Topical Steroid Withdrawal (TSW): What’s Known

Published by Joseph, EditorCompiled from cited sources · not yet medically reviewedUpdated Oct 29, 20264 sources

Need help now? SAMHSA’s National Helpline is free, confidential and open 24/7 in English and Spanish: 1-800-662-4357. In a mental health crisis, call or text 988. In an emergency, call 911.

For information only, not medical advice. Talk to a doctor before stopping or changing any medication. Medical disclaimer

Quick answer

Topical steroid withdrawal (TSW), sometimes called ‘red skin syndrome’ or ‘topical steroid addiction’, is a reaction some long-term users of steroid creams and ointments report after stopping. The UK medicines regulator (MHRA) describes redness that can spread beyond the treated area, burning or stinging, intense itching, peeling, and oozing open sores, appearing days or weeks after stopping. A 2024 joint statement from UK dermatology groups says it may take many months to resolve, and occasionally doesn’t resolve fully.

It’s thought to be rare and is not well studied: the MHRA can’t estimate how often it happens, and there’s no agreed medical definition. It’s usually seen after very frequent or long-term use of strong (moderate to high potency) steroids, for example longer than 6 to 12 months in adults, or as little as 2 months of continual use in children, and is more common after use on the face or genitals. It hasn’t been reported with short courses or with breaks in treatment. Topical steroids remain safe and effective when used as directed.

Topical steroid withdrawal timeline at a glance

When did you last use or take it?

This places the typical ranges from this article's sources on your date. It is not a prediction or a diagnosis, and being past a phase does not mean symptoms or risks are over.

A rough guide from published sources, not medical advice. Everyone is different.

Phase	When	What you may feel	Severity	Red flags
Onset	Days to weeks after stopping a long-term topical steroid	Redness (pink, red or purple, or darkening/greying on darker skin) that can spread beyond where the cream was used; Burning or stinging, often more than itch; Intense itching	Moderate	Widespread redness over most of the body, swollen glands, or feeling very unwell: get urgent medical help
Active reaction	Weeks to months; the joint statement says it may take many months to resolve	Peeling or flaking skin; Oozing open sores; Swelling and thickened ‘elephant skin’; Feeling ill and weak in severe cases	Moderate	Dizziness or fainting: get checked, as adrenal suppression from steroid overuse needs urgent assessment
Long tail (some people)	Months or even years in patient reports; occasionally doesn’t resolve fully	Skin more sensitive than before, for example to sunlight; Symptoms that persist or recur	Mild	Pus-filled spots or oozing that may be infection: see a doctor

Print a daily symptom log for this timeline · My quit tracker

Symptoms, phase by phase

The MHRA says to contact your doctor if, after stopping treatment, you get redness or darkening of skin colour (or greying in darker complexions) that can extend beyond the area treated, or burning, stinging, itching or peeling skin, or oozing open sores. The 2024 joint statement from the National Eczema Society, British Dermatological Nursing Group and British Association of Dermatologists adds patient-reported features such as thickened ‘elephant skin’, the ‘sleeve sign’ (palms spared) and the ‘headlight sign’ (centre of the face spared), ongoing skin sensitivity, and, in severe cases, feeling ill and weak for months.

Onset: Days to weeks after stopping a long-term topical steroid

Redness (pink, red or purple, or darkening/greying on darker skin) that can spread beyond where the cream was used
Burning or stinging, often more than itch
Intense itching

Active reaction: Weeks to months; the joint statement says it may take many months to resolve

Peeling or flaking skin
Oozing open sores
Swelling and thickened ‘elephant skin’
Feeling ill and weak in severe cases

Long tail (some people): Months or even years in patient reports; occasionally doesn’t resolve fully

Skin more sensitive than before, for example to sunlight
Symptoms that persist or recur

TSW, eczema flare, or something else?

