needs to keep the outer layer of skin resilient, intact, and hydrated, resulting in extremely dry skin, often much worse than the pre-treatment condition.

People with eczema who have begun treatment using steroids can often feel trapped, fearing that stopping treatment will result in a painful flare-up. As TSW is still being explored, there are currently no cures once it begins, causing affected people to experience extreme pain and reduced mobility that prevents them from living normal lives. For those experiencing or suspecting TSW, the National Eczema Society has recommended people start by seeing a qualified dermatologist, noting that many choose to stop the use of topical steroids altogether and wait out the symptoms. Additionally, as TSW is slowly gaining popularity, raising awareness and researching other eczema treatments are key to combatting this consuming condition. Many have been able to control their eczema through the use of holistic measures, diet changes, UV therapy, or other types of medications.

While TSW remains a huge risk of using topical steroids, it is still important to note that, with the right treatment plan and team of professionals, topical steroids can still be used as a successful option in minimizing the symptoms of eczema. With the research and strides made in the previous few years, many experts in the field have a hopeful outlook on the future of TSW and treatments for eczema, reassuring the millions of people living with the condition.