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How To Overcome Topical Steroid Withdrawal (TSW)/Red Skin Syndrome

by Dr. Chris Reynolds. M.B.,B.S.


"Every time I see a doctor or dermatologist they don't know what I am talking about - they say steroids just thin the skin. The most recent derm who I was told was one of the best in Sydney started off by saying that TSW is a "load of s**t" and doesn't really exist. I was so upset when she told me to just go back on steroids."  Bev. Australia

Does that sound familiar? But many doctors, including dermatologists, don't believe there is such a thing as topical steroid withdrawal or "red skin syndrome"! 

"It's just the eczema playing up again. Let's try something a little stronger."

In other words, ALL the symptoms of TSW must be due to "eczema", NOT topical steroids (TS) or other similar drugs prescribed for this condition. If there's cracking, weeping, pain, infection etc. keep applying steroids and if it doesn't improve, we'll use a stronger, "more powerful" drug to keep the "eczema" under control. For example, cyclosporin, tacrolimus (Protopic - which should be avoided at all costs) and other potent drugs that not only suppress the immune system, sometimes severely, but cause marked atrophy (thinning) of the skin as well.

This is simply not true.

Most eczema sufferers outgrow the condition by the age of 20, so why do symptoms of the condition frequently persist, even into old age? 

Because the skin damage is caused by topical steroids, not eczema! I know this because I have successfully weaned numerous patients off TS in their 70's who were still being treated for "eczema"! But they didn't have eczema, because once they were weaned off TS using wheatgrass extract, their skin returned to normal.

Having helped numerous patients recover from TSW/RSS over the past 20 years or so, (View some examples) it seems that overuse/abuse of TS has been the prime cause of needless patient suffering since the early 1950's when they were first introduced. Ironically, these drugs revolutionised the treatment of numerous skin conditions and eased much suffering - but at the high price of skin atrophy or thinning. Damage occurs to the 'microcirculation' i.e. the tiny blood vessels and nerves that control the skin's blood flow. This then slows the healing process.  Also, pain-sensing nerve receptors (nociceptors) are confined mainly to the upper layers of the skin. As the skin gradually atrophies or thins out, these nerve endings are exposed which can result in severe pain.

Also, damage by TS to immune system cells in the upper layer of the skin further reduces the skin's ability to protect the body from infection by bacteria. 

So, the TS-dependent patient seems to have only two choices: 

1. Go 'cold turkey' and stop using TS, or, 
2. C
ontinue using TS but suffer longer term consequences.

The first choice could take 3 to 5 years for recovery, but the suffering can be, and often is, severe. Or, continue with TS, endlessly thinning and damaging the structure and function of the skin, going from bad to worse and becoming increasingly dependent on these drugs.

But it's not just the skin that's adversely affected. There is a "whole body" effect as well because TS penetrate the skin which often results in long term damage to the immune system. In turn, this compromises one's ability to recover from TSW, and even when the skin has recovered, skin eruptions can continue for several years due to these "whole body" negative effects. View this article for more information.

After continued TS use, "flares" or "rebound" effects can occur not long after ceasing the drugs. The reaction can be severe, distressful and difficult to control. Burning pain, weeping skin, constant itching, scratching, dryness, recurrent bacterial infections, patchy discoloration, disfigurement, cracking and tightening of the skin may occur. Urgent admission to hospital for treatment of blood-poisoning with intravenous antibiotics is not uncommon and the severe stress involved and unsightliness of one's skin can lead to adverse psychological effects such as depression.

In many cases, rebound "flares" come to control the patient's life who is often referred to as being "steroid-addicted", which I think is unfair. Instead, perhaps we should ask why these drugs were prescribed in the first place. After all, topical steroids are standard drugs for the treatment of eczema, both infantile and adult. (Please note, for infantile eczema I recommend wheatgrass extract INSTEAD of TS.) (See how wheatgrass can control infantile eczema without resorting to TS)


Wheatgrass and other cereal grasses have been the subject of extensive clinical and laboratory research since the 1930's in the US and elsewhere. It has been proven highly successful for the treatment of burns, injuries, skin pathology, including TSW, and many other conditions.

The wheatgrass extract I recommend and use in clinical practice has worked well for numerous TSW patients since I began using it in 1995. It is derived from young wheatgrass sprouts at the stage of maximum therapeutical activity.

How does the extract help with TSW? It appear the bioactives in wheatgrass, which are known to be potent healing agents e.g. for wounds, burns, psoriasis etc. are able to "notify" the brain of the TS damaged skin. The brain then does what it can to effect repair. However, in TSW this is often severe, so it takes some time for repair to occur. 

Here are some examples demonstrating how quickly wheatgrass can heal damaged skin most likely by the process I've just described: 

  • Healing of diabetic foot ulcers 
  • Rapid skin graft healing
  • Second degree burn healing

    However, it is important to know that although wheatgrass can help you through TSW by reducing pain, burning and itching to some extent, its most important function is to stimulate new growth of skin cells and repair the skin's structure and functionality. But, with perseverance and applying a little wheatgrass extract once on alternate days your damaged skin will eventually recover, and considerably quicker than going 'cold turkey'. In most of my cases it has taken about 12 to 14 months. 