Telling TSW apart from a flare of the original condition is difficult, and a skin biopsy generally doesn’t help, according to the MHRA. The MHRA says TSW should be considered if:

burning rather than itch is the main symptom
redness is continuous rather than patchy (which may be less obvious on darker skin)
the rash looks like eczema but is in unusual places and feels ‘different’ from your usual condition
you’ve used a moderate or high potency steroid continuously for a long time

The joint statement lists conditions that can be mistaken for TSW:

Condition	How it differs
Relapse of eczema	Eczema comes and goes; a flare after stopping isn’t necessarily TSW
Rebound redness	Usually settles within days, and only where the steroid was applied
Rosacea, acne or perioral dermatitis	Can be caused by steroids and have specific non-steroid treatments
Skin infection	Bacterial, viral or fungal infection can look like pimples or oozing skin
Contact dermatitis	An allergy, sometimes to an ingredient in the steroid itself; a patch test can help
Erythroderma	Inflammation over more than 90% of the body with swollen glands and problems with temperature and fluid balance; usually needs urgent treatment, often in hospital

What makes it more or less likely

Potency. Stronger steroids carry more risk. UK steroids come in four potencies: mild (e.g. hydrocortisone), moderate (clobetasone), potent (beclometasone) and very potent (clobetasol).
Long, continuous use. The MHRA’s 2024 leaflet says it’s usually seen after very frequent or long-term use, for example longer than 6 to 12 months in adults.
Age. In children it has been seen after as little as 2 months of continual use.
Body area. More common after use on sensitive areas such as the face or genitals.
Eczema. The MHRA says people with atopic dermatitis are thought to be most at risk.
Short courses and breaks. TSW hasn’t been reported when steroids are used for suitable conditions for short periods or with breaks in treatment.

When to see a doctor or get help now

The MHRA advises that if your skin condition returns within 2 weeks of stopping, don’t restart the steroid without consulting your prescriber, unless they’ve already told you to.
If redness spreads beyond the original area with burning after your condition had cleared, the MHRA says to seek medical advice before restarting.
Get urgent help for widespread redness covering most of your body with swollen glands, trouble controlling your temperature, or feeling very unwell: the joint statement says erythroderma usually needs urgent treatment.
Dizziness, fainting or extreme weakness need prompt assessment: adrenal suppression from steroid overuse can be life-threatening.
Concerned about your steroid use? The joint statement says to speak to a health care professional before taking any action, and that alternatives may be available.

You can report a suspected reaction through the MHRA Yellow Card scheme (UK) or the FDA’s MedWatch (US). See also Get Help.

Tapering

There’s no agreed tapering plan for TSW in the sources we used. For people on long-term topical steroids, the MHRA advises prescribers to consider reducing the potency or how often it’s applied, or both. If you’ve used steroid creams continuously for a long time, the MHRA suggests asking your prescriber for a treatment review. Effective treatments for TSW itself are poorly researched; the joint statement calls for urgent high-quality research.

Tips for getting through it

Take photos of your skin and keep notes on which areas you treated, with which cream, and for how long; this helps a doctor tell TSW from other conditions
Ask whether a patch test makes sense if you might be reacting to an ingredient
Keep your patient information leaflet and note the potency of each product
Look for support from organisations such as the National Eczema Society

Frequently asked questions

How long does topical steroid withdrawal last?

It isn’t well studied. The 2024 UK joint statement says it may take many months to resolve, and occasionally doesn’t resolve fully. People report sensitive skin for months or even years.

Is TSW real?

UK dermatology bodies acknowledge it, and the MHRA added a warning about it to all topical steroid products in the UK after a 2021 review. It has no agreed medical definition yet, and some people who think they have it may have another condition.

How common is TSW?

Unknown. The MHRA can’t estimate the frequency, but given how many people use topical steroids, it understands severe reactions to be very infrequent. Dermatologists say it affects only a small proportion of the patients they see.

Does hydrocortisone cause TSW?

TSW is linked mainly to moderate to high potency steroids used long term. Hydrocortisone is a mild steroid. The MHRA says reactions are more common after use on sensitive areas such as the face or genitals.

Should I stop using my steroid cream?

Speak to a health care professional before taking action. The joint statement says concerns about TSW shouldn’t put people off steroids when they help, and that alternatives may be available if they don’t.

Next steps

Talk to others going through it. Share your experience or ask questions on the Antidepressants & Other Prescriptions board in our community forum. Forum posts are personal experiences, not medical advice. Please read the community guidelines.

Sources

Last reviewed: October 29, 2026. Researched and written by Withdrawal Timelines from the cited sources. This article has not yet been reviewed by a medical professional. See How We Review and our Medical Disclaimer. This is general information, not medical advice.

More timelines

View all