RSS or Red Skin Syndrome, also known as Topical Steroid Addiction (TSA) or Topical Steroid Withdrawal (TSW), is a debilitating condition that can arise from the use of topical steroids to treat a skin problem, such as eczema. RSS can also arise from topical steroid use in individuals with no prior skin condition; such as with cosmetic use for skin bleaching or to treat acne, or in the case of caregivers who neglect to wash their hands after applying topical steroids on someone else. Topical steroids are also called topical corticosteroids, glucocorticosteroids, and cortisone. They come in many different preparations including creams, ointments, oils, gels, and lotions. Some are sold over-the-counter; others require a doctor’s prescription. RSS is characterized by red, itchy, burning skin that can appear after ceasing topical steroid treatments, or even between treatments. In RSS, topical steroids are effective for a period of time to treat the skin condition. As time passes, however, applying topical steroids results in less and less clearing. The original problem escalates as it spreads to other areas of the body. In the case of eczema, this “progression” is often mistaken for worsening eczema.
Topical Steroid Addiction (TSA)
The term “addiction” is used to describe a situation that includes both 1) increased tolerance to a given substance and 2) well-defined physiological symptoms upon withdrawal. “Topical Steroid Addiction” describes the origin of Red Skin Syndrome, in which the body develops tolerance to topical steroid therapy— requiring more of the drug to be used to achieve the previous therapeutic benefit, and causing the skin to “rebound” upon withdrawal. The medical term for becoming tolerant or resistant to treatment is “tachyphylaxsis.” The “rebound effect’ or “rebound phenomenon” is defined as the emergence or re-emergence of symptoms that were either absent or controlled while taking a medication, but appear when that same medication is discontinued, or reduced in dosage. In the case of re-emergence, the severity of the symptoms is often worse than pretreatment levels.
Topical Steroid Withdrawal (TSW)
“Withdrawal,” in reference to medication, is defined as a group of symptoms that occur after stopping or reducing intake of a drug. “Topical Steroid Withdrawal” refers to the symptoms that occur when someone with RSS stops topical steroid use, reduces potency, applies topical steroids to reduced areas of the body, or applies them less often. Weaning, stepping down or ceasing use can all cause varying degrees of withdrawal symptoms. In the RSS community, “TSW” is also used to reflect the timeframe of the withdrawal phase. For example, “6 months TSW” refers to the time that has passed since ceasing topical steroid treatment.
What are the most common symptoms of RSS once steroids have been stopped?
- Skin flushing bright red, resembling a sunburn
- Visible and measurable flaking of skin
- Oozing exudate
- Skin cycling between oozing, swelling, burning, and flaking
- Red sleeves: (arms/legs become red and inflamed, sparing palms/soles)
- Thermoregulation altered (feeling too cold or too hot)
- Hypersensitivity of the skin to water, movement, moisturizer, fabrics, temperature, etc.
- Nerve pain, sometimes described as “sparklers” or “zingers”
- Enlarged lymph nodes
- Edema
- Eye dryness and irritation
- Skin atrophy (often manifesting as “elephant wrinkles“)
- Hair loss: (head and/or body)
- Insomnia and altered body clock
- Appetite changes Fatigue Emotional fluctuations, depression, anxiety
Information sourced from ITSAN
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