    The pictures below will give you some idea as to how effectively wheatgrass can heal TS-damaged skin. The patient, who had been using TS for 30 years had developed severe 'elephant skin' - a common "side effect" of TSW. In this case, her skin returned almost to normal in two months. You can see that the skin has become lax, with large, flaccid "folds" developing. 

    So, if wheatgrass can achieve this level of skin repair, there is no reason why it can't repair ALL TSW damage. So do your best to persevere. 

    But this is not a 'quick fix'. It takes time - around 6 to 12 months - sometimes longer - for new skin to appear and immunological "flares" can take even longer. But that's a lot better than the 4 to 5 years recovery time it takes if you go 'cold turkey'. Even so-called "irreversible damage" can be repaired. By comparison, because the skin structure and function has not been restored, 'cold turkey' patients may be left with permanent atrophy and associated skin dysfunction.



    My advice for parents of eczema-affected children is to avoid the use of topical steroids if at all possible. If the rash isn't too bad and the child is not bothered by it, don't use anything. Often the skin may look bad, but if it is not bothering your child, leave it alone. Avoid soap, baths (use a damp flannel for washing), and any other skin applications that might irritate the skin. And if you must "treat" your child, try to find an alternative, non-steroidal, natural remedy instead. Wheatgrass (preferably the skin spray) can work well for infantile eczema, but only use it once on alternate days. You can also use wheatgrass juice or grow your own wheatgrass and juice it in a blender. Numerous websites will show you how to do this.


    As with infantile eczema, the aim is to stimulate skin cell growth and repair and subsequent recovery. Apply wheatgrass extract once on alternate days to the TSW-affected areas. It is important not to over-treat. The whole point of using wheatgrass is to ensure that when you have overcome withdrawal, that your skin's reconstruction is complete. This can take 12 months or more, so try to be patient.

    Alternatively, you could try to locate a doctor to help you gradually reduce the amount of TS you're applying to your skin. I have used this method successfully many times. However, this is not easy due to rebound flares, which may require support from oral steroids from time to time, but if you reduce the dose gradually, it can work well. You should also keep a record of your treatment so you can follow your progress of TS reduction and show it to your doctor each time you visit the surgery. In the early stages it can be difficult to reduce even one application of TS, but if you persevere, you will eventually only need wheatgrass to keep your skin stable. Eventually, when your skin has "normalised" you will be able to dispense with the wheatgrass altogether. Also, only use very small amounts of TS and apply only to the very worst areas. We're only looking at "controlling" your symptoms as much as possible, not stopping them altogether. They will stop in due course. 

    Remember, it is your courage that will pull you through. You may go through hell and back, but your skin will gradually begin to show signs of healing. Try to look forward to the day when you are TS-FREE! Mark your calendar for 12 months and tick off the days. You may not be fully recovered by then, but you will be well on the way. You'll know it and will feel proud of yourself for having persevered.

    Remember, the aim may be to rid yourself of TS, but you want to have
    normal skin at the end of the ordeal. So try to see this 12 months as a transitional phase. It's okay to use TS sparingly from time to time if you're desperate, but do your utmost not to. Think how long you've suffered already. Every day without TS is another day towards an improved quality of life.

    If possible, combine the topical with daily oral antioxidant-rich wheatgrass extract (e.g. wheatgrass shots, or wheatgrass juice). This can help repair and maintain a damaged immune system caused by topical and/or oral steroids. 

    Finally, try not to use any applications on your TS-affected skin other than wheatgrass and water, at least on the days you apply it. Because your skin's immune status has been highly compromised your skin is most likely sensitised to ANY kind of application. e.g. soap, coconut and other oils, cosmetics, shampoo - almost anything. The fewer substances you apply, the more likely your skin will recover sooner. (View this excellent example) I have learned this over the years from my patients who have experimented with wheatgrass and found that when they stopped using all topicals other than wheatgrass, improvement in their skin recovery accelerated.

    Please watch this video  on how to get maximum benefit from taking wheatgrass. 

    Finally, try to avoid soap. It denies your skin the natural oils that help keep it moist. Also, reduce hot water exposure, it dries your skin by removing sebum, the oily natural moisturiser essential for normal skin function. Take 5 minute (warm if necessary) showers and NO BATHS.


    Probably the most efficient and rapid way to overcome TSW and avoiding severe withdrawal symptoms is by using the oral corticosteroid, prednisolone. In fact, in a number of cases, so severe was the suffering, I had no choice but to use this method. Also, I can often wean patients off TS more rapidly this way using wheatgrass extract and the medication together. This method generally works well. However, in my experience, the standard approach of high starting doses (e.g.50 mg) which are then reduced by large increments over a few weeks is excessive. Instead, I start with 20/25 mg. then reduce the dose gradually by 2.5mg. or 5mg. increments depending on the patient's response. Close medical supervision is however, essential, as is wheatgrass application on alternate days.

    Dr. Chris Reynolds. M.B.,B.S.


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