My Account  |  Contact Us  |  info@scratchsleeves.co.uk  |  +44 1962 890210

Is topical steroid withdrawal (TSW) a risk for babies and children?

Toddler girl scratching her neck with one hand and holding a sign asking Steriods? in the other
Like most parents new to baby eczema, we turned to the internet to find out more about out son’s condition. It didn’t take us long to discover a wealth of scary stories about the dangers of using the very treatment that our caring family doctor had prescribed for our son. While the internet has many benefits it can also be a source of mis-information and worry. In this article we look at the science behind the scary topical steroid withdrawal (TSW) stories and ask: is TSW a genuine risk for babies and children? And should we be using the topical corticosteroid (TCS) creams prescribed for our eczema baby?

The 3 most important things we learned about topical steroid withdrawal (TSW):

  • If your child is being treated by your GP, the risk of any side-effects for topical steroid treatments, including topical steroid withdrawal, is minimal
  • Only 0.3% of recorded cases of topical steroid withdrawal affected children under 3 years old
  • Leaving early-onset eczema (<4 months old) untreated increases the risk of your baby developing potentially life threatening food allergies in later life

What is topical steroid withdrawal (TSW)?

‘Topical steroid withdrawal’ (TSW) is a name given to the symptoms some people experience when they suddenly stop using topical corticosteroids (TCS) after a long period (typically over a year) of continuous use. These symptoms are also referred to as ‘topical steroid addiction’ or ‘red skin syndrome’ (RSS). This last name refers to the reddening or darkening of the skin which results dilation of blood vessels when TCS treatment is stopped1. This reddening typically spreads to areas that have not been treated with TCS and is typically accompanied by a return of the symptoms that the TCS were originally treating. This can be followed by a long period when the affected skin is scaly, cracked and weeping. TSW sufferers can feel tired and weak and may even be bed-bound. The condition can continue for months or even years but does eventually resolve.

Topical steroid withdrawal is acknowledged by the medical profession as a rare side-effect typically associated with long-term misuse of moderate to strong TCS treatments.

What are topical corticosteroids?

Severe eczema flares require a trip to the doctor or the dermatologist. Alongside the mainstay regime of emollients, your healthcare provider may prescribe topical corticosteroids (TCS). These have been in use for more than 70 years and are considered some of the safest and most cost-effective drugs in dermatology. You can find more information about TCS treatments here.

TCS are closely related to the corticosteroids our bodies make daily in the adrenal glands. As such they work directly to reduce inflammation. They may come in cream, gel, lotion or ointment form and are effective on eczema flares which may not be responding to baseline treatments (such as emollients and irritant avoidance). 

TCS treatments come in different potentencies and may affect different areas of the body more than others. As such it is very important to follow your medical practioner’s instructions carefully. Do not use more or less than you are told. Do not use anyone else’s TCS as a stand in and always finish the prescribed course. Using too little can prolong the length of time treatment which is actually more likely to cause issues than a short sharp burst. 

If your child is prescribed a strong potency TCS treatment, you should be given instructions on how to taper off the treatment. This usually means switching from daily treatments, to alternate days and then to once a week. This allows the body to gradually readjust to its natural levels of corticosteroids. It’s important to contact your healthcare provider if the eczema flare-up returns during this phase of treatment.

What causes topical steroid withdrawal? 

Topical steroid withdrawal (TSW) is typically caused by suddenly ceasing topical corticosteroid treatment after a long period of use (think years rather than weeks). Just like quitting any drug which the body has become dependent on, the body can react negatively as it tries to redress the deficit left when TCS treatments are stopped.

The speed with which this reaction comes on and the severity depend on a number of factors. The strength of the TCS used, the length of time they have been used and how slowly they are reduced as all factors.

The mechanisms behind TSW are not yet clear. Various mechanisms have been put forward, however none have sufficient evidence to either prove or disprove them. As a result, there are growing calls from the medical community for more research into the area2.

It is worth noting that the most commonly affected people are women who have been using TCS for a long time for cosmetic purposes3. As such there is limited research into the effects of TSW on children as they are rarely affected3. Just 0.3% of recorded cases affect children under 3, which we hope you will find reassuring. This is despite eczema being most common in the children under 3 years old.

What are the symptoms of topical steroid withdrawal?

According to the National Eczema Association “Burning, stinging, and bright red skin are the typical features of topical steroid overuse and withdrawal. The signs and symptoms occur within days to weeks after TCS discontinuation”. In general, TSW can be divided into two distinct subtypes: erythematoedematous (the skin is red and/or swollen) and papulopustular (with pimples and acne-like spots) 3.

The erythematoedematous subtype most common in people with a previous diagnosis of eczema, while more common papulopustular subtype is typically found in patients who have been using TCS to treat cosmetic issues like acne. Research to date, indicates that both subtypes primarily affect the face of adult females and are typically associated with inappropriately using moderate- to high-potency topical corticosteroids daily for more than 12 months3.

TSW typically occurs in four stages

  1. A few days (usually, but possible weeks) after discontinuation of TCS treatment, skin reddens or darkens with the discolouration often extending beyond the area previously treated with TCS. A ‘red sleeve’ is a classic sign of TSW, typically arms and legs are discoloured but hands and feet are unaffected with a clear boundry between discoloured and normal skin. The discoloured skin usually has a burning or stinging sensation and is painful to touch. This is different to the incessant itch associated with eczema. The skin may start to weep or blister. Swelling of hands and feet is common, as is thickening of the skin into folds behind the knees and inside the elbows, sometimes referred to as ‘elephant skin’.
  2. Over time, the affected skin becomes dry and itchy and starts to flake.
  3. Eventually, the skin starts to recover but has increased sensitivity and intermittent flare-ups.
  4. Finally the skin recovers to the state prior to stopping TCS treatment. The recovery process may take weeks to years.

Other TSW symptoms can include enlarged lymph nodes, difficulty in regulating body temperature, decreased energy levels, difficulty sleeping and, of course, reoccurrence of symptoms that the TCS treatments were originally targeting.

Treatment for topical steroid withdrawal

Topical steroid withdrawal is very rare in children, however if you suspect that your child is suffering from TSW, you need to discuss this with your healthcare provider. They will be able to establish if the symptoms have a different cause, such is infection or allergic reaction. If TSW is diagnosed there are a number of possible options available to reduce the symptoms of both the TSW and the underlying eczema. The majority of these are only available on prescription. These include tapering the TCS treatments, calcineurin inhibitor creams, phototherapy, switching to a oral steroid treatment for a few weeks to control symptoms while other treatments start to work, and other eczema systemic treatments.

Other things that you can do to alleviate the symptoms include:

  • experimenting with different emollients to one that works better
  • applying cold compresses to reduce itching
  • antihistamines can help control the itching in some people
  • keep skin clean and minimise scratching to reduce the risk of skin infections
  • sticking to a healthy, junk food free diet will support the body’s natural healing, you can read more here.

While healthcare professionals have been slow to acknowledge TSW (the first case was reported in the medical journals back in 19795), there is now a growing awareness of the condition. In the UK, specific guidance on TSW has recently been added to the patient information leaflets included with all TCS treatments.

Will my TSW concerns be taken seriously?

A recent survey of UK dermatologist attitudes showed that 85% of respondents agreed that TSW needed further research and that younger respondents were typically more cautious is prescribing TCS treatments due to the TSW concerns6. While some healthcare professionals may appear resistant to acknowledging the risks of TCS treatments, there is growing understanding of the problem and you should be able to find a sympathetic ear.

That said, in the UK the current NICE guidelines should protect against TSW occurring provided you follow the instructions for TCS usage. These guidelines make clear that if optimal emollient and TCS treatments are consistently not working or increasingly longer periods of high potency treatments are required to control symptoms then alternative treatments should be considered. Given the possible side-effects of these alternative treatments for eczema, they are not generally offered unless TCS treatment has failed.

If your child is being treated by your GP, the risk of TSW is minimal as the stronger TCS treatments associated with TSW are only prescribed by specialists with the NHS. The ‘steroid ladder‘ is useful tool in understanding which potency your child has been prescribed.

It’s important to know that there are other possible causes for TSW like symptoms7 and your healthcare provider needs to be sure that these are not the cause of your child’s symptoms before treating them for TSW. You will need to be patient and work with your healthcare provider to eliminate these other possible causes.

Why are babies and children prescribed topical steroid treatments?

The flip-slip of real, but very small risk of topical steroid withdrawal, is the growing problem of ‘steroid phobia’8. This is where parents and patients are so concerned about TSW and other side-effects of TCS treatments that eczema is inadequately treated.

Importantly, there are risks to not treating your child’s eczema effectively. This is especially true for early onset eczema (in babies under 4 months) where the successful treatment of eczema is thought to minimise the risk of food allergies in later life. You can read more about food allergy prevention here.

In older babies and children, untreated eczema flares can have a profound effect on both your child’s quality of life and family life. Interrupted sleep can cause mood and behavioral changes and impact school performance. Embarrassment from eczema can cause social isolation and impacts the daily life activities of childhood such as clothing choices, holidays, interaction with friends, owning pets, swimming and the ability to play sports or go to school.

Topical steroid treatments are the first line childhood eczema treatment for a good reason. They work really well and typically have minimal side-effects. They have been in use for more than 70 years and are considered some of the safest and most cost-effective drugs in dermatology. 

Provided you follow instructions given by your healthcare provider regarding safe TCS usage, your child is highly unlikely to be affected by TCW. It is a rare side-effect that typically associated with long-term, inappropriate TCS usage. That said there has been one reported case of TSW occurring in a child after only 2 months of continuous TCS treatment9, so it is sensible to be aware of TSW and to raise any concerns with your doctor.

Our sources

  1. B, Sheary. “Topical Corticosteroid Addiction and Withdrawal – an Overview for GPS.” Australian Family Physician, U.S. National Library of Medicine, June 2016, https://pubmed.ncbi.nlm.nih.gov/27622228/
  2. Marshall, HF, et al. “Topical Steroid Withdrawal and Atopic Dermatitis.” Annals of Allergy, Asthma & Immunology, U.S. National Library of Medicine, Apr. 2024,
    https://pubmed.ncbi.nlm.nih.gov/38142858/
  3. Hajar, T, et al. “A Systematic Review of Topical Corticosteroid Withdrawal (‘steroid Addiction’) in Patients with Atopic Dermatitis and Other Dermatoses.” Journal of the American Academy of Dermatology, U.S. National Library of Medicine, Mar. 2015, https://pubmed.ncbi.nlm.nih.gov/25592622/
  4. B, Sheary. “Topical Steroid Withdrawal: A Case Series of 10 Children.” Acta Dermato-Venereologica, U.S. National Library of Medicine, May 2019, https://pubmed.ncbi.nlm.nih.gov/30734047/
  5. Kligman, PJ, and AM Frosch. “Steroid Addiction.” International Journal of Dermatology, U.S. National Library of Medicine, Jan. 1979, https://pubmed.ncbi.nlm.nih.gov/153891/
  6. Barlow, R, et al. “Topical Steroid Withdrawal: A Survey of UK Dermatologists’ Attitudes.” Clinical and Experimental Dermatology, U.S. National Library of Medicine, May 2024, https://pubmed.ncbi.nlm.nih.gov/38320214/
  7. Topical Steroid Withdrawal. A joint statement by National Eczema Society, the British Dermatological Nursing Group, and the British Association of Dermatologists. Feb, 2024, https://cdn.bad.org.uk/uploads/2024/02/22095550/Topical-Steroid-Withdrawal-Joint-Statement.pdf
  8. Contento, M, et al. “Steroid Phobia: A Review of Prevalence, Risk Factors, and Interventions.” American Journal of Clinical Dermatology, U.S. National Library of Medicine, Nov. 2021, https://pubmed.ncbi.nlm.nih.gov/34287768/
  9. Juhász, ML, et al. “Systematic Review of the Topical Steroid Addiction and Topical Steroid Withdrawal Phenomenon in Children Diagnosed With Atopic Dermatitis and Treated With Topical Corticosteroids” Journal of the Dermatology Nurses’ Association, 2019, https://journals.lww.com/jdnaonline/fulltext/2017/09000/systematic_review_of_the_topical_steroid_addiction.2.aspx

Further reading

What to know more? These are reliable sources of well researched information


Here at ScratchSleeves, we don’t just share our experiences of bringing up an eczema child and favourite allergy-friendly recipes, we also manufacture and sell our unique stay-on scratch mitts and PJs for itchy babies, toddlers and children. We now stock sizes from 0-adult years in a range of colours. Visit our main website for more information.

The Calm Skin Guide

Love our blog? It's also available in book format with:

Signed copies available at no extra cost

Written by:

Coming from a family of eczema sufferers, Jae draws on years of practical, first hand experience living with eczema.

Interesting article? Don't keep it to yourself...

Read next...

You may also find helpful...

Conventional Treatments
Like most parents new to baby eczema, we turned to the internet to find out more about out son’s condition....
Conventional Treatments | Eczema 101
If you are in the UK and your child has eczema, it is likely that this was diagnosed by your...
Conventional Treatments | Sleep & Scratching
As long as there is habitual scratching of eczema patches, skin never gets the chance to heal fully. This means...
Conventional Treatments | Eczema 101
Keeping emollients on a wriggly little one for long enough to be absorbed can be challenging. Most eczema parents have...
Bathing & Washing | Conventional Treatments
While bleach bathes can sound a bit drastic to the new eczema parent, they are actually not that different from...
Family Life | Conventional Treatments
It's rare for children to end up in hospital with eczema, but if your little one is admitted, this post...
Conventional Treatments
Looking at the conversations on parenting forums, it’s clear that many parents have concerns over using prescribed hydrocortisone cream and...
Conventional Treatments | Eczema 101
If you have just been told by your doctor or health care provider that your little one has eczema, the...
Conventional Treatments
After months of battling the healthcare system, at last, you’ve got a dermatology appointment to see a consultant about your...
Featured Article | Eczema 101 | Conventional Treatments
There’s more information about baby eczema available on the web than anyone can hope to read in a lifetime so...
Triggers | Conventional Treatments
Babies and children with eczema are more likely to suffer from dangerous allergic reactions. We asked Dr Nikky Ellis – A&E doctor,...
Featured Article | Eczema 101 | Conventional Treatments
Looking after a scratchy baby can be stressful enough, without feeling like you are fighting the healthcare system on your...

Quick buy

What our lovely customers say...

More reviews are available on...

Multi Buy Discount

DiscountLogo

Spend between £30 - £60 and save 5%
Spend between £60 - £120 and save 10%
Spend over £120 and save 15%

Discount automatically applied at checkout

No Quibbles Guarantee

output-onlinepngtools (48)

ScratchSleeves abide by a no quibbles guarantee.

Free UK Postage

output-onlinepngtools (85)

Free packing and postage on all UK orders. For overseas orders to Europe postage is from £3.50, to USA is £8.50 and to the rest of the world, from £6.50.

Scroll to Top