{"id":94,"date":"2021-05-13T15:52:59","date_gmt":"2021-05-13T15:52:59","guid":{"rendered":"https:\/\/itsan.net\/?page_id=94"},"modified":"2024-03-12T17:32:49","modified_gmt":"2024-03-12T17:32:49","slug":"for-doctors","status":"publish","type":"page","link":"https:\/\/www.itsan.org\/us\/for-doctors\/","title":{"rendered":"For Doctors"},"content":{"rendered":"\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3pxrva-da85c30999a983a18ff4b220384acb59\">\n.avia-section.av-3pxrva-da85c30999a983a18ff4b220384acb59{\nbackground-color:#f7f7f7;\nbackground-image:unset;\n}\n<\/style>\n<div id='av_section_1'  class='avia-section av-3pxrva-da85c30999a983a18ff4b220384acb59 main_color avia-section-default avia-no-shadow  avia-builder-el-0  el_before_av_section  avia-builder-el-first  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><main  role=\"main\" itemprop=\"mainContentOfPage\"  class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-94'><div class='entry-content-wrapper clearfix'>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3p6v72-49c36db9f190b6562d8a8effd39e0483\">\n.flex_column.av-3p6v72-49c36db9f190b6562d8a8effd39e0483{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-3p6v72-49c36db9f190b6562d8a8effd39e0483 av_one_full  avia-builder-el-1  el_before_av_hr  avia-builder-el-first  first flex_column_div av-zero-column-padding  '     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3oljiy-4f81762eb259ecd68c7203813452061b\">\n#top .av-special-heading.av-3oljiy-4f81762eb259ecd68c7203813452061b{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-3oljiy-4f81762eb259ecd68c7203813452061b .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-3oljiy-4f81762eb259ecd68c7203813452061b .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-3oljiy-4f81762eb259ecd68c7203813452061b av-special-heading-h2  avia-builder-el-2  el_before_av_textblock  avia-builder-el-first '><h2 class='av-special-heading-tag'  itemprop=\"headline\"  >TSW Syndrome and Resources for Doctors<\/h2><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-3o2knm-65ba6536fb0b02ae3bb86175e8c8487f '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p>ITSAN is a member in good standing of the\u00a0<a href=\"http:\/\/coalitionofskindiseases.org\/\" target=\"_blank\" rel=\"noopener noreferrer\">Coalition of Skin Diseases<\/a>\u00a0and an affiliate cited in the\u00a0<a href=\"https:\/\/www.aad.org\/about\/affiliate\/patient_advocates\" target=\"_blank\" rel=\"noopener noreferrer\">Patient Advocate Resource Center<\/a> of the American Academy of Dermatology.\u00a0\u00a0See the <a href=\"https:\/\/www.itsan.org\/us\/about-itsan\/\">About ITSAN<\/a> tab for more information <span style=\"font-weight: 400;\">on our professional affiliations.<\/span><\/p>\n<p><b>This page is a resource for Healthcare Providers seeking answers from the experts about Topical Steroid Withdrawal Syndrome &#8211; also known as Topical Steroid Addiction and Red Skin Syndrome.<\/b><b>\u00a0<\/b><\/p>\n<\/div><\/section><\/p><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-d4h96-9a6686a2613ed9ae2eea96a580b2292b\">\n#top .hr.hr-invisible.av-d4h96-9a6686a2613ed9ae2eea96a580b2292b{\nheight:30px;\n}\n<\/style>\n<div  class='hr av-d4h96-9a6686a2613ed9ae2eea96a580b2292b hr-invisible  avia-builder-el-4  el_after_av_one_full  el_before_av_one_fourth '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3mr53e-58216648fa5a36b5a8131e7f127403fd\">\n.flex_column.av-3mr53e-58216648fa5a36b5a8131e7f127403fd{\nborder-width:1px;\nborder-color:#0a0a0a;\nborder-style:solid;\nborder-radius:10px 10px 10px 10px;\npadding:20px 20px 20px 20px;\n}\n<\/style>\n<div  class='flex_column av-3mr53e-58216648fa5a36b5a8131e7f127403fd av_one_fourth  avia-builder-el-5  el_after_av_hr  el_before_av_one_fourth  first flex_column_div  '     ><section  class='av_textblock_section av-3man1a-8851b441fe45b70541f9ac2d8114dd36 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"text-align: center;\"><span style=\"font-weight: 400;\">Please read \u201cTopical Steroid Withdrawal Syndrome &#8211; Time to Bridge the Gap\u201d a recently published article in the <a href=\"https:\/\/onlinelibrary.wiley.com\/journal\/13652133\">British Journal of Dermatology<\/a> calling for improved topical steroid prescribing guidelines and patient support.<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-weight: 400;\"> <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/bjd.21770\" target=\"_blank\" rel=\"noopener\">Click Here to Read More<\/a><br \/>\n<\/span><\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/bjd.21770\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-9808 alignnone\" src=\"https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2022\/09\/Screen-Shot-2022-09-07-at-9.57.14-AM-300x257.png\" alt=\"\" width=\"255\" height=\"218\" srcset=\"https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2022\/09\/Screen-Shot-2022-09-07-at-9.57.14-AM-300x257.png 300w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2022\/09\/Screen-Shot-2022-09-07-at-9.57.14-AM-768x659.png 768w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2022\/09\/Screen-Shot-2022-09-07-at-9.57.14-AM-705x605.png 705w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2022\/09\/Screen-Shot-2022-09-07-at-9.57.14-AM-450x386.png 450w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2022\/09\/Screen-Shot-2022-09-07-at-9.57.14-AM.png 898w\" sizes=\"auto, (max-width: 255px) 100vw, 255px\" \/><\/a><\/p>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3lr2y2-94da9e12f1308bdc765e3050f4c48eaf\">\n#top .hr.hr-invisible.av-3lr2y2-94da9e12f1308bdc765e3050f4c48eaf{\nheight:30px;\n}\n<\/style>\n<div  class='hr av-3lr2y2-94da9e12f1308bdc765e3050f4c48eaf hr-invisible  avia-builder-el-7  el_after_av_textblock  el_before_av_hr '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3l4x9e-f20e4c1664c34303c1ea38aa01acdabb\">\n#top .hr.hr-invisible.av-3l4x9e-f20e4c1664c34303c1ea38aa01acdabb{\nheight:30px;\n}\n<\/style>\n<div  class='hr av-3l4x9e-f20e4c1664c34303c1ea38aa01acdabb hr-invisible  avia-builder-el-8  el_after_av_hr  el_before_av_hr '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3ki6ie-0b55a17c86a79d36ea698868901d8145\">\n#top .hr.hr-invisible.av-3ki6ie-0b55a17c86a79d36ea698868901d8145{\nheight:30px;\n}\n<\/style>\n<div  class='hr av-3ki6ie-0b55a17c86a79d36ea698868901d8145 hr-invisible  avia-builder-el-9  el_after_av_hr  avia-builder-el-last '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><\/p><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3jiv4y-4fea5cf2717e4fbedf22bbb5f561d5f6\">\n.flex_column.av-3jiv4y-4fea5cf2717e4fbedf22bbb5f561d5f6{\nborder-width:1px;\nborder-color:#0a0a0a;\nborder-style:solid;\nborder-radius:10px 10px 10px 10px;\npadding:20px 20px 20px 20px;\n}\n<\/style>\n<div  class='flex_column av-3jiv4y-4fea5cf2717e4fbedf22bbb5f561d5f6 av_one_fourth  avia-builder-el-10  el_after_av_one_fourth  el_before_av_one_fourth  flex_column_div  '     ><section  class='av_textblock_section av-3j118m-4b581932ded4b9475274d3b65dcf183d '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"text-align: center;\">Press release from <a href=\"https:\/\/www.gov.uk\/\" target=\"_blank\" rel=\"noopener\">GOV.UK<\/a> &#8211; Drug safety update on the risk of Topical Steroid Withdrawal reactions to topical steroid medication from the <a href=\"https:\/\/www.gov.uk\/government\/organisations\/medicines-and-healthcare-products-regulatory-agency\" target=\"_blank\" rel=\"noopener\">Medicines and Healthcare products Regulatory Agency<\/a>.<\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/www.gov.uk\/government\/news\/long-term-continual-use-of-topical-steroids-linked-to-skin-withdrawal-side-effects?fbclid=IwAR09KIqqQUlf5T6kawdb7q-UZmXMwJa7t145YHWt_F9UvwDCa62915PEVk0\" target=\"_blank\" rel=\"noopener\">Click Here to Read More<\/a><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/www.gov.uk\/government\/news\/long-term-continual-use-of-topical-steroids-linked-to-skin-withdrawal-side-effects?fbclid=IwAR09KIqqQUlf5T6kawdb7q-UZmXMwJa7t145YHWt_F9UvwDCa62915PEVk0\" target=\"_blank\" rel=\"noopener\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-6225\" src=\"https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2022\/01\/docss2.png\" alt=\"\" width=\"251\" height=\"336\" srcset=\"https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2022\/01\/docss2.png 251w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2022\/01\/docss2-224x300.png 224w\" sizes=\"auto, (max-width: 251px) 100vw, 251px\" \/><\/a><\/p>\n<p><span style=\"font-weight: 400;\"><a href=\"https:\/\/www.canada.ca\/en.html\">Government of Canada<\/a>\u00a0&#8211; Safety brief\u00a0<\/span><span style=\"font-weight: 400;\">on topical corticosteroids and the risk of topical withdrawal reactions. <a href=\"https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-health-products\/medeffect-canada\/health-product-infowatch\/july-2022.html?fbclid=IwAR00B-0n8WpclMEVRqcvagtgKqdIVhO2ZUDsHyBVgCaCdUqr0FP7FAn73Wo#a6.1.1\">Click here.<\/a><\/span><\/p>\n<\/div><\/section><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3ij162-5c7a481e9ca50a20f5bdc98faf10f2ec\">\n.flex_column.av-3ij162-5c7a481e9ca50a20f5bdc98faf10f2ec{\nborder-width:1px;\nborder-color:#0a0a0a;\nborder-style:solid;\nborder-radius:10px 10px 10px 10px;\npadding:20px 20px 20px 20px;\n}\n<\/style>\n<div  class='flex_column av-3ij162-5c7a481e9ca50a20f5bdc98faf10f2ec av_one_fourth  avia-builder-el-12  el_after_av_one_fourth  el_before_av_one_fourth  flex_column_div  '     ><section  class='av_textblock_section av-3i3wq2-e3bb3f957342e78d402e199dce5035ab '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"text-align: center;\"><span style=\"font-weight: 400;\">Please see the joint position statement on Topical Steroid Withdrawal by the <\/span><a href=\"https:\/\/eczema.org\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">National Eczema Society<\/span><\/a><span style=\"font-weight: 400;\"> (United Kingdom) and <\/span><a href=\"https:\/\/www.bad.org.uk\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">British Association of Dermatologists<\/span><\/a><span style=\"font-weight: 400;\">:<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-weight: 400;\"><br \/>\n<a href=\"https:\/\/eczema.org\/wp-content\/uploads\/Topical-Steroid-Withdrawal-position-statement.pdf\" target=\"_blank\" rel=\"noopener\">Click to Enlarge<\/a><br \/>\n<\/span><\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/eczema.org\/wp-content\/uploads\/Topical-Steroid-Withdrawal-position-statement.pdf\" target=\"_blank\" rel=\"noopener\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-5828\" src=\"https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/07\/docss.png\" alt=\"\" width=\"251\" height=\"336\" srcset=\"https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/07\/docss.png 251w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/07\/docss-224x300.png 224w\" sizes=\"auto, (max-width: 251px) 100vw, 251px\" \/><\/a><\/p>\n<\/div><\/section><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3ha4fa-eac6c61abe904abc81ca691146102f53\">\n.flex_column.av-3ha4fa-eac6c61abe904abc81ca691146102f53{\nborder-width:1px;\nborder-color:#0a0a0a;\nborder-style:solid;\nborder-radius:10px 10px 10px 10px;\npadding:20px 20px 20px 20px;\n}\n<\/style>\n<div  class='flex_column av-3ha4fa-eac6c61abe904abc81ca691146102f53 av_one_fourth  avia-builder-el-14  el_after_av_one_fourth  el_before_av_hr  flex_column_div  '     ><section  class='av_textblock_section av-3gsrnm-1638476934e1b9dd762fcefbfa5d2018 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"text-align: center;\">Please read this article on how to recognize TSW Syndrome, published by the<a href=\"https:\/\/nationaleczema.org\/topical-steroid-withdrawal\/\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=https:\/\/nationaleczema.org\/topical-steroid-withdrawal\/&amp;source=gmail&amp;ust=1625924394530000&amp;usg=AFQjCNGJha52D6rNapBWVy3mqOmtjS9jZw\"> National Eczema Association<\/a>. Includes insight from eczema experts Dr. Lawrence Eichenfield, Dr. Eric Simpson, and Dr. Peter Lio.<\/p>\n<p style=\"text-align: center;\"><span style=\"font-weight: 400;\"> <a href=\"https:\/\/nationaleczema.org\/tsw-need-to-know\/\" target=\"_blank\" rel=\"noopener\">Click Here to Read More<\/a><br \/>\n<\/span><\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/nationaleczema.org\/tsw-need-to-know\/\" target=\"_blank\" rel=\"noopener\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-5831 size-full\" src=\"https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/07\/art2.png\" alt=\"\" width=\"251\" height=\"336\" srcset=\"https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/07\/art2.png 251w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/07\/art2-224x300.png 224w\" sizes=\"auto, (max-width: 251px) 100vw, 251px\" \/><\/a><\/p>\n<\/div><\/section><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3g713e-ab1f00b3a35a061477bf44007b6783d6\">\n#top .hr.hr-invisible.av-3g713e-ab1f00b3a35a061477bf44007b6783d6{\nheight:30px;\n}\n<\/style>\n<div  class='hr av-3g713e-ab1f00b3a35a061477bf44007b6783d6 hr-invisible  avia-builder-el-16  el_after_av_one_fourth  avia-builder-el-last '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n\n<\/div><\/div><\/main><!-- close content main element --><\/div><\/div><div id='av_section_2'  class='avia-section av-cd9uu-51d7effa81a78732a312943202d8a969 main_color avia-section-small avia-no-shadow  avia-builder-el-17  el_after_av_section  el_before_av_section  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-94'><div class='entry-content-wrapper clearfix'>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3eplpq-78ff19473732befab0352521f8beee74\">\n#top .hr.hr-invisible.av-3eplpq-78ff19473732befab0352521f8beee74{\nheight:5px;\n}\n<\/style>\n<div  class='hr av-3eplpq-78ff19473732befab0352521f8beee74 hr-invisible  avia-builder-el-18  el_before_av_heading  avia-builder-el-first '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3ehfnm-0586998254566b67f0ec33722e19e74d\">\n#top .av-special-heading.av-3ehfnm-0586998254566b67f0ec33722e19e74d{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-3ehfnm-0586998254566b67f0ec33722e19e74d .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-3ehfnm-0586998254566b67f0ec33722e19e74d .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-3ehfnm-0586998254566b67f0ec33722e19e74d av-special-heading-h2  avia-builder-el-19  el_after_av_hr  el_before_av_textblock '><h2 class='av-special-heading-tag'  itemprop=\"headline\"  >Educational videos on TSW Syndrome <\/h2><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div>\n<section  class='av_textblock_section av-3dsgi6-ff7c24835cd31866f82499a032631b99 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p><span style=\"font-weight: 400;\">Medical doctors answering the most common questions other doctors may have about this emerging diagnosis &#8212;\u00a0 including how to recognize, diagnose, treat and prevent TSW Syndrome.<\/span><\/p>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3cxycu-5d46e87fd9a9e96e3236988bc5638488\">\n#top .hr.hr-invisible.av-3cxycu-5d46e87fd9a9e96e3236988bc5638488{\nheight:15px;\n}\n<\/style>\n<div  class='hr av-3cxycu-5d46e87fd9a9e96e3236988bc5638488 hr-invisible  avia-builder-el-21  el_after_av_textblock  el_before_av_one_third '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<div class='flex_column_table av-3cn2dq-a398cfc13db517a7a08edf0170f2fc27 sc-av_one_third av-equal-height-column-flextable'>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3cn2dq-a398cfc13db517a7a08edf0170f2fc27\">\n.flex_column.av-3cn2dq-a398cfc13db517a7a08edf0170f2fc27{\nborder-width:1px;\nborder-color:#0a0a0a;\nborder-style:solid;\nborder-radius:10px 10px 10px 10px;\npadding:20px 20px 20px 20px;\nbackground-color:#f7f7f7;\n}\n<\/style>\n<div  class='flex_column av-3cn2dq-a398cfc13db517a7a08edf0170f2fc27 av_one_third  avia-builder-el-22  el_after_av_hr  el_before_av_one_third  first flex_column_table_cell av-equal-height-column av-align-top  '     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3c0j9q-75be84da051b2d2b9e9a59da4638b493\">\n#top .av-special-heading.av-3c0j9q-75be84da051b2d2b9e9a59da4638b493{\npadding-bottom:30px;\n}\nbody .av-special-heading.av-3c0j9q-75be84da051b2d2b9e9a59da4638b493 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-3c0j9q-75be84da051b2d2b9e9a59da4638b493 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-3c0j9q-75be84da051b2d2b9e9a59da4638b493 av-special-heading-h4  avia-builder-el-23  el_before_av_video  avia-builder-el-first '><h4 class='av-special-heading-tag'  itemprop=\"headline\"  >Dr. Belinda Sheary<\/h4><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><br \/>\n<div  class='avia-video av-3bme0e-d7da66f7db29ed731dbca610c37a25eb avia-video-16-9 av-no-preview-image avia-video-load-always av-lazyload-immediate av-lazyload-video-embed'  itemprop=\"video\" itemtype=\"https:\/\/schema.org\/VideoObject\"  data-original_url=' https:\/\/www.youtube.com\/watch?v=79ydTOyDPiU'><script type='text\/html' class='av-video-tmpl'><div class='avia-iframe-wrap'><iframe loading=\"lazy\" title=\"ITSAN - Dr. Belinda  Sheary  Presentation for &quot;Spark&quot; Conference May 2021\" width=\"1500\" height=\"844\" src=\"https:\/\/www.youtube.com\/embed\/79ydTOyDPiU?feature=oembed&autoplay=0&loop=0&controls=1&mute=0\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe><\/div><\/script><div class='av-click-to-play-overlay'><div class=\"avia_playpause_icon\"><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-bwnv2-91e9f8bea0267bb3e6e2d46f1a52b4f7 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p><b>Questions answered in this video:\u00a0<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">What is Topical Steroid Withdrawal (TSW)? Definitions from the literature.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">What is actually happening to the skin in TSW?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">How is TSW diagnosed?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Management of TSW &#8211; including mental health<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prognosis &#8211; How long do symptoms last?<\/span><\/li>\n<\/ul>\n<p><b>Learn more:<\/b><span style=\"font-weight: 400;\"> Sheary B. <\/span><span style=\"font-weight: 400;\">\u201c<\/span><a href=\"https:\/\/www.racgp.org.au\/afp\/2016\/june\/topical-corticosteroid-addiction-and-withdrawal-%E2%80%93-an-overview-for-gps\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Topical corticosteroid addiction and withdrawal \u2013 An overview for GPs.<\/span><\/a><span style=\"font-weight: 400;\">\u201d <\/span><i><span style=\"font-weight: 400;\">Australian Family Physician <\/span><\/i><span style=\"font-weight: 400;\">2016.June;45(6):386-388.<\/span><\/p>\n<\/div><\/section><\/p><\/div><div class='av-flex-placeholder'><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-bu1ca-7ac1fd9e651c4cbc78e0ca6c0ff4b1fb\">\n.flex_column.av-bu1ca-7ac1fd9e651c4cbc78e0ca6c0ff4b1fb{\nborder-width:1px;\nborder-color:#0a0a0a;\nborder-style:solid;\nborder-radius:10px 10px 10px 10px;\npadding:20px 20px 20px 20px;\nbackground-color:#f7f7f7;\n}\n<\/style>\n<div  class='flex_column av-bu1ca-7ac1fd9e651c4cbc78e0ca6c0ff4b1fb av_one_third  avia-builder-el-26  el_after_av_one_third  el_before_av_one_third  flex_column_table_cell av-equal-height-column av-align-top  '     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-bqjki-18a99a8403edf6123448136e398fe218\">\n#top .av-special-heading.av-bqjki-18a99a8403edf6123448136e398fe218{\npadding-bottom:30px;\n}\nbody .av-special-heading.av-bqjki-18a99a8403edf6123448136e398fe218 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-bqjki-18a99a8403edf6123448136e398fe218 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-bqjki-18a99a8403edf6123448136e398fe218 av-special-heading-h4  avia-builder-el-27  el_before_av_video  avia-builder-el-first '><h4 class='av-special-heading-tag'  itemprop=\"headline\"  >Dr. Peter Lio<\/h4><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><br \/>\n<div  class='avia-video av-399omm-33fc2187e31c3932d0ed17675b88024f avia-video-16-9 av-no-preview-image avia-video-load-always av-lazyload-immediate av-lazyload-video-embed'  itemprop=\"video\" itemtype=\"https:\/\/schema.org\/VideoObject\"  data-original_url='https:\/\/youtu.be\/PePru4C01mA'><script type='text\/html' class='av-video-tmpl'><div class='avia-iframe-wrap'><iframe loading=\"lazy\" title=\"Ask the Ecz-perts: How do you know if you&#039;re experiencing Topical Steroid Withdrawal (TSW)?\" width=\"1500\" height=\"844\" src=\"https:\/\/www.youtube.com\/embed\/PePru4C01mA?feature=oembed&autoplay=0&loop=0&controls=1&mute=0\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe><\/div><\/script><div class='av-click-to-play-overlay'><div class=\"avia_playpause_icon\"><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-388nde-2797e813c08ac759409b407f46a987df '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p><b>Questions answered in this video:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">What is Topical Steroid Withdrawal (TSW)?\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Why is TSW difficult to diagnose? <\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">How is TSW diagnosed?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Can TSW be prevented?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">What should patients do if they believe they have TSW?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Total avoidance of all topical steroids recommended for TSW patients\u00a0<\/span><\/li>\n<\/ul>\n<p><b>Webinar: <\/b><span style=\"font-weight: 400;\">Topical Steroid Withdrawal with Dr. Peter Lio found <\/span><a href=\"https:\/\/www.youtube.com\/watch?v=lB40oxfp_RI\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">here<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<p><b>Learn more:<\/b><span style=\"font-weight: 400;\"> Lio PA, Chandan N. \u201c<\/span><a href=\"https:\/\/practicaldermatology.com\/articles\/2019-aug\/topical-steroid-withdrawal-in-atopic-dermatitis\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Topical Steroid Withdrawal in Atopic Dermatitis.<\/span><\/a><span style=\"font-weight: 400;\">\u201d <\/span><i><span style=\"font-weight: 400;\">Practical Dermatology<\/span><\/i><span style=\"font-weight: 400;\"> 2019.August:36-42.\u00a0<\/span><\/p>\n<\/div><\/section><\/p><\/div><div class='av-flex-placeholder'><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-34ncwa-fa18300b07cfb58d783dfd2fa5f0e5ee\">\n.flex_column.av-34ncwa-fa18300b07cfb58d783dfd2fa5f0e5ee{\nborder-width:1px;\nborder-color:#0a0a0a;\nborder-style:solid;\nborder-radius:10px 10px 10px 10px;\npadding:20px 20px 20px 20px;\nbackground-color:#f7f7f7;\n}\n<\/style>\n<div  class='flex_column av-34ncwa-fa18300b07cfb58d783dfd2fa5f0e5ee av_one_third  avia-builder-el-30  el_after_av_one_third  el_before_av_hr  flex_column_table_cell av-equal-height-column av-align-top  '     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-34cpeq-bbb1bd3c2a0ff81dc1dbdfdc27245e4e\">\n#top .av-special-heading.av-34cpeq-bbb1bd3c2a0ff81dc1dbdfdc27245e4e{\npadding-bottom:30px;\n}\nbody .av-special-heading.av-34cpeq-bbb1bd3c2a0ff81dc1dbdfdc27245e4e .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-34cpeq-bbb1bd3c2a0ff81dc1dbdfdc27245e4e .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-34cpeq-bbb1bd3c2a0ff81dc1dbdfdc27245e4e av-special-heading-h4  avia-builder-el-31  el_before_av_video  avia-builder-el-first '><h4 class='av-special-heading-tag'  itemprop=\"headline\"  >Dr. Mototsugu Fukaya, et al<\/h4><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><br \/>\n<div  class='avia-video av-33po5y-b325f6540884f8c4a61c7fcbe24872b7 avia-video-16-9 av-no-preview-image avia-video-load-always av-lazyload-immediate av-lazyload-video-embed'  itemprop=\"video\" itemtype=\"https:\/\/schema.org\/VideoObject\"  data-original_url='https:\/\/www.youtube.com\/watch?v=O82WQR1yo0I&amp;t=165s'><script type='text\/html' class='av-video-tmpl'><div class='avia-iframe-wrap'><iframe loading=\"lazy\" title=\"Topical steroid addiction in atopic dermatitis - Video abstract 69201\" width=\"1500\" height=\"844\" src=\"https:\/\/www.youtube.com\/embed\/O82WQR1yo0I?start=165&feature=oembed&autoplay=0&loop=0&controls=1&mute=0\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe><\/div><\/script><div class='av-click-to-play-overlay'><div class=\"avia_playpause_icon\"><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-332cyu-097432ed81ec8071d9157da25fc4e842 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p><b>Questions answered in this video:<\/b><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">How is Steroid Addiction defined?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">What are the clinical findings of Topical Steroid Addiction?\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">What strength of steroid and usage pattern leads to steroid addiction?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">How is steroid addiction treated?\u00a0<\/span><\/li>\n<\/ul>\n<p><b>Learn more: <\/b><span style=\"font-weight: 400;\">Fukaya M, Sato K, Sato M, et al. \u201c<\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4207549\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Topical Steroid Addiction in Atopic Dermatitis<\/span><\/a><span style=\"font-weight: 400;\">.\u201d <\/span><i><span style=\"font-weight: 400;\">Drug, Healthcare and Patient Safety<\/span><\/i><span style=\"font-weight: 400;\">, 2014;6:131\u2013138<\/span><\/p>\n<\/div><\/section><\/p><\/div><\/div><!--close column table wrapper. Autoclose: 1 -->\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-37r0vq-993e1b4377d27ce658c80438e1c3eaa0\">\n#top .hr.hr-invisible.av-37r0vq-993e1b4377d27ce658c80438e1c3eaa0{\nheight:35px;\n}\n<\/style>\n<div  class='hr av-37r0vq-993e1b4377d27ce658c80438e1c3eaa0 hr-invisible  avia-builder-el-34  el_after_av_one_third  avia-builder-el-last '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<\/div><\/div><\/div><!-- close content main div --><\/div><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-31qiz6-59390b5c6588d0ad2c265ff0b2fdd2ad\">\n.avia-section.av-31qiz6-59390b5c6588d0ad2c265ff0b2fdd2ad{\nbackground-color:#f7f7f7;\nbackground-image:unset;\n}\n<\/style>\n<div id='questions'  class='avia-section av-31qiz6-59390b5c6588d0ad2c265ff0b2fdd2ad main_color avia-section-default avia-no-shadow  avia-builder-el-35  el_after_av_section  el_before_av_section  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-94'><div class='entry-content-wrapper clearfix'>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3130zm-e7506a9461863c5f884a7caa2cea0dbf\">\n#top .av-special-heading.av-3130zm-e7506a9461863c5f884a7caa2cea0dbf{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-3130zm-e7506a9461863c5f884a7caa2cea0dbf .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-3130zm-e7506a9461863c5f884a7caa2cea0dbf .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-3130zm-e7506a9461863c5f884a7caa2cea0dbf av-special-heading-h2  avia-builder-el-36  el_before_av_one_full  avia-builder-el-first '><h2 class='av-special-heading-tag'  itemprop=\"headline\"  >Q&amp;A: Answers from the literature<\/h2><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-30p9b6-c9a22dc1f5630ac4ac944a3dc8ab7910\">\n.flex_column.av-30p9b6-c9a22dc1f5630ac4ac944a3dc8ab7910{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-30p9b6-c9a22dc1f5630ac4ac944a3dc8ab7910 av_one_full  avia-builder-el-37  el_after_av_heading  avia-builder-el-last  first flex_column_div av-zero-column-padding  '     ><section  class='av_textblock_section av-3013ha-a05a32e7c82ffe2f1152c3705af3e695 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p>This information comes directly from the literature via doctors and researchers who have experience with TSW Syndrome.\u00a0 Additional commentary and photos with perspective from ITSAN\u2019s worldwide TSW Syndrome community complete the clinical picture.<\/p>\n<p style=\"font-size: 19px; font-weight: bold;\"><a href=\"#names\">Q: What are other names for TSW Syndrome in the literature?<\/a><\/p>\n<p style=\"font-size: 19px; font-weight: bold;\"><a href=\"#present\">Q: How does TSWS present?<\/a><\/p>\n<p style=\"font-size: 19px; font-weight: bold;\"><a href=\"#eczema\">Q: How can TSWS be differentiated from severe Eczema?<\/a><\/p>\n<p style=\"font-size: 19px; font-weight: bold;\"><a href=\"#children\">Q: How does TSWS present in children?<\/a><\/p>\n<p style=\"font-size: 19px; font-weight: bold;\"><a href=\"#children\">Q: <\/a><a href=\"#treatment\">How is TSWS treated?<\/a><\/p>\n<p style=\"font-size: 19px; font-weight: bold;\"><a href=\"#children\">Q: <\/a><a href=\"#timeframe\">What is the time frame for TSWS to resolve?<\/a><\/p>\n<p style=\"font-size: 19px; font-weight: bold;\"><a href=\"#children\">Q: <\/a><a href=\"#phobic\">Are TSWS patients \u2018Steroid Phobic\u2019?<\/a><\/p>\n<p style=\"font-size: 19px; font-weight: bold;\"><a href=\"#children\">Q: <\/a><a href=\"#prevalence\">What is the prevalence of TSWS?<\/a><\/p>\n<p style=\"font-size: 19px; font-weight: bold;\"><a href=\"#children\">Q: <\/a><a href=\"#prevention\">How can TSWS be prevented?<\/a><\/p>\n<\/div><\/section><\/div>\n<\/p>\n<\/div><\/div><\/div><!-- close content main div --><\/div><\/div><div id='names'  class='avia-section av-2zhzaa-3e80c3bed96e491c7843ec640726dc0f main_color avia-section-default avia-no-shadow  avia-builder-el-39  el_after_av_section  el_before_av_section  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-94'><div class='entry-content-wrapper clearfix'>\n<section  class='av_textblock_section av-2yn3v6-7e1fa8066463f22c475743ab6caf40d9 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"48\" data-lineheight=\"56\"><strong>Q: What are other names for TSW Syndrome in the literature?<\/strong><\/h3>\n<h4 data-fontsize=\"32\" data-lineheight=\"36\">At a glance:<\/h4>\n<p>Click the term below to link to an example of where each term is used within the literature:<\/p>\n<table>\n<tbody>\n<tr>\n<td>\n<ul>\n<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25378953\" target=\"_blank\" rel=\"noopener noreferrer\">Topical Steroid Addiction<\/a><\/li>\n<li><a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-4362.1979.tb01905.x\/abstract\" target=\"_blank\" rel=\"noopener noreferrer\">Steroid Addiction<\/a><\/li>\n<li><a href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0738081X02003656\" target=\"_blank\" rel=\"noopener noreferrer\">Corticosteroid Addiction<\/a><\/li>\n<li><a href=\"http:\/\/journals.lww.com\/nursing\/Citation\/2007\/09000\/Facing_up_to_withdrawal_from_topical_steroids.46.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Steroid Addiction Syndrome<\/a><\/li>\n<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4171914\/\" target=\"_blank\" rel=\"noopener noreferrer\">Topical Corticosteroid Addiction<\/a><\/li>\n<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25592622\" target=\"_blank\" rel=\"noopener noreferrer\">Topical Corticosteroid Withdrawal<\/a><\/li>\n<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25592622\" target=\"_blank\" rel=\"noopener noreferrer\">Topical Corticosteroid Withdrawal Syndrome<\/a><\/li>\n<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=steroid-induced+rosacea-like+eruption\" target=\"_blank\" rel=\"noopener noreferrer\">Steroid-induced Rosacea-like Eruption<\/a><\/li>\n<\/ul>\n<\/td>\n<td>\n<ul>\n<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4228634\/\" target=\"_blank\" rel=\"noopener noreferrer\">Topical Steroid Damaged Facies<\/a><\/li>\n<li><a href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0738081X02003656\" target=\"_blank\" rel=\"noopener noreferrer\">Red Burning Skin Syndrome<\/a><\/li>\n<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12046812\" target=\"_blank\" rel=\"noopener noreferrer\">Steroid Dermatitis<\/a><\/li>\n<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3654273\/\" target=\"_blank\" rel=\"noopener noreferrer\">Steroid Dermatitis Resembling Rosacea<\/a><\/li>\n<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19445310\" target=\"_blank\" rel=\"noopener noreferrer\">Steroid-Induced Rosacea-like Dermatitis<\/a><\/li>\n<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21220878\" target=\"_blank\" rel=\"noopener noreferrer\">Topical Corticosteroid-Induced Rosacea-like Dermatitis (TCIRD)<\/a><\/li>\n<li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12781438\" target=\"_blank\" rel=\"noopener noreferrer\">Red Skin Syndrome<\/a><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3 data-fontsize=\"32\" data-lineheight=\"36\">Excerpts from the literature:<\/h3>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-2yezcm-d2b3b4b2b10c40e94eda20bc25341722\">\n#top .hr.hr-invisible.av-2yezcm-d2b3b4b2b10c40e94eda20bc25341722{\nheight:15px;\n}\n<\/style>\n<div  class='hr av-2yezcm-d2b3b4b2b10c40e94eda20bc25341722 hr-invisible  avia-builder-el-41  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-2xqzm6-137f10adbd75f8dc13ecbd717aa395c4 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><strong><em>Journal of the American Academy of Dermatology, March 2015:<\/em><\/strong><\/p>\n<p><em><b>\u201c<\/b>Nomenclature: Using our a priori definition of TCS withdrawal, the following names listed were used to describe this entity: facial corticosteroid addictive dermatitis, red skin syndrome, topical corticosteroid induced rosacea-like dermatitis, steroid addiction syndrome, steroid withdrawal syndrome, steroid dermatitis, post-laser peel erythema, status cosmeticus, red scrotum syndrome, chronic actinic dermatitis, anal atrophoderma, chronic eczema, corticosteroid addiction, light-sensitive seborrheid, perioral dermatitis, rosacea-like dermatitis, steroid- rosacea, and steroid dermatitis resembling rosacea.\u201d \u00a0(<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25592622\">1<\/a>)<\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-ajami-5676e1d60d11becfcbbef8964b76f4e1\">\n#top .hr.hr-invisible.av-ajami-5676e1d60d11becfcbbef8964b76f4e1{\nheight:15px;\n}\n<\/style>\n<div  class='hr av-ajami-5676e1d60d11becfcbbef8964b76f4e1 hr-invisible  avia-builder-el-43  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-2wnhmi-20bbd068dc0780c4834db2f9c8972186 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3>ITSAN Support Community:<\/h3>\n<p>Within the ITSAN Support community, the following terms are used almost exclusively: Topical Steroid Addiction (TSA), Topical Steroid Withdrawal (TSW), and Red Skin Syndrome (RSS). TSW Syndrome can occur when using topical or oral steroids for any purpose, in susceptible individuals. ITSAN has chosen to use TSW Syndrome (TSWS) as an umbrella term to describe the disease until medical consensus is reached concerning naming.<\/p>\n<p style=\"text-align: right;\"><a href=\"#questions\">\u25b2 Back to Questions<\/a><\/p>\n<\/div><\/section>\n\n<\/div><\/div><\/div><!-- close content main div --><\/div><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-2vqjcy-d3a418d1c27f27b93b1d8e099a4a3027\">\n.avia-section.av-2vqjcy-d3a418d1c27f27b93b1d8e099a4a3027{\nbackground-color:#f7f7f7;\nbackground-image:unset;\n}\n<\/style>\n<div id='present'  class='avia-section av-2vqjcy-d3a418d1c27f27b93b1d8e099a4a3027 main_color avia-section-default avia-no-shadow  avia-builder-el-45  el_after_av_section  el_before_av_section  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-94'><div class='entry-content-wrapper clearfix'>\n<section  class='av_textblock_section av-2vheku-f94aee9631caa42cbac2fa6e8a978eca '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"48\" data-lineheight=\"56\"><strong>Q: <\/strong>How does TSWS present?<\/h3>\n<h4 data-fontsize=\"32\" data-lineheight=\"36\">At a glance:<\/h4>\n<table width=\"700\">\n<tbody>\n<tr>\n<td>\n<ul>\n<li>Pruritus<\/li>\n<li>Oozing\/weeping exudate<\/li>\n<li>Erythema<\/li>\n<li>Burning\/stinging<\/li>\n<li>Rebound eruption<\/li>\n<li>Escalating dosage and frequency of application<\/li>\n<li>History of corticosteroids<\/li>\n<li>Scaling<\/li>\n<li>Cracking<\/li>\n<\/ul>\n<\/td>\n<td>\n<ul>\n<li>Swelling\/edema<\/li>\n<li>Tenderness<\/li>\n<li>Nerve pain<\/li>\n<li>Fatigue<\/li>\n<li>Desquamation\/peeling<\/li>\n<li>Elevated IgE<\/li>\n<li>Swollen lymph nodes<\/li>\n<li>Diminished tolerance for emollients<\/li>\n<li>Symptoms are long-lasting and severe<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Below are pictures submitted by members of the ITSAN community to illustrate how TSW Syndrome typically presents, and eventually resolves, by total cessation of topical steroids.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-198\" src=\"https:\/\/itsan.net\/wp-content\/uploads\/2021\/05\/rss_presentation.jpg\" alt=\"\" width=\"745\" height=\"1024\" srcset=\"https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/rss_presentation.jpg 745w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/rss_presentation-218x300.jpg 218w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/rss_presentation-513x705.jpg 513w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/rss_presentation-450x619.jpg 450w\" sizes=\"auto, (max-width: 745px) 100vw, 745px\" \/><\/p>\n<h3 data-fontsize=\"32\" data-lineheight=\"36\">Excerpts from the literature:<\/h3>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-2uv9wa-3a111913a5b726984d29ce0516c20faa\">\n.flex_column.av-2uv9wa-3a111913a5b726984d29ce0516c20faa{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-2uv9wa-3a111913a5b726984d29ce0516c20faa av_one_full  avia-builder-el-47  el_after_av_textblock  el_before_av_one_full  first flex_column_div av-zero-column-padding  column-top-margin'     ><section  class='av_textblock_section av-2tzlum-958d8c9558d8fe319b77284c96db15ce '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Journal of the American Academy of Dermatology<\/b><b>, March 2015:<\/b><\/em><\/p>\n<p><em>\u201cIn the erythematoedematous variant, the most commonly reported signs were erythema, scaling, papules, nodules, desquamation\/peeling, and swelling\/ edema. The most commonly reported symptoms were burning\/stinging (94.6%), pruritus, pain, and diminished tolerance for emollients. The papulopustular variant may be distinguished from the erythematoedematous variant by the prominent features of pustules, papules, nodules, and less frequently edema and burning\/stinging.\u201d (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25592622\" target=\"_blank\" rel=\"noopener noreferrer\">1<\/a>)<\/em><\/p>\n<\/blockquote>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-2tliiq-77b2411c8109155f3b06a7cd01e5735d\">\n#top .hr.hr-invisible.av-2tliiq-77b2411c8109155f3b06a7cd01e5735d{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-2tliiq-77b2411c8109155f3b06a7cd01e5735d hr-invisible  avia-builder-el-49  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n<section  class='av_textblock_section av-2t4khm-2e838ad1fa4f372bf597dcb0476b70df '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Clinics in Dermatology<\/b><b>, May-June 2003:<\/b><\/em><\/p>\n<p><em>\u201cAll of these patients had been treated with long-term topical corticosteroids, usually with escalating dosage and frequency of application. \u00a0In the majority of patients, the initial symptom of pruritus commonly evolved into a characteristic, severe burning sensation. In many cases, systemic corticosteroids had also been administered to relieve the severe erythema and burning, but this only exacerbated the condition. . . .<\/em><\/p>\n<p><em>The pattern of corticosteroid withdrawal was usually quite characteristic. Seven to 10 days after corticosteroids were stopped, an initial flare of erythema occurred at the site of the original dermatitis, accompanied by local spread and marked burning. This flare lasted anywhere from 7 to 14 days and culminated with exfoliation.. . .<\/em><\/p>\n<p><em>Withdrawal symptoms, manifested by angry erythema and burning, were long-lasting and severe.\u201d\u00a0<a href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0738081X02003656\" target=\"_blank\" rel=\"noopener noreferrer\">(3)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-2slaia-6f1446056091eecf80439c072cd3d0e4\">\n#top .hr.hr-invisible.av-2slaia-6f1446056091eecf80439c072cd3d0e4{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-2slaia-6f1446056091eecf80439c072cd3d0e4 hr-invisible  avia-builder-el-51  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n<section  class='av_textblock_section av-2rp5y6-1fe747e7aa88cfc314f1e851235bc1b7 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Drug, Healthcare and Patient Safety,<\/b>\u00a0<b>October 2014:<\/b><\/em><\/p>\n<p><em>\u201cTSA [Topical Steroid Addiction] is the situation where skin develops more severe or diverse skin manifestations after the withdrawal from TCS than at preapplication. . . . Before withdrawal, the addicted skin usually looks almost normal or well-controlled by TCS. Patients often subjectively notice . . . the itching may be more uncomfortable than before . . . or the TCS do not work as well as before. . . .<\/em><\/p>\n<p><em>After TCS withdrawal, the erythema often develops from the area of the skin where the intractable eczema remained and spreads gradually day by day. . . . This rebound eruption extends to areas of the skin where TCS have never been applied. The typical spreading course of the rebound eruption extends from the face to the neck, upper extremities, trunk, and then to the lower extremities, although there may be many variants. Sometimes, the rebound eruption spreads from only one eczematous finger to the arms, trunk, face, and lower extremities and then on to the whole body, even when there had been no other eczema on the patient and TCS had been used only on the affected finger. . . .<\/em><\/p>\n<p><em>After the acute phase of the red exudative rebound, a dry, itchy phase follows, with thickened and desquamative skin.\u201d<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4207549\/\" target=\"_blank\" rel=\"noopener noreferrer\">(2)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-2r3mka-0de9e0b83ee8123a603cd977469d288b\">\n#top .hr.hr-invisible.av-2r3mka-0de9e0b83ee8123a603cd977469d288b{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-2r3mka-0de9e0b83ee8123a603cd977469d288b hr-invisible  avia-builder-el-53  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n<section  class='av_textblock_section av-2qrteq-971b9b66c2de88adfc083a8c118d17bd '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Cutis,\u00a0<\/b><b>April 2009:<\/b><\/em><\/p>\n<p><em>\u201cChildren often present with the classic perioral type as well as perinasal and periocular eruptions. . . .\u201d<\/em><\/p>\n<p><em>\u201cAlthough it was believed that only high-potency topical steroids could produce SIRD [Steroid-induced Rosacea-like Dermatitis], it is important to note that topical hydrocortisone \u00a01% also can cause such an eruption after prolonged use.\u201d\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19445310\" target=\"_blank\" rel=\"noopener noreferrer\">(11)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-2puc0a-35851b7be50049ab9a3fe2cb474a8225\">\n#top .hr.hr-invisible.av-2puc0a-35851b7be50049ab9a3fe2cb474a8225{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-2puc0a-35851b7be50049ab9a3fe2cb474a8225 hr-invisible  avia-builder-el-55  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n<section  class='av_textblock_section av-2peqwa-363f54fcc7401ee550b0641119af2304 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>International Journal of Dermatology,\u00a0<\/b><b>January 1979:<\/b><\/em><\/p>\n<p><em>\u201c[Topical corticosteroid] Treatment continues optimistically for some weeks or months. Then, deliberately or accidentally (went on vacation without drug, forgot to refill) the skin receives no drug. Promptly, within a day or two, the treated areas become reddened, tender, itchy, cracked, scaling, and erupting into pustules, especially on the face. The original disease may exacerbate, but the key event is the rebound dermatitis which is exceedingly uncomfortable and distressing. The patient rushes to reapply the steroid and secures immediate relief. The itching, dryness, and scaling quickly abate. All is well until the next lapse when rebound dermatitis returns with greater intensity than before. The patient becomes \u201chooked\u201d in order to prevent the misery producing rebound flare. . . . \u00a0At this stage, stopping the steroids leads to a ferocious rebound within one or two days with fissuring, exudation, pustulation (of the face) and always with intolerable discomfort. The patient is now solidly addicted and cannot escape unless fortune furnishes a physician who recognizes the situation and specifies the one treatment the patient fears \u2014 withdrawal from the steroid (or starts the weaning process by substituting a weaker steroid).\u201d (<a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-4362.1979.tb01905.x\/abstract\" target=\"_blank\" rel=\"noopener noreferrer\">4<\/a>)<\/em><\/p>\n<\/blockquote>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-9nyoy-1d27b9d1c679882e54a4cedf967c382e\">\n#top .hr.hr-invisible.av-9nyoy-1d27b9d1c679882e54a4cedf967c382e{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-9nyoy-1d27b9d1c679882e54a4cedf967c382e hr-invisible  avia-builder-el-57  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n<section  class='av_textblock_section av-9lrzm-2bdc8096b4a4c11918d0ce7a73dd73c8 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Medical Hypotheses<\/b>,\u00a0<b>May-June<\/b>\u00a0<b>2005:<\/b><\/em><\/p>\n<p><em>\u201cThe therapy by corticosteroids influences the production of IgE, that is one of the key markers of the atopic diseases. Thus, therapy of patients with atopic dermatitis by topical corticosteroids within two weeks resulted in the elevation of spontaneous production of IgE by B-cells in vitro. The experiment has showed that corticosteroids are able to induce IgE production by B-lymphocytes when added to a culture in vitro. A synergy of IL-4 and corticosteroids in induction by B-cells of IgE production plays, probably, some role in the influence of corticosteroids on the course of atopic diseases.\u201d\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15617870\" target=\"_blank\" rel=\"noopener noreferrer\">(17)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section><\/p><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-2ncv92-1c22021115fa009e6c7a57dd55173ef0\">\n.flex_column.av-2ncv92-1c22021115fa009e6c7a57dd55173ef0{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-2ncv92-1c22021115fa009e6c7a57dd55173ef0 av_one_full  avia-builder-el-59  el_after_av_one_full  avia-builder-el-last  first flex_column_div av-zero-column-padding  column-top-margin'     ><section  class='av_textblock_section av-2mvh8y-1284dcb9f0aa77c3c0000133f38489a5 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"32\" data-lineheight=\"36\">ITSAN Support Community:<\/h3>\n<p>TSWS appears in our members without regard to area treated or topical steroid potency. Some members, especially infants and children, develop TSWS after very short periods, using low potency topical steroids on very small areas of the body. The first symptoms are usually spreading rashes and red, inflamed, itching, burning skin. Doctors have often advised treating more often, on larger areas, with a higher potency topical steroid. This exacerbates the problem as the burning, diffuse rash spreads to other areas of the body.<\/p>\n<p>If topical steroid therapy is withdrawn (even for brief periods between treatments), topical steroid withdrawal symptoms emerge: burning, stinging, oozing, massive flaking, swelling, swollen lymph nodes, elevated IgE levels, etc. As topical steroid withdrawal progresses, the \u201csyndrome\u201d symptoms emerge: insomnia, fatigue, altered thermoregulation, appetite changes, loose skin, hair loss, endocrine symptoms, immunological symptoms, etc.<\/p>\n<p>If steroid therapy is resumed, success is short-lived before leading to the same cycle of escalating symptoms. More aggressive treatment with super high potency topical steroids, oral steroids, or injected steroids lead to severe rebound upon cessation as well as withdrawal symptoms. Please see the\u00a0<a href=\"https:\/\/www.itsan.org\/us\/what-is-tsw-syndrome\/\">\u201cWhat is TSWS?\u201d<\/a>\u00a0tab for a detailed list of TSWS symptoms before and after topical steroid withdrawal.<\/p>\n<p style=\"text-align: right;\"><a href=\"#questions\">\u25b2 Back to Questions<\/a><\/p>\n<\/div><\/section><\/div>\n\n<\/div><\/div><\/div><!-- close content main div --><\/div><\/div><div id='eczema'  class='avia-section av-2mnc1e-cd819a2cd26467328d2764c3c8063a8d main_color avia-section-default avia-no-shadow  avia-builder-el-61  el_after_av_section  el_before_av_section  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-94'><div class='entry-content-wrapper clearfix'>\n<section  class='av_textblock_section av-2lyi22-67221be07c0b7fb7b520b44a7437cfeb '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"48\" data-lineheight=\"56\"><strong>Q: How can TSWS be differentiated from severe Eczema?<\/strong><\/h3>\n<h4 data-fontsize=\"32\" data-lineheight=\"36\">At a glance:<\/h4>\n<\/div><\/section>\n<div class='avia-data-table-wrap av-2lcpsq-842f0291d4d5973876cd67c08d6d8cb8 avia_responsive_table avia-table-1'><table  class='avia-table avia-data-table avia_pricing_default  avia-builder-el-63  el_after_av_textblock  el_before_av_textblock '  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/Table\" ><tbody><tr class='avia-heading-row'><th class=''>Eczema<\/th><th class=''>Topical Steroid Withdrawal Syndrome<\/th><\/tr><tr class=''><td class=''>Etiology: Spontaneous. Occasional family history of eczema.<\/td><td class=''>Etiology: History of topical steroid use with progressive exacerbation of original condition<\/td><\/tr><tr class=''><td class=''>Itchy<\/td><td class=''>Burning, stinging, incessant itch<\/td><\/tr><tr class=''><td class=''>Flakey<\/td><td class=''>Constant, profuse shedding of skin flakes (\u201csnowing\u201d)<\/td><\/tr><tr class=''><td class=''>Patches<\/td><td class=''>Diffuse, flushing rashes; erythema; general skin vasodilation; weeping\/oozing<\/td><\/tr><tr class=''><td class=''>Patches cycle, resolve, clear, and include periods of remission post treatment with topical steroid<\/td><td class=''>Rebound flares usually occur within days post topical steroid therapy, with increasing severity. Diligent topical steroid therapy becomes less effective over time with little or no period of remission.<\/td><\/tr><tr class=''><td class=''>Symptoms are skin-related: skin discomfort, sleep disruption, and self-consciousness<\/td><td class=''>Symptoms constitute a syndrome in addition to skin issues: enlarged lymph nodes, edema, altered thermoregulation, hair loss, extreme fatigue, appetite changes, hypersensitivity, nerve pain.<\/td><\/tr><\/tbody><\/table><\/div><style type='text\/css'>.avia-table-1 td:nth-of-type(1):before { content: 'Eczema'; } .avia-table-1 td:nth-of-type(2):before { content: 'Topical Steroid Withdrawal Syndrome'; } <\/style>\n<section  class='av_textblock_section av-28d3b2-91dda19e7c13cc70fd8195886f7ef6f0 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"48\" data-lineheight=\"56\"><strong>Excerpts from the literature:<\/strong><\/h3>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-27guyu-290b228d8ebcc5a4456ded07b1b7e97c\">\n.flex_column.av-27guyu-290b228d8ebcc5a4456ded07b1b7e97c{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-27guyu-290b228d8ebcc5a4456ded07b1b7e97c av_one_full  avia-builder-el-65  el_after_av_textblock  el_before_av_one_full  first flex_column_div av-zero-column-padding  column-top-margin'     ><section  class='av_textblock_section av-26tnh2-38370912199c01b0b929c57709b58891 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Drug, Healthcare and Patient Safety,<\/b>\u00a0<b>October 2014:<\/b><\/em><\/p>\n<p><em>\u201cAlthough the appearance of the skin lesion of TSA [Topical Steroid Addiction] is generally difficult to distinguish from the original skin disease, the distribution or expansion of the lesion might be a little different. The orthodox distribution of atopic dermatitis involves the neck, knees, or elbows (flexor parts of the body); in TSA, the appearance of a skin lesion is not limited to those sites. The only areas not affected by TSA or the rebound eruption are the palms and soles. . . . However, these can also be partially affected in severe cases.\u201d (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4207549\/\" target=\"_blank\" rel=\"noopener noreferrer\">2<\/a>)<\/em><\/p>\n<\/blockquote>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-266i2a-4dc19a91be341675bb4cf981b7c4eceb\">\n#top .hr.hr-invisible.av-266i2a-4dc19a91be341675bb4cf981b7c4eceb{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-266i2a-4dc19a91be341675bb4cf981b7c4eceb hr-invisible  avia-builder-el-67  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n<section  class='av_textblock_section av-25qxc6-61e431b9b499ff70914964633743d44e '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Dermatology Times<\/b>,<b>\u00a0October 2012:<\/b><\/em><\/p>\n<p><em>\u201cWhen examining the patient, look at the erythematous lesions. They will have a different appearance from classic eczema. Atopic dermatitis typically has excoriated, lichenified lesions in the antecubital and popliteal areas. In contrast, patients with steroid-induced dermatitis have distant pruritic papules, nummular wet lesions and general skin vasodilation.\u201d (<a class=\"_mPS2id-h\" href=\"#citations\">5<\/a>)<\/em><\/p>\n<\/blockquote>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-24zix2-df49b9e6093a79155d86176057e422a6\">\n#top .hr.hr-invisible.av-24zix2-df49b9e6093a79155d86176057e422a6{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-24zix2-df49b9e6093a79155d86176057e422a6 hr-invisible  avia-builder-el-69  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n<section  class='av_textblock_section av-7nxmy-9ff62b7a7972e19d7a861fc18b06d6c9 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Journal of the American Academy of Dermatology<\/b><\/em><b><em>, March 2015: \u00a0\u00a0\u00a0<\/em>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/b><\/p>\n<p><em>\u201cExtrapolating from our review, a clinician should favor TCS withdrawal over a flareup of the underlying atopic dermatitis if the following features are present: (1) burning is the prominent symptom, (2) confluent erythema occurs within days to weeks of TCS discontinuation, and (3) a history of frequent, prolonged TCS use on the face or genital region.\u201d (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25592622\" target=\"_blank\" rel=\"noopener noreferrer\">1<\/a>)<\/em><\/p>\n<\/blockquote>\n<\/div><\/section><\/p><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-23oo42-6afeb379008ff084e48a5d00d1253e43\">\n.flex_column.av-23oo42-6afeb379008ff084e48a5d00d1253e43{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-23oo42-6afeb379008ff084e48a5d00d1253e43 av_one_full  avia-builder-el-71  el_after_av_one_full  avia-builder-el-last  first flex_column_div av-zero-column-padding  column-top-margin'     ><section  class='av_textblock_section av-238zom-383a5ca837f963e9669b9db8b9dd678a '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"32\" data-lineheight=\"36\">ITSAN Support Community:<\/h3>\n<p>Eczema and\u00a0Topical Steroid Withdrawal Syndrome\u00a0are easier to differentiate if the clinician knows the history of corticosteroid use of the patient, and has close follow-up with the patient between treatments. Unlike eczema,\u00a0TSWS\u00a0escalates over time despite aggressive topical steroid therapy.\u00a0TSWS\u00a0has a distinctive presentation that is not typical of eczema, especially after ceasing topical steroid therapy. Our community reports that the skin symptoms, as well as the syndrome symptoms, are nothing like the original eczema. Many in our community did not present with eczema in the first place. Some experienced\u00a0TSWS\u00a0from topical steroids in cosmetics or skin products, some from being a caregiver and applying topical steroids to another person, while others experienced it without any previous skin condition after receiving oral or injected corticosteroids.<\/p>\n<p style=\"text-align: right;\"><a href=\"#questions\">\u25b2 Back to Questions<\/a><\/p>\n<\/div><\/section><\/div>\n\n<\/div><\/div><\/div><!-- close content main div --><\/div><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-22wlji-f15236337d52eabe7d8b0ba7f683d0a5\">\n.avia-section.av-22wlji-f15236337d52eabe7d8b0ba7f683d0a5{\nbackground-color:#f7f7f7;\nbackground-image:unset;\n}\n<\/style>\n<div id='children'  class='avia-section av-22wlji-f15236337d52eabe7d8b0ba7f683d0a5 main_color avia-section-default avia-no-shadow  avia-builder-el-73  el_after_av_section  el_before_av_section  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-94'><div class='entry-content-wrapper clearfix'>\n<section  class='av_textblock_section av-228l42-07118f9f184a5fdcec90b29e6fbde9c5 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"48\" data-lineheight=\"56\"><strong>Q: How does TSWS present in children?<\/strong><\/h3>\n<h4 data-fontsize=\"32\" data-lineheight=\"36\">At a glance:<\/h4>\n<ul>\n<li>Presentation and treatment is similar to that of adults<\/li>\n<li>The clinical picture is variable, taking an average of 1 year to clear<\/li>\n<li>Pediatric community must be alerted to this avoidable and difficult problem<\/li>\n<li>No large-scale studies have attempted to quantify the incidence of TSWS in children<\/li>\n<li>Cases of TCS withdrawal in the pediatric population are underreported<\/li>\n<\/ul>\n<p>Below are images of children from the ITSAN\u00a0 support group who have recovered after ceasing use of topical steroids:<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-203\" src=\"https:\/\/itsan.net\/wp-content\/uploads\/2021\/05\/chiildren2.jpg\" alt=\"\" width=\"791\" height=\"1024\" srcset=\"https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/chiildren2.jpg 791w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/chiildren2-232x300.jpg 232w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/chiildren2-768x994.jpg 768w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/chiildren2-545x705.jpg 545w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/chiildren2-450x583.jpg 450w\" sizes=\"auto, (max-width: 791px) 100vw, 791px\" \/><\/p>\n<h3 data-fontsize=\"32\" data-lineheight=\"36\">Excerpts from the literature:<\/h3>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-21gaza-4aa8af9d482ebfbb2f4958bb8572792b\">\n#top .hr.hr-invisible.av-21gaza-4aa8af9d482ebfbb2f4958bb8572792b{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-21gaza-4aa8af9d482ebfbb2f4958bb8572792b hr-invisible  avia-builder-el-75  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-20vy9i-1a6cf78ebde416f87784dbc2ac8c34af '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Journal of the American Medical Association Pediatrics (<\/b><b>Formerly<\/b><b>\u00a0Archives of Pediatric and Adolescent Medicine)<\/b><b>, January 2000:<\/b><\/em><\/p>\n<p><em>\u201cWe evaluated 106 (46 boys and 60 girls) who developed steroid rosacea. . . . The mean age at onset was 7.04 years (range, 6 months to 13 years). Twenty-nine children [27%] were younger than 3 years.\u201d\u00a0<a href=\"http:\/\/archpedi.jamanetwork.com\/article.aspx?articleid=348509\" target=\"_blank\" rel=\"noopener noreferrer\">(14)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-20gri6-15e2d1982d56c34fd62e986de54cbdad\">\n#top .hr.hr-invisible.av-20gri6-15e2d1982d56c34fd62e986de54cbdad{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-20gri6-15e2d1982d56c34fd62e986de54cbdad hr-invisible  avia-builder-el-77  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-1zoxkq-26c5270f66f757e7cf36695a130b0182 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Journal of the American Academy of Dermatology<\/b><b>, March 2015:<\/b><\/em><\/p>\n<p><em>\u201c. . . 69 (7.1%) cases were reported in patients 18 years of age and younger, of which only 0.3% were reported younger than 3 years. Burning and stinging are the most frequently reported symptoms with erythema being the most common sign. Signs and symptoms occur days to weeks after TCS discontinuation. . . . there are no data regarding the prevalence of this condition. It is also unclear whether children are actually less likely to develop this disorder or that cases of TCS withdrawal in the pediatric population are underreported.\u201d (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25592622\" target=\"_blank\" rel=\"noopener noreferrer\">1<\/a>)<\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-1z2adi-8b9cd95fa1cbafad2cd76805cb65fb16\">\n#top .hr.hr-invisible.av-1z2adi-8b9cd95fa1cbafad2cd76805cb65fb16{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-1z2adi-8b9cd95fa1cbafad2cd76805cb65fb16 hr-invisible  avia-builder-el-79  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-1ynk1u-1456671891762f12184dc64032f1ba12 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>British Journal of Dermatology<\/b><b>,<\/b><b>\u00a0November 1972<\/b>:<\/em><\/p>\n<p><em>\u201cEleven children have shown similar changes on the facial skin. A bright malar flush was accompanied at times by small superficial papules, pustules and scaling. The clinical picture was variable, sometimes closely resembling rosacea and sometimes peri-oral dermatitis, taking an average of 1 year to clear. . . . Seven of the 11 children had a family history of atopy, and 2 had a family history of rosacea. Potent topical corticosteroids may have played a role in the cause of these children\u2019s rash and, on withdrawal, there was sometimes a pustular exacerbation. . . . at least 8 were known to have been treated with potent topical corticosteroids.\u201d\u00a0<a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-2133.1972.tb01589.x\/abstract\" target=\"_blank\" rel=\"noopener noreferrer\">(12)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-1y4h0i-df97fea52bb61aa9136144d9a9327a8f\">\n#top .hr.hr-invisible.av-1y4h0i-df97fea52bb61aa9136144d9a9327a8f{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-1y4h0i-df97fea52bb61aa9136144d9a9327a8f hr-invisible  avia-builder-el-81  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-1xju1a-4482f2c7d79ffd27f1037c5e5a7f8e2f '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Pediatrics<\/b><b>, July 1979:<\/b><\/em><\/p>\n<p><em>\u201cCase reports of steroid rosacea in children are not as abundant . . . \u00a0in the American Literature. The purpose of this communication is to describe four children who developed steroid rosacea following the use of topical fluorinated glucocorticosteroids and to alert the pediatric community of this avoidable and at times difficult problem.\u201d\u00a0<a href=\"http:\/\/pediatrics.aappublications.org\/content\/pediatrics\/64\/1\/36.full.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">(13)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-1x0beu-fb1d253a5f69be7d36c1d135ada91938\">\n#top .hr.hr-invisible.av-1x0beu-fb1d253a5f69be7d36c1d135ada91938{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-1x0beu-fb1d253a5f69be7d36c1d135ada91938 hr-invisible  avia-builder-el-83  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-1vytpy-8ae969e2c1c1a2b6a83afbef280f1efa '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"32\" data-lineheight=\"36\"><\/h3>\n<h3 data-fontsize=\"24\" data-lineheight=\"30\">ITSAN Support Community:<\/h3>\n<p>The pediatric population represents a sizable percentage of the ITSAN support group. The symptoms in children mirror the symptoms in adults, and treatment modalities are comparable. Children seem to recover more rapidly than adults \u2014 though recovery times vary. Generally speaking, children with TSW have severe withdrawal symptoms in the first 6 months and make significant progress by 12-18 months off topical steroids, with the majority returning to normal life (whether completely symptom free or not) within 24 months. TSW Syndrome is woefully underreported in the pediatric population. Prevalence is not known and is therefore assumed to be rare. However, \u201crare\u201d must never be confused with \u201cnon-existent.\u201d Prevention and\/or early recognition is key.<\/p>\n<p>Consider TSW Syndrome for pediatric patients whose mild eczema becomes widespread and aggressive, despite meticulous use of topical steroids, exactly as directed.\u00a0Reconcile all use of over-the-counter topical corticosteroids, as well as prescriptions written by other specialists: allergists, pediatricians, dermatologists, family doctors, etc. Has the patient also used other forms of corticosteroids, especially concurrently? Side effects, including TSWS, are even more likely with a cumulative steroid load of topical steroids, nasal sprays, metered dose inhalers, nebulizers, and\/or oral steroids.<\/p>\n<p>For more insight into TSW Syndrome in children, please see this review: \u201c<a href=\"https:\/\/tswresearchgroup.files.wordpress.com\/2015\/06\/systematic-review-of-tsw-in-children-diagnosed-with-eczema-rev.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">A systematic review of topical steroid withdrawal in children diagnosed with eczema<\/a>,\u201d which analyzes data from the blogs of 26 children with TSWS. \u00a0(<a href=\"http:\/\/www.crd.york.ac.uk\/PROSPERO\/display_record.asp?ID=CRD42015019001\" target=\"_blank\" rel=\"noopener noreferrer\">16<\/a>)<\/p>\n<p style=\"text-align: right;\"><a href=\"#questions\">\u25b2 Back to Questions<\/a><\/p>\n<\/div><\/section>\n\n<\/div><\/div><\/div><!-- close content main div --><\/div><\/div><div id='treatment'  class='avia-section av-1vghja-9a5f4fbf5cc6f82c6629ec5758b3e7ed main_color avia-section-default avia-no-shadow  avia-builder-el-85  el_after_av_section  el_before_av_section  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-94'><div class='entry-content-wrapper clearfix'>\n<section  class='av_textblock_section av-1uzg3y-fba9ac770ce2224fa7d2c1e965c45df5 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"48\" data-lineheight=\"56\"><strong>Q: How is TSWS treated?<\/strong><\/h3>\n<h4 data-fontsize=\"32\" data-lineheight=\"36\">At a glance:<\/h4>\n<\/div><\/section>\n<div class='avia-data-table-wrap av-1u6rpa-dcfcd33e63231f616797a880f669ee10 avia_responsive_table avia-table-2'><table  class='avia-table avia-data-table avia_pricing_default  avia-builder-el-87  el_after_av_textblock  el_before_av_textblock '  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/Table\" ><tbody><tr class='avia-heading-row'><th class=''>Symptom<\/th><th class=''>Treatment<\/th><\/tr><tr class=''><td class=''>Topical Steroid Withdrawal Syndrome<\/td><td class=''>Total cessation of topical steroid therapy (no consensus on tapering vs \u201ccold turkey\u201d)<\/td><\/tr><tr class=''><td class=''>Burning<\/td><td class=''>Cold compresses, tepid baths, mineral water sprays (refrigerated), wet wraps<\/td><\/tr><tr class=''><td class=''>Stinging\/ Nerve pain<\/td><td class=''>Oral Gabapentin, Pregabalin, pain medications<\/td><\/tr><tr class=''><td class=''>Itching\/Pruritus<\/td><td class=''>Oral antihistamines (Diphenhydramine, Hydroxyzine), Doxepin, Topical Pramoxine, dry wraps (gauze, eczema wear, gloves)<\/td><\/tr><tr class=''><td class=''>Oozing\/weeping<\/td><td class=''>Burow\u2019s solution (Domeboro), Zinc paste, Viscopaste bandages<\/td><\/tr><tr class=''><td class=''>Infection\/Inflammation<\/td><td class=''>Topical\/Oral antibiotics, Antivirals, Antifungals \u2013 per swab for culture and sensitivity.<\/td><\/tr><tr class=''><td class=''>Insomnia<\/td><td class=''>Sleep aids, relaxation techniques<\/td><\/tr><tr class=''><td class=''>Anxiety\/Depression<\/td><td class=''>Anxiety medications\/anti-depressants, phone calls, frequent follow-up, emotional support<\/td><\/tr><tr class=''><td class=''>Skin shedding\/flaking\/peeling<\/td><td class=''>Emollients, dry wraps (gauze, eczema wear, gloves)<\/td><\/tr><tr class=''><td class=''>Rashes\/Itching in later stages of TSWS<\/td><td class=''>Narrowband UVB light therapy<\/td><\/tr><\/tbody><\/table><\/div><style type='text\/css'>.avia-table-2 td:nth-of-type(1):before { content: 'Symptom'; } .avia-table-2 td:nth-of-type(2):before { content: 'Treatment'; } <\/style>\n<section  class='av_textblock_section av-1abkha-b6c7e24be8e427cde44a961c3392d5c5 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"32\" data-lineheight=\"36\">Excerpts from the literature:<\/h3>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-19p6ui-0df569746b55e7489a118371a1d42f49\">\n#top .hr.hr-invisible.av-19p6ui-0df569746b55e7489a118371a1d42f49{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-19p6ui-0df569746b55e7489a118371a1d42f49 hr-invisible  avia-builder-el-89  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-18zls6-fe08dde5cf045751e972fe9f79f227ba '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Journal of the American Academy of Dermatology<\/b><b>, March 2015:<\/b><\/em><\/p>\n<p><em>\u201cAlmost all authors recommended discontinuing the use of TCS (95.5%). The papulopustular subgroup was more frequently treated with oral antibiotics whereas the erythematoedematous variant reported the use of antihistamines, ice\/cool compresses, and psychological support. \u00a0. . . It is unclear if either a tapering off of TCS or immediate discontinuation has any added benefits.\u201d (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25592622\" target=\"_blank\" rel=\"noopener noreferrer\">1<\/a>)<\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-18jq0u-3b4ec169aea3d9ca0bf718aff2d27b11\">\n#top .hr.hr-invisible.av-18jq0u-3b4ec169aea3d9ca0bf718aff2d27b11{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-18jq0u-3b4ec169aea3d9ca0bf718aff2d27b11 hr-invisible  avia-builder-el-91  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-17y48u-952e45dd101dc268735f017f0805a7ca '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Practical Dermatology<\/b><b>, September 2015:<\/b><\/em><\/p>\n<p><em>\u201cFor those suffering with topical steroid addiction\/withdrawal, we should work to maximize all of our other non-cortisone treatments, from antihistamines to phototherapy and beyond\u2014along with lots and lots of support\u2014to help get through it. Systemic cyclosporine also may be helpful in cases where TSW is present but atopic dermatitis is still raging elsewhere and needing control. Nerve calming preparations such as topical pramoxine, oral gabapentin, and even simple cooling techniques with cool compresses, wet wraps, and even mineral water sprays can work together to offer relief in aggregate for these unfortunate patients.\u201d (<a href=\"https:\/\/practicaldermatology.com\/articles\/2015-sep\/the-challenges-of-topical-steroid-withdrawalogy\" target=\"_blank\" rel=\"noopener noreferrer\">7<\/a>)<\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-173lei-333c5d6136c59e1492db201221713474\">\n#top .hr.hr-invisible.av-173lei-333c5d6136c59e1492db201221713474{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-173lei-333c5d6136c59e1492db201221713474 hr-invisible  avia-builder-el-93  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-16srcu-f7bc586c12474edede875e400633c79a '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Clinics in Dermatology<\/b><b>, May-June 2003:<\/b><\/em><\/p>\n<p><em>\u201cIn addition to discontinuation of all corticosteroids, we instituted a therapeutic regimen of emollients, antihistamines, baths, Burow\u2019s solution, and ice compresses. As flares became progressively less severe, UVA and UVB treatments, one to three times a week, were begun in some patients. In five cases, PUVA was instituted when initial atopic dermatitis had been very widespread. Two patients had tried topical tacrolimus but had stopped because of increased irritation. Two of the patients with chronic actinic dermatitis were given a 2-to-3 month course of oral cyclosporin, 1 to 3 mg\/kg\/day, which appeared not to alter the course of the withdrawal phase. In no other instance were antimitotics, immunosuppressives, or immunomodulators utilized.\u201d \u00a0(<a href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0738081X02003656\" target=\"_blank\" rel=\"noopener noreferrer\">3)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-164v3e-6ce7202adf93296039a6840bdfe54ccd\">\n#top .hr.hr-invisible.av-164v3e-6ce7202adf93296039a6840bdfe54ccd{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-164v3e-6ce7202adf93296039a6840bdfe54ccd hr-invisible  avia-builder-el-95  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-1554wm-0b141e7f99ba08f7130a49094f8ea4d9 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>International Journal of Dermatology, Jan-Feb 1979:<\/b><\/em><\/p>\n<p><em>\u201cFinally, what can be done for addicted patients? This is no enterprise for the short- tempered, impatient physician. Withdrawal is agonizing and the doctor must be enrolled in the battle emotionally, providing strenuous support and unremitting encouragement. Frequent contact, by phone and in person, will be necessary to allay fear and to maintain an optimistic outlook.\u201d . . .<\/em><\/p>\n<p><em>\u201cFor stalwart, stoical patients, we have used \u201ccold turkey,\u201d replacing the steroid with lubricating cream, applied liberally q.i.d. . . . For most patients, we follow a weaning protocol, using first 2.5% hydrocortisone for several weeks with a warning that this may not completely prevent a rebound flare. Eventually we drop to 1.0% hydrocortisone and finally we substitute lubricating cream, at which time a minor flare is not unusual.\u201d\u00a0<a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-4362.1979.tb01905.x\/abstract\" target=\"_blank\" rel=\"noopener noreferrer\">(4)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-14yta6-c611ff377f1df20628a59bcdbf45b0f8\">\n#top .hr.hr-invisible.av-14yta6-c611ff377f1df20628a59bcdbf45b0f8{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-14yta6-c611ff377f1df20628a59bcdbf45b0f8 hr-invisible  avia-builder-el-97  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-148eie-55ca0f0a50c3d2c5b4dc05e79876ab40 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Cutis,\u00a0<\/b><b>April 2009:<\/b><\/em><\/p>\n<p><em>\u201cIn children, the treatment of SIRD [Steroid-induced Rosacea-like Dermatitis] is similar to adults and involves cessation of topical steroid use as well as therapy with oral and topical \u00a0antibiotics. As tetracyclines are contraindicated in children because of discoloration of teeth, oral erythromycin is the antibiotic of choice. \u00a0A dosage of 30 mg\/kg daily every 12 hours for \u00a04 weeks has been recommended. There have been no case reports regarding the use of tacrolimus and pimecrolimus in the treatment of children with SIRD.\u201d \u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19445310\" target=\"_blank\" rel=\"noopener noreferrer\">(11)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-13df2u-af0378ea6a26f3d7008bc7d2bb350210\">\n#top .hr.hr-invisible.av-13df2u-af0378ea6a26f3d7008bc7d2bb350210{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-13df2u-af0378ea6a26f3d7008bc7d2bb350210 hr-invisible  avia-builder-el-99  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-131w9i-4f698e285f468f0b2b19f0eb33cc4673 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Journal of the American Medical Association Pediatrics<\/b><b>\u00a0(Formerly\u00a0<\/b><b>Archives of Pediatric and Adolescent Medicine<\/b><b>), January 2000:<\/b><\/em><\/p>\n<p><em>\u201cAlthough it has been recommended to gradually withdraw topical steroids in children for fear of a worsening of the rosacea, we reasoned that to continue treating with the preparation that induced the condition could not be supported. Therefore, in all patients, we recommended an abrupt cessation of topical steroid use and initiating treatment with oral erythromycin stearate at 30 mg\/kg per day in 2 daily doses for 4 weeks or topical clindamycin phosphate twice daily for 4 weeks in 6 patients who had a history of erythromycin intolerance or allergy. . . .<\/em><\/p>\n<p><em>\u201cAbrupt discontinuation of topical corticosteroids and institution of oral antibiotics resulted in clearing . . .. This finding does not support the concept that prepubertal children with steroid rosacea need to continue low-strength steroids in a gradual withdrawal strategy. This conclusion is supported by the finding that 54% developed the steroid rosacea while being treated with the lowest-strength (class 7) topical corticosteroids. Even over-the-counter hydrocortisone preparations induced steroid rosacea in susceptible children.\u201d\u00a0<a href=\"http:\/\/archpedi.jamanetwork.com\/article.aspx?articleid=348509\" target=\"_blank\" rel=\"noopener noreferrer\">(14)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-127u0e-5456a24a2faa496bba5171229e2c569b\">\n#top .hr.hr-invisible.av-127u0e-5456a24a2faa496bba5171229e2c569b{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-127u0e-5456a24a2faa496bba5171229e2c569b hr-invisible  avia-builder-el-101  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-11yile-bcff8a08d8494398a965358cac880617 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Nursing 2007<\/b>,\u00a0<b>September 2007:<\/b><\/em><\/p>\n<p><em>\u201cYour patient will need a clear outline of what to expect during the withdrawal period. For example, she needs to know that rebound flares will occur, but that they\u2019ll be temporary. To relieve withdrawal symptoms, tell her she can apply cool compresses or refrigerated emollients such as petroleum jelly (Vaseline) or glycerin and rosewater, which have minimal irritant and sensitization potential. . . . Learn to recognize this condition in patients, then give them your guidance and emotional support as they withdraw from steroids and break the cycle.\u201d (<a href=\"http:\/\/journals.lww.com\/nursing\/Citation\/2007\/09000\/Facing_up_to_withdrawal_from_topical_steroids.46.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">8<\/a>)<\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-1135fe-05244ccfd92b01a5e55c53e2613afdcb\">\n#top .hr.hr-invisible.av-1135fe-05244ccfd92b01a5e55c53e2613afdcb{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-1135fe-05244ccfd92b01a5e55c53e2613afdcb hr-invisible  avia-builder-el-103  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-10hgy6-44f9600fb4646fa2e78225b154c34d74 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Indian Journal of Dermatology<\/b>,\u00a0<b>Venereology and Leprology,<\/b><b>\u00a02011:<\/b><\/em><\/p>\n<p><em>\u201cTreatment is difficult as there is rebound phenomenon with discontinuation of the topical steroid. Gradual tapering with complete cessation of the topical steroid and addition of oral anti-inflammatory antibiotics and\/or topical antibiotics are usually recommended to get a good clinical result.\u201d (<a href=\"https:\/\/ijdvl.com\/topical-corticosteroid-induced-rosacea-like-dermatitis-a-clinical-study-of-110-cases\/\" target=\"_blank\" rel=\"noopener noreferrer\">6)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-109lrq-2ce00cd3019a97f0bed80e7d2a0fc16a\">\n#top .hr.hr-invisible.av-109lrq-2ce00cd3019a97f0bed80e7d2a0fc16a{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-109lrq-2ce00cd3019a97f0bed80e7d2a0fc16a hr-invisible  avia-builder-el-105  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-zglei-800360f8d7169c69b2b4991b9acdc4eb '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Clinical, Cosmetic and Investigational Dermatology,\u00a0<\/b><b>July 2016<\/b><b>:<\/b><\/em><\/p>\n<p><em>\u201cSince the long-term prognosis in AD patients using TCS is not superior to those not using TCS, and there is evidence that a significant number of AD patients improve without using TCS, managing patients declining TCS should be an acceptable scenario. Moreover, if these patients have topical steroid addiction in addition to AD, their symptoms will not resolve unless they cease using TCS. If physicians decline to manage these patients and they are left without medical supervision, then they would be at greater risk of an adverse outcome due to secondary infections. Hence, we believe that physicians treating AD patients should be open to managing them without the use of TCS, if the patient is competent and makes this choice.\u201d\u00a0<a href=\"https:\/\/www.dovepress.com\/a-prospective-study-of-atopic-dermatitis-managed-without-topical-corti-peer-reviewed-fulltext-article-CCID\" target=\"_blank\" rel=\"noopener noreferrer\">(15)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-yozce-e8d3cdcc1c3b50faa2e2ee8b5f54633a\">\n#top .hr.hr-invisible.av-yozce-e8d3cdcc1c3b50faa2e2ee8b5f54633a{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-yozce-e8d3cdcc1c3b50faa2e2ee8b5f54633a hr-invisible  avia-builder-el-107  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-yg3we-afa615481d38d155ebdca80979be4933 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"32\" data-lineheight=\"36\"><b>ITSAN Support Community:<\/b><\/h3>\n<p>The vast majority of our members ceased topical steroids \u201ccold turkey.\u201d Our members report that tapering topical steroids (whether by substituting a weaker steroid or using less of often, or both) seemed to prolong the steroid\u00a0<a href=\"http:\/\/www.medsafe.govt.nz\/profs\/PUArticles\/June2013Steroid.htm#1\">rebound phase<\/a>. \u00a0To date, a topical steroid \u201cstep down\u201d method without rebound or relapse of symptoms has not been discovered. However, step down therapies may (in theory) be helpful in reducing the systemic symptoms of the syndrome. Successful treatment regimens include ceasing topical\/oral\/injected corticosteroids, treating symptoms, and monitoring for infection.<\/p>\n<p>Narrowband UVB light therapy can be a helpful option in the later stages of TSWS, when the skin is no longer raw, burning or oozing. UV therapy can cause irritation when used in the early stages, so caution must be used.<\/p>\n<p>Immunosuppressants and immunomodulators have also helped some of our community members lessen the severity of TSWS symptoms. However, these medications are not meant to be used long term. There are side effects and risks that all patients need to be aware of to have proper informed consent. Many in the TSW community also experienced short-lived relief, with return of symptoms and\/or new symptoms over time \u2013 mirroring their topical steroid withdrawal experience.<\/p>\n<p>Infections reported in support groups are most commonly Staph, MRSA, and Eczema Herpeticum. Skin is open and vulnerable to infection during TSWS, so physician support and close monitoring is imperative. Treatment methods for infection and infection prevention include: swabbing for infection, antibiotics (oral or topical), antivirals, bleach baths, apple cider vinegar baths, saltwater baths, as well as dry wrapping (or with an emollient) in gauze, eczema wear, and gloves. Many of our members also seek out alternatives for infection prevention which include silver sprays, antibacterial essential oil blends, coconut oil, etc. Please see the \u201c<a href=\"https:\/\/www.itsan.org\/us\/coping-with-tsw\/\">Coping with TSWS<\/a>\u201d tab for tips culminating in a \u201c<a href=\"https:\/\/www.itsan.org\/us\/coping-with-tsw\/#survival\">Survival Guide<\/a>\u201d for TSWS sufferers from one member to another.<\/p>\n<p>The most important things to remember when treating TSWS topical steroid cessation is imperative, the time frame is protracted, symptoms vary at different stages, and treatment must be tailored to the individual.<\/p>\n<p style=\"text-align: right;\"><a href=\"#questions\">\u25b2 Back to Questions<\/a><\/p>\n<\/div><\/section>\n\n<\/div><\/div><\/div><!-- close content main div --><\/div><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-xuujm-7e3e4f3a804cc183375b4bf8db8c2b1d\">\n.avia-section.av-xuujm-7e3e4f3a804cc183375b4bf8db8c2b1d{\nbackground-color:#f7f7f7;\nbackground-image:unset;\n}\n<\/style>\n<div id='timeframe'  class='avia-section av-xuujm-7e3e4f3a804cc183375b4bf8db8c2b1d main_color avia-section-default avia-no-shadow  avia-builder-el-109  el_after_av_section  el_before_av_section  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-94'><div class='entry-content-wrapper clearfix'>\n<section  class='av_textblock_section av-x0p1u-412af55ccfc871c91ea5d7966f7db86c '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"48\" data-lineheight=\"56\"><strong>Q: What is the time frame for TSWS to resolve?<\/strong><\/h3>\n<h4 data-fontsize=\"32\" data-lineheight=\"36\">At a glance:<\/h4>\n<ul>\n<li>Recovery is protracted<\/li>\n<li>Time required to recover is proportionate to the time topical steroids were used<\/li>\n<li>Symptoms take many months to several years to resolve<\/li>\n<\/ul>\n<h3 data-fontsize=\"32\" data-lineheight=\"36\">Excerpts from the literature:<\/h3>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-wmo6u-586d6b5fd3547d0912eb2e080973cb3b\">\n#top .hr.hr-invisible.av-wmo6u-586d6b5fd3547d0912eb2e080973cb3b{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-wmo6u-586d6b5fd3547d0912eb2e080973cb3b hr-invisible  avia-builder-el-111  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-bgkm-81c1a2e8814436365f69b52ece558b66 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Dermatology Times<\/b>,<b>\u00a0October 2012:<\/b><\/em><\/p>\n<p><em>\u201cIt can take several months to several years for the erythema and symptoms to subside\u2026\u201d \u00a0(<a class=\"_mPS2id-h\" href=\"#citations\">5<\/a>)<\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-v7pxi-d502cecec08c4bb98afe09e93042b073\">\n#top .hr.hr-invisible.av-v7pxi-d502cecec08c4bb98afe09e93042b073{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-v7pxi-d502cecec08c4bb98afe09e93042b073 hr-invisible  avia-builder-el-113  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-urel2-1083eba80282a8f4f545dd9b4da56d90 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Australian Family Physician<\/b><b>, June 2016:<\/b><\/em><\/p>\n<p><em>\u201cThe prolonged withdrawal period (months to years) can take a significant toll on the patient\u2019s mental health. Multiple telephone calls and visits for reassurance have been recommended.\u201d\u00a0<a href=\"http:\/\/www.racgp.org.au\/afp\/2016\/june\/topical-corticosteroid-addiction-and-withdrawal-%E2%80%93-an-overview-for-gps\/\" target=\"_blank\" rel=\"noopener noreferrer\">(9)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-u87rm-e66e6fcc265fe8950517c4d61d710f8c\">\n#top .hr.hr-invisible.av-u87rm-e66e6fcc265fe8950517c4d61d710f8c{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-u87rm-e66e6fcc265fe8950517c4d61d710f8c hr-invisible  avia-builder-el-115  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-t9vt6-a74b35ba4a01095b425fed4ec0e838a4 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>International Journal of Dermatology, Jan-Feb 1979:<\/b><\/em><\/p>\n<p><em>\u201cThe first few weeks will be a living hell. The time required for the skin to return to normal depends on the degree of atrophy. Long-term addicts may have damage which cannot be completely reversed, but for the most part great improvement can be anticipated over a period of months. It is not wise to underestimate the time required.\u201d \u00a0<a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-4362.1979.tb01905.x\/abstract\" target=\"_blank\" rel=\"noopener noreferrer\">(4)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-t4hae-0e725a03ed240cdcb79054c6cb7f1319\">\n#top .hr.hr-invisible.av-t4hae-0e725a03ed240cdcb79054c6cb7f1319{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-t4hae-0e725a03ed240cdcb79054c6cb7f1319 hr-invisible  avia-builder-el-117  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-sac9a-29436e5d173a6b4acf443141a7a7a0e2 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Clinics in Dermatology<\/b><b>, May-June 2003:<\/b><\/em><\/p>\n<p><em>\u201cThis pattern of flare and quiescence repeated itself but each time with flares of shorter duration and more prolonged quiescent periods. . . . Edema, burning, and erythema decreased with each episode of flare. . . . The time required for corticosteroid withdrawal mirrored the time over which they had originally been applied, and was often protracted.\u201d (<a href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0738081X02003656\" target=\"_blank\" rel=\"noopener noreferrer\">3<\/a>)<\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-ryqa2-55ee6e47a2c059781e4a6de71157481b\">\n#top .hr.hr-invisible.av-ryqa2-55ee6e47a2c059781e4a6de71157481b{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-ryqa2-55ee6e47a2c059781e4a6de71157481b hr-invisible  avia-builder-el-119  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-r8xvu-87a22940c2a33b454513b92726ff1f99 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>British Journal of Dermatology, November 1972:<\/b><\/em><\/p>\n<p><em>\u201cThe clinical picture was variable, sometimes closely resembling rosacea and sometimes peri-oral dermatitis, taking an average of 1 year to clear.\u201d <a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-2133.1972.tb01589.x\/abstract\" target=\"_blank\" rel=\"noopener noreferrer\">(12)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-2nno2-9f79914f194264f949de27f933c10556\">\n#top .hr.hr-invisible.av-2nno2-9f79914f194264f949de27f933c10556{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-2nno2-9f79914f194264f949de27f933c10556 hr-invisible  avia-builder-el-121  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-ppila-7437bb6547839ff5cba068fc14f8c68e '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Nursing 2007<\/b>,\u00a0<b>September 2007:<\/b><\/em><\/p>\n<p><em>\u201cYour patient may need support by telephone follow-up because emotional distress often accompanies withdrawal. Warn her that symptoms may last for many months, proportionate to the time she used the topical steroid.\u201d\u00a0<a href=\"http:\/\/journals.lww.com\/nursing\/Citation\/2007\/09000\/Facing_up_to_withdrawal_from_topical_steroids.46.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">(8)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-p7vhe-3b4b56c11a1ad5800b30c0b16c317a73\">\n#top .hr.hr-invisible.av-p7vhe-3b4b56c11a1ad5800b30c0b16c317a73{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-p7vhe-3b4b56c11a1ad5800b30c0b16c317a73 hr-invisible  avia-builder-el-123  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-oykga-357ff002b19d047ff596eaf8023a1f3b '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"32\" data-lineheight=\"36\">ITSAN Support Community:<\/h3>\n<p>Within the ITSAN community, recovery time is variable, protracted and measured in months to years. Full recovery from all symptoms takes years for the vast majority. There have been several cases that resolved in 12 months or less, but these are not common within the TSWS community. There seems to be a misunderstanding in the medical community about length of time required to resolve\u00a0TSW Syndrome; the persistent belief is that the time frame is far too prolonged to be accurate. However, both the literature and reports within the ITSAN support groups reveal that recovery is a lengthy process that is not linear \u2013 often described as \u201ctwo steps forward, one step back.\u201d<\/p>\n<p>The path to recovery is marked by repeated flares and calm periods, with symptoms generally being the most severe during the first year. \u00a0Flares eventually become few and far between, less severe, and no longer full body. Many report becoming fully clear after\u00a0TSWS resolves, while some (especially children) report returning to typical eczema-looking patches in conventional places (hands, feet, behind the knees, creases of elbow, etc.). Our members report preferring to treat residual patches without steroids, as opposed to risking relapse of TSWS. Current therapies focus on comfort and infection prevention. More research is needed to discover treatments that could possibly speed up the recovery time frame. \u00a0Cortisone-free alternatives need to be sought out for these patients who can no longer tolerate topical steroid therapy.<\/p>\n<p style=\"text-align: right;\"><a href=\"#questions\">\u25b2 Back to Questions<\/a><\/p>\n<\/div><\/section>\n\n<\/div><\/div><\/div><!-- close content main div --><\/div><\/div><div id='phobic'  class='avia-section av-odjnu-261b94bb2f0f4a1b2379250cf5bd9a33 main_color avia-section-default avia-no-shadow  avia-builder-el-125  el_after_av_section  el_before_av_section  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-94'><div class='entry-content-wrapper clearfix'>\n<section  class='av_textblock_section av-ndiim-a814ae6fb30c9c27a2652e6918c59b67 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"48\" data-lineheight=\"56\"><strong>Q: Are TSWS patients \u2018Steroid Phobic\u2019?<\/strong><\/h3>\n<h4 data-fontsize=\"32\" data-lineheight=\"36\">At a glance:<\/h4>\n<ul>\n<li>Patients who discontinue steroids are not \u201csteroid-phobic,\u201d but are seeking to treat TSW Syndrome in earnest<\/li>\n<li>Recovery is achieved by discontinuing topical steroids, steroid phobia is a separate issue<\/li>\n<li>TSWS results from use of topical steroids, not \u201cunderuse\u201d or avoidance<\/li>\n<\/ul>\n<h3 data-fontsize=\"32\" data-lineheight=\"36\">Excerpts from the literature:<\/h3>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-mueee-5091860fe39dd4a4231149fbfc5fb3fb\">\n#top .hr.hr-invisible.av-mueee-5091860fe39dd4a4231149fbfc5fb3fb{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-mueee-5091860fe39dd4a4231149fbfc5fb3fb hr-invisible  avia-builder-el-127  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-mjb3e-f89c9bbe55530e0061b958f901953271 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p data-fontsize=\"14\" data-lineheight=\"23\"><em><b>Australian Family Physician<\/b>,\u00a0<b>June 2016<\/b>:<\/em><\/p>\n<p><em>\u201cSteroid phobia is a separate issue and is not applicable in these patients: TCS addiction is thought to be the result of TCS misuse (overuse and not underuse of TCS). After complete withdrawal, a patient with TCS addiction can expect normal skin or the original eczema symptoms.\u201d . . .<\/em><\/p>\n<p><em>\u201cBy being aware of TCS addiction and withdrawal, practitioners may be better able to help prevent this adverse effect and offer supportive care to patients in TCS withdrawal. It would also be useful for GPs to be able to discuss TCS addiction and withdrawal with patients who seek to clarify information they glean from non-medical sources.\u201d\u00a0<a href=\"http:\/\/www.racgp.org.au\/afp\/2016\/june\/topical-corticosteroid-addiction-and-withdrawal-%E2%80%93-an-overview-for-gps\/\" target=\"_blank\" rel=\"noopener noreferrer\">(9)<\/a> <\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-lnagy-b2f6124bdaeae056b6bfb73be9b4a5c2\">\n#top .hr.hr-invisible.av-lnagy-b2f6124bdaeae056b6bfb73be9b4a5c2{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-lnagy-b2f6124bdaeae056b6bfb73be9b4a5c2 hr-invisible  avia-builder-el-129  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-l90i6-2f963ee8bf94dfd6d6dd5c771c9edbb4 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Drug, Healthcare and Patient Safety,\u00a0<\/b><b>October 2014:<\/b><\/em><\/p>\n<p><em>\u201cThe undertreatment because of steroid phobia is discussed here. . . . TCS is effective, at least for short-term use, on the condition that the patients are not addicted. Therefore, the excessive warning regarding \u201cundertreatment\u201d may may infringe on the patients\u2019 right to select treatment methods and induce the social prejudice that such patients may not be trying to treat the disease earnestly. . . .<\/em><\/p>\n<p><em>Moreover, when the patient becomes addicted to TCS, the recovery cannot be achieved without \u201cundertreatment\u201d.\u201d (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4207549\/\" target=\"_blank\" rel=\"noopener noreferrer\">2<\/a>)<\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-ktzly-799de446f18e687593898ddbfca47f5d\">\n#top .hr.hr-invisible.av-ktzly-799de446f18e687593898ddbfca47f5d{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-ktzly-799de446f18e687593898ddbfca47f5d hr-invisible  avia-builder-el-131  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-k3s3a-2fdad3022162f041ecb2ea1f4ff5da95 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"32\" data-lineheight=\"36\">ITSAN Support Community:<\/h3>\n<p>This is a sensitive topic within the community. Our members have all used topical steroids diligently in the past. However, topical steroid therapy was ineffective and created a new, more severe problem. The term \u201cphobia\u201d denotes extreme or irrational fears. TSWS patients are not abstaining from a treatment based on irrational fears \u2014 they are abstaining from a treatment that has caused an iatrogenic condition.<\/p>\n<p>According to a recent poll of the ITSAN Support community, 99.99% of those polled (160 people) used\u00a0<i>prescription<\/i>\u00a0topical steroids, as opposed to strictly over-the-counter. \u00a0In a subsequent poll, 86% reported developing TSWS while using their medication exactly as their doctor prescribed. \u00a0This is a patient population who sees their doctors, fills their prescriptions and uses them as directed. This is not a population that is afraid of medical therapies. TSWS is a corticosteroid-induced condition that requires cessation of steroid therapy to treat the condition \u2014 this must never be confused for \u201csteroid phobia.\u201d<\/p>\n<p style=\"text-align: right;\"><a href=\"#questions\">\u25b2 Back to Questions<\/a><\/p>\n<\/div><\/section>\n\n<\/div><\/div><\/div><!-- close content main div --><\/div><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-jfdma-3b5510551bc0e9c659ecb7aeac211e10\">\n.avia-section.av-jfdma-3b5510551bc0e9c659ecb7aeac211e10{\nbackground-color:#f7f7f7;\nbackground-image:unset;\n}\n<\/style>\n<div id='prevalence'  class='avia-section av-jfdma-3b5510551bc0e9c659ecb7aeac211e10 main_color avia-section-default avia-no-shadow  avia-builder-el-133  el_after_av_section  el_before_av_section  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-94'><div class='entry-content-wrapper clearfix'>\n<section  class='av_textblock_section av-iuc7m-b5dff5d9007d64deca7bcb8ea7efe66c '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"48\" data-lineheight=\"56\"><strong>Q: What is the prevalence of TSWS?<\/strong><\/h3>\n<h4 data-fontsize=\"32\" data-lineheight=\"36\">At a glance:<\/h4>\n<ul>\n<li>Prevalence of TSWS is unknown<\/li>\n<li>TSWS is underreported and not well characterized<\/li>\n<li>TSWS is more common than realized, but frequently goes unrecognized<\/li>\n<\/ul>\n<h3 data-fontsize=\"32\" data-lineheight=\"36\">Excerpts from the literature:<\/h3>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-i0jzm-551f7e7daa28f3d0f1eced75fa364df9\">\n#top .hr.hr-invisible.av-i0jzm-551f7e7daa28f3d0f1eced75fa364df9{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-i0jzm-551f7e7daa28f3d0f1eced75fa364df9 hr-invisible  avia-builder-el-135  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-htogi-c1ca41b737836e83eb05aa1c019425e8 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p data-fontsize=\"14\" data-lineheight=\"23\"><em><b>Australian Family Physician<\/b>,\u00a0<b>June 2016<\/b>:<\/em><\/p>\n<p><em>\u201cThe incidence and prevalence of TCS addiction and withdrawal are unknown.\u201d\u00a0<a href=\"http:\/\/www.racgp.org.au\/afp\/2016\/june\/topical-corticosteroid-addiction-and-withdrawal-%E2%80%93-an-overview-for-gps\/\" target=\"_blank\" rel=\"noopener noreferrer\">(9)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-gtxvu-5b826c8a266470e7a0fe238fe1c095e2\">\n#top .hr.hr-invisible.av-gtxvu-5b826c8a266470e7a0fe238fe1c095e2{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-gtxvu-5b826c8a266470e7a0fe238fe1c095e2 hr-invisible  avia-builder-el-137  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-1m84y-b04f50fd5833108bfa2b6d12cbb203af '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Cutis,\u00a0<\/b><b>April 2009:<\/b><\/em><\/p>\n<p><em>\u201cThe exact incidence of SIRD [Steroid-induced Rosacea-like dermatitis] is not known . . . . The most common age at presentation is 40 to 50 years; however, it also has been described in infants, children, and elderly patients.\u201d \u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19445310\" target=\"_blank\" rel=\"noopener noreferrer\">(11)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-fr7im-bbb46d77b2a81cc3d68ad0bc0af5bcac\">\n#top .hr.hr-invisible.av-fr7im-bbb46d77b2a81cc3d68ad0bc0af5bcac{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-fr7im-bbb46d77b2a81cc3d68ad0bc0af5bcac hr-invisible  avia-builder-el-139  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-fcena-be3782e0377904b90b8fcb9de72f34fb '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Journal of the American Academy of Dermatology<\/b><b>, March 2015:<\/b><\/em><\/p>\n<p><em>\u201cMore data are needed regarding the frequency and duration of use that predisposes to this condition. Further, there are no data regarding the prevalence of this condition. It is also unclear whether children are actually less likely to develop this disorder or that cases of TCS withdrawal in the pediatric population are underreported.\u201d (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25592622\" target=\"_blank\" rel=\"noopener noreferrer\">1<\/a>)<\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-ee7h2-d26dbf8ba8a634a86d7db0afeeff4e2e\">\n#top .hr.hr-invisible.av-ee7h2-d26dbf8ba8a634a86d7db0afeeff4e2e{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-ee7h2-d26dbf8ba8a634a86d7db0afeeff4e2e hr-invisible  avia-builder-el-141  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-e4b2i-9b406dd2a1e4bb5f632f4d367606d1f9 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>International Journal of Dermatology, Jan-Feb 1979:<\/b><\/em><\/p>\n<p><em>\u201cSteroid addiction is a more subtle and more insidious type of side reaction. It is common but is not high in medical consciousness because it frequently goes unrecognized. Hence, it is underreported and not well characterized. Because it develops in stages, often slowly, both the physician and the patient may fail to incriminate the steroid.\u201d\u00a0<a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-4362.1979.tb01905.x\/abstract\" target=\"_blank\" rel=\"noopener noreferrer\">(4)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-dfkva-84a0355008c1d9752966c6de45b2c7e1\">\n#top .hr.hr-invisible.av-dfkva-84a0355008c1d9752966c6de45b2c7e1{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-dfkva-84a0355008c1d9752966c6de45b2c7e1 hr-invisible  avia-builder-el-143  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-crrgm-7ebb116115ff56cdc11aef982188c1e4 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><strong>Drug, Healthcare and Patient Safety, October 2014:<\/strong><\/em><\/p>\n<p><em>\u201cThere are no statistics regarding the prevalence of TSA, but a survey conducted in Japan in 2000 may provide us with some information. In the study, the situations of patients with atopic dermatitis [treated] with TCS were compared, before and after 6 months of treatment. The proportion of poorly controlled disease was 19% in adults . . . \u00a0Calculated as 19% \u2212 7% = 12% addicted adult patients, and 7% uncontrolled by other factors (ie, undertreatment).\u201d (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4207549\/\" target=\"_blank\" rel=\"noopener noreferrer\">2<\/a>)<\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-c3vl2-390b5e2aaf622baaed235e3f6e49f612\">\n#top .hr.hr-invisible.av-c3vl2-390b5e2aaf622baaed235e3f6e49f612{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-c3vl2-390b5e2aaf622baaed235e3f6e49f612 hr-invisible  avia-builder-el-145  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-btc3y-dfbdac04bfa38d0707aabd79cb3ad31a '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"32\" data-lineheight=\"36\">ITSAN Support Community:<\/h3>\n<p>Members of our community have often expressed that prevalence is underreported. Many have even suggested making themselves or their children case studies, but treating doctors have rarely done so. \u00a0Because so few pediatric cases exist in the literature, doctors may be hesitant to diagnose this condition in children. This actually perpetuates under-diagnosing and underreporting. \u00a0Our community represents thousands of people, including children, yet only a few have doctors who recognize TSWS. Accurate diagnosis is key to not only providing care, but precise prevalence data. \u00a0ITSAN is striving to raise awareness of this often unrecognized disease. \u00a0In addition, ITSAN is laying the groundwork to organize a patient registry so that prevalence can be more accurately represented. As of now, there is no process for reporting or accessing prevalence data. To best support our patient population, please report any and all cases of TSWS that you diagnose and treat. Please publish case studies. In addition, please contact us at\u00a0<a href=\"mailto:info@ITSAN.org\">info@ITSAN.org<\/a>\u00a0to be placed on our internal physician referral list.<\/p>\n<p style=\"text-align: right;\"><a href=\"#questions\">\u25b2 Back to Questions<\/a><\/p>\n<\/div><\/section>\n\n<\/div><\/div><\/div><!-- close content main div --><\/div><\/div><div id='prevention'  class='avia-section av-av5pi-5e2eb8a08c8924063cd5bcdb7b4539c8 main_color avia-section-default avia-no-shadow  avia-builder-el-147  el_after_av_section  el_before_av_section  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-94'><div class='entry-content-wrapper clearfix'>\n<section  class='av_textblock_section av-11yl2-06e2de32b48f373284a99ecec0a01303 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"48\" data-lineheight=\"56\"><strong>Q: How can TSWS be prevented?<\/strong><\/h3>\n<h4 data-fontsize=\"32\" data-lineheight=\"36\">At a glance:<\/h4>\n<ul>\n<li><b>Physicians must avoid inappropriate prescribing and lax monitoring of refills<\/b><\/li>\n<li>Patients should be counseled regarding the risks, including TCS withdrawal\/RSS<\/li>\n<li>The best time to prevent TSWS is when topical corticosteroids are first prescribed<\/li>\n<li>Safe and effective long term treatment does not include daily use of TCS<\/li>\n<li>Perform medication reconciliation \u2014 be sure to ask specifically about topical products<\/li>\n<li>Proper guidance, respectful usage, and close monitoring are key<\/li>\n<li>Avoid TCS as a first line treatment<\/li>\n<\/ul>\n<h3 data-fontsize=\"32\" data-lineheight=\"36\">Excerpts from the literature:<\/h3>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-10dpu-4381c78a05aed9e4c988a1867569bb07\">\n#top .hr.hr-invisible.av-10dpu-4381c78a05aed9e4c988a1867569bb07{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-10dpu-4381c78a05aed9e4c988a1867569bb07 hr-invisible  avia-builder-el-149  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-992yu-a2400203b70dfa66d460217a5aec6ed4 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Journal of the American Academy of Dermatology<\/b><b>, March 2015:<\/b><\/em><\/p>\n<p><em>\u201cClinicians and patients should be aware of this entity and the predisposing factors. Patients should be counseled regarding the risks, including TCS withdrawal, from prolonged daily use of TCS beyond their approved indication. Physicians must avoid inappropriate overprescribing and lax monitoring of refills.\u201d\u00a0(<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25592622\" target=\"_blank\" rel=\"noopener noreferrer\">1<\/a>)<\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-8p902-bbb71f1b09ff9d152e98225ec9598578\">\n#top .hr.hr-invisible.av-8p902-bbb71f1b09ff9d152e98225ec9598578{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-8p902-bbb71f1b09ff9d152e98225ec9598578 hr-invisible  avia-builder-el-151  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-8bs7a-1d840e89bc508611426aee0d75088527 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>International Journal of Dermatology, Jan-Feb 1979:<\/b><\/em><\/p>\n<p><em>\u201cAddiction to topical steroids is a serious medical problem which reaches tragic proportions in some cases. It is more common than realized, sly and seductive and will be prevented only when the physician becomes as impressed with the steroids capacity to do harm as they are with their remarkable power to suppress, not cure, virtually any inflammatory disease.\u201d. . .<\/em><\/p>\n<p><em>\u201cWhat can be done to minimize the danger of steroid addiction? Banning steroids would be a final solution, but no reasonable person would propose anything so Draconian. The goal must be to use steroids sensibly and with full awareness of the risks.\u201d\u00a0\u00a0<a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-4362.1979.tb01905.x\/abstract\" target=\"_blank\" rel=\"noopener noreferrer\">(4)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-7l0gu-c1ff063ade03fa853cea3cc1ec873837\">\n#top .hr.hr-invisible.av-7l0gu-c1ff063ade03fa853cea3cc1ec873837{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-7l0gu-c1ff063ade03fa853cea3cc1ec873837 hr-invisible  avia-builder-el-153  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-6y83i-1288bd6953d0b70b3619c0edced22ac5 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Journal of the American Medical Association Pediatrics (<\/b><b>Formerly<\/b><b>\u00a0Archives of Pediatric and Adolescent Medicine)<\/b><b>, January 2000:<\/b><\/em><\/p>\n<p><em>\u201cIt has been presumed that over-the-counter hydrocortisone and prescription 1% hydrocortisone were safe to use in children. This is based on the inability of these preparations to suppress the hypothalamic-pituitary-adrenal axis. From our findings it is evident that low-strength steroids may induce rosacea, at least in susceptible children. The finding that the lowest-strength steroids induce rosacea contradicts the strategy that recommends decreasing the strength of topical steroid during treatment of steroid rosacea. Superpotent topical steroids, such as clobetasol propionate or betamethasone dipropionate (including the combination product Lotrisone), were responsible for the steroid rosacea in only 3% of children.\u201d\u00a0<a href=\"http:\/\/archpedi.jamanetwork.com\/article.aspx?articleid=348509\" target=\"_blank\" rel=\"noopener noreferrer\">(14)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-6b3ja-198ae92d7bf77fc990f4a606e7d057c0\">\n#top .hr.hr-invisible.av-6b3ja-198ae92d7bf77fc990f4a606e7d057c0{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-6b3ja-198ae92d7bf77fc990f4a606e7d057c0 hr-invisible  avia-builder-el-155  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-5hp7a-8a88288048e37299933ba618a7c42c58 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p data-fontsize=\"14\" data-lineheight=\"23\"><em><b>Australian Family Physician<\/b>,\u00a0<b>June 2016<\/b>:<\/em><\/p>\n<p><em>\u201cWhile research is very limited to date, avoiding prolonged use of moderate-to-potent TCS on the face may be prudent as this is a highly significant risk factor for the development of TCS addiction and withdrawal. Avoiding continuous use of TCS for longer than two weeks has been suggested by Fukaya et al, and the US National Eczema Association has advised the following:<\/em><\/p>\n<p><em>\u2018Do not use TCS continuously for more than two to four weeks \u2013 then frequency should be tapered to twice weekly use. Your provider should strive to help create a safe and effective long term treatment plan that does not include daily use of TCS, especially on more sensitive areas.\u2019\u201d\u00a0<a href=\"http:\/\/www.racgp.org.au\/afp\/2016\/june\/topical-corticosteroid-addiction-and-withdrawal-%E2%80%93-an-overview-for-gps\/\" target=\"_blank\" rel=\"noopener noreferrer\">(9)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-4vlr6-3710477857c6f36137def2bfe5d7f44e\">\n#top .hr.hr-invisible.av-4vlr6-3710477857c6f36137def2bfe5d7f44e{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-4vlr6-3710477857c6f36137def2bfe5d7f44e hr-invisible  avia-builder-el-157  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-4ptym-e3f9c31894a6a88413043edbd6626242 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Nursing 2007<\/b>,\u00a0<b>September 2007:<\/b><\/em><\/p>\n<p><em>\u201cWhen you perform medication reconciliation, be sure to ask specifically about topical products; many people don\u2019t consider creams to be medications and inadvertently omit them from the medication list. Ask your patient for a complete list of topical medications that she currently uses or has used on the affected areas, including steroids, herbal preparations, and over-the-counter products. It\u2019s a good idea to ask your patient to bring in any medications that she\u2019s used on the affected area for you to inspect because some products contain unlabeled steroids. . . . The best time to prevent steroid rosacea is when topical corticosteroids are first prescribed. Tell your patient not to use steroids on her face for longer than 2 weeks and explain adverse drug effects such as steroid rosacea.\u201d\u00a0(<a href=\"http:\/\/journals.lww.com\/nursing\/Citation\/2007\/09000\/Facing_up_to_withdrawal_from_topical_steroids.46.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">8)<\/a><\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3v5hi-50d020688644f9915bca5160f7706d65\">\n#top .hr.hr-invisible.av-3v5hi-50d020688644f9915bca5160f7706d65{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-3v5hi-50d020688644f9915bca5160f7706d65 hr-invisible  avia-builder-el-159  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-3e2wi-6fa26ec2e7c37307f5b5939544830ecd '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><blockquote>\n<p><em><b>Practical Dermatology<\/b><b>, September 2015:<\/b><\/em><\/p>\n<p><em>\u201cWith proper guidance, respectful usage, and close monitoring, it seems that the vast majority of patients can use topical steroids briefly when needed, and then be steroid-free with very little risk and great benefit. . . .<\/em><\/p>\n<p><em>Close follow up remains critical: for patients who are unable to sufficiently improve or remain clear, moving to the next rung of the therapeutic ladder is imperative, rather than simply settling for daily use of TCS. . . .<\/em><\/p>\n<p><em>While TSW [Topical Steroid Withdrawal] may be more common than we yet know, it seems to be preventable in at least the majority of cases. This gives hope that with widespread recognition of TSW and cautious use of topical corticosteroids, we can take better care of our patients than ever before and hopefully send TSW back into obscurity.\u201d\u00a0(<a href=\"https:\/\/practicaldermatology.com\/articles\/2015-sep\/the-challenges-of-topical-steroid-withdrawalogy\" target=\"_blank\" rel=\"noopener noreferrer\">7<\/a>)<\/em><\/p>\n<\/blockquote>\n<\/div><\/section>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-2ha6y-d1ff929e1730a7cf5a97496c557c479d\">\n#top .hr.hr-invisible.av-2ha6y-d1ff929e1730a7cf5a97496c557c479d{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-2ha6y-d1ff929e1730a7cf5a97496c557c479d hr-invisible  avia-builder-el-161  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n<section  class='av_textblock_section av-21x9e-51457fe93cdb3338bb6480be3d671403 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h3 data-fontsize=\"32\" data-lineheight=\"36\">ITSAN Support Community:<\/h3>\n<p>Many feel that their TSWS could have been prevented if: (1) they had been educated about the predisposing factors\/risks of TSWS, (2) their topical steroid use had been closely monitored, and (3) steroids had not been prescribed as a \u201cfirst line\u201d treatment.<\/p>\n<p>Many point out that they were not properly educated on topical steroid use by their healthcare provider \u2013 particularly how long is \u201ca long period of time,\u201d \u00a0how much is \u201ctoo much\u201d or what constitutes a \u201clarge area of the body.\u201d \u00a0They feel the instructions given by their doctors, such as \u201cuse on affected areas,\u201d gave no parameters on how long to treat or how large an area was safe to treat. The \u201caffected area\u201d was often a \u201clarge area of the body\u201d and grew larger over time, but this was not usually addressed. In addition, some patients were encouraged to use their prescription \u201coff label.\u201d \u00a0Assertions of \u201csteroid misuse,\u201d \u201csteroid overuse\u201d or even \u201csteroid underuse\u201d places undue blame on the patient who is actually using exactly as directed by their doctors.<\/p>\n<p>Members report that their physician did not ask about their topical steroid use. Prescriptions from Allergists, Dermatologists, General Practitioners, Pediatricians, etc., were not routinely reconciled by their doctors. Some also reported using over-the-counter steroid creams or topical medications from family members that were never reconciled by their doctors. Members also report that follow-up information on number of finger tip units, areas of use, uses per day, days per month, etc., was not requested by their doctors. They did not feel their doctor knew which areas, how much, how often, or what type of topical medication they actually used during a given time frame. It is important for the physician to understand their patient\u2019s pattern of use to properly evaluate the risk of developing TSWS.<\/p>\n<p>Our members also feel that steroids should not be a first line treatment for eczema or dermatitis \u2013 especially for children and infants. Many feel that if they had been patch tested for contact dermatitis as a first step, they may have been more able to avoid triggers, thereby minimizing or completely avoiding use of topical steroids from the beginning.<\/p>\n<p style=\"text-align: right;\"><a href=\"#questions\">\u25b2 Back to Questions<\/a><\/p>\n<\/div><\/section>\n\n<\/div><\/div><\/div><!-- close content main div --><\/div><\/div><div id='citations'  class='avia-section av-1qx72-4eea3575ca9ec95fac42dea7e3a8d82c main_color avia-section-default avia-no-shadow  avia-builder-el-163  el_after_av_section  avia-builder-el-last  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-94'><div class='entry-content-wrapper clearfix'>\n<section  class='av_textblock_section av-15m2e-8acd6e0b6bbb0944524d7f094557203f '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h2 data-fontsize=\"48\" data-lineheight=\"56\"><strong>Citations:<\/strong><\/h2>\n<ol>\n<li>\u201cA systematic review of topical corticosteroid withdrawal (\u201csteroid addiction\u201d) in patients with atopic dermatitis and other dermatoses,\u201d The National Eczema Association Task Force: Tamar Hajar MD, Yael A. Leshem MD, Jon Hanifin MD, Susan T. Nedorost MD, Peter Lio MD, Amy S. Paller MD, Julie Block BA, Eric L. Simpson MD,\u00a0<em>Journal of the American Academy of Dermatology<\/em>, 2015 March, 72(3), pp. 541-549. DOI:\u00a0<a href=\"http:\/\/dx.doi.org\/10.1016\/j.jaad.2014.11.024\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/dx.doi.org\/10.1016\/j.jaad.2014.11.024<\/a><\/li>\n<li>\u201cTopical Steroid Addiction in Atopic Dermatitis,\u201d Mototsugu Fukaya MD, et al.\u00a0<em>Drug, Healthcare and Patient Safety<\/em>, 2014;6: pp.131\u2013138.\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4207549\/\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4207549\/<\/a><\/li>\n<li>\u201cCorticosteroid Addiction and Withdrawal in the Atopic: The Red Burning Skin Syndrome\u201d Marvin J. Rapaport, MD and Mark Lebwohl, MD.\u00a0<em>Clinics in Dermatology<\/em>, May\u2013June 2003, Volume 21, Issue 3, pp. 201\u2013214\u00a0<a href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0738081X02003656\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0738081X02003656<\/a><\/li>\n<li>\u201cSteroid Addiction.\u201dAlbert \u00a0M. Kligman, M.D., Ph.D. and Peter J. Frosch, M.D.\u00a0<em>International Journal of Dermatology<\/em>, Jan-Feb 1979,Vol 18, pp 23-31.\u00a0<a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-4362.1979.tb01905.x\/abstract\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-4362.1979.tb01905.x\/abstract<\/a><\/li>\n<li>\u201cTopical corticosteroid addiction may be to blame when \u2018rash\u2019 defies treatment,\u201d Paula Moyer,\u00a0<em>Dermatology Times<\/em>, 1 October 2012.\u00a0<a href=\"http:\/\/dermatologytimes.modernmedicine.com\/dermatology-times\/news\/modernmedicine\/modern-medicine-news\/topical-corticosteroid-addiction-may-be-b?page=full\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/dermatologytimes.modernmedicine.com\/dermatology-times\/news\/modernmedicine\/modern-medicine-news\/topical-corticosteroid-addiction-may-be-b?page=full<\/a><\/li>\n<li>\u201cTopical corticosteroid-induced rosacea-like dermatitis: A clinical study of 110 cases,\u201d Sanjay K Rathi MD and Leishiwon Kumrah MD,\u00a0<em>Indian Journal of Dermatology, Venereology, and Leprology<\/em>, 2011,Volume 77, Issue 1, pp 42-46. <a href=\"https:\/\/ijdvl.com\/topical-corticosteroid-induced-rosacea-like-dermatitis-a-clinical-study-of-110-cases\/\" target=\"_blank\" rel=\"noopener\">https:\/\/ijdvl.com\/topical-corticosteroid-induced-rosacea-like-dermatitis-a-clinical-study-of-110-cases\/<\/a><\/li>\n<li>\u201cAddressing the Challenge of Topical Steroid Withdrawal,\u201d Peter Lio MD,\u00a0<em>Practical Dermatology<\/em>, September 2015, pp 41-42.\u00a0<a href=\"https:\/\/practicaldermatology.com\/articles\/2015-sep\/the-challenges-of-topical-steroid-withdrawalogy\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/practicaldermatology.com\/2015\/09\/the-challenges-of-topical-steroid-withdrawalogy\/<\/a><\/li>\n<li>\u201cFacing up to withdrawal from topical steroids,\u201d Mary C. Smith, RN, MSN; Susan Nedorost, MD; and Brandie Tackett, MD,\u00a0<em>Nursing<\/em>, September 2007, vol 37, issue 9, pp 60-61.\u00a0<a href=\"http:\/\/journals.lww.com\/nursing\/Citation\/2007\/09000\/Facing_up_to_withdrawal_from_topical_steroids.46.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/journals.lww.com\/nursing\/Citation\/2007\/09000\/Facing_up_to_withdrawal_from_topical_steroids.46.aspx<\/a><\/li>\n<li>\u201cTopical corticosteroid addiction and withdrawal \u2013 An overview for GPs,\u201d Belinda Sheary,\u00a0<em>Australian Family Physician<\/em>, June 2016, vol 45, No. 6, Pages 386-388.\u00a0<a href=\"http:\/\/www.racgp.org.au\/afp\/2016\/june\/topical-corticosteroid-addiction-and-withdrawal-%E2%80%93-an-overview-for-gps\/\">http:\/\/www.racgp.org.au\/afp\/2016\/june\/topical-corticosteroid-addiction-and-withdrawal\u2013-an-overview-for-gps\/<\/a><\/li>\n<li>National Eczema Association Education Announcement: Use of Topical Corticosteroids for Eczema. \u00a0<a href=\"https:\/\/nationaleczema.org\/education-announcement-topical-corticosteroids-eczema\/\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/nationaleczema.org\/education-announcement-topical-corticosteroids-eczema\/<\/a><\/li>\n<li>\u201cSteroid-Induced Rosacea-like Dermatitis: Case Report and Review of the Literature,\u201d Amy Y-Y Chen, MD; Matthew J. Zirwas, MD,\u00a0<em>Cutis<\/em>, April 2009, Volume 83, pp 198-204.\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19445310\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19445310<\/a><\/li>\n<li>\u201cA rosacea-like eruption of children.\u201d JA Savin, S Alexander, R Marks, \u00a0<em>British Journal of Dermatology<\/em>, November 1972,\u00a0<a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/bjd.1972.87.issue-5\/issuetoc\" target=\"_blank\" rel=\"noopener noreferrer\">Volume 87, Issue 5,<\/a>\u00a0pages 425\u2013429.\u00a0<a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-2133.1972.tb01589.x\/abstract\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-2133.1972.tb01589.x\/abstract<\/a><\/li>\n<li>\u201cSteroid \u00a0rosacea \u00a0in \u00a0children,\u201d HL Franco, \u00a0WL Weston,\u00a0<em>Pediatrics<\/em><a href=\"http:\/\/pediatrics.aappublications.org\/content\/64\/1\" target=\"_blank\" rel=\"noopener noreferrer\">, July 1979, Volume 64, Issue 1<\/a>, pages 36-38.\u00a0<a href=\"http:\/\/pediatrics.aappublications.org\/content\/pediatrics\/64\/1\/36.full.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/pediatrics.aappublications.org\/content\/pediatrics\/64\/1\/36.full.pdf<\/a><\/li>\n<li>\u201cSteroid \u00a0rosacea \u00a0in \u00a0prepubertal Children,\u201d WL Weston, \u00a0JG Morelli,\u00a0<em>Journal of the American Medical Association Pediatrics<\/em>\u00a0(Formerly\u00a0<em>Archives of Pediatric and Adolescent Medicine<\/em>), January 2000, Volume 154, Number 1, pages 62-64.\u00a0<a href=\"http:\/\/archpedi.jamanetwork.com\/article.aspx?articleid=348509\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/archpedi.jamanetwork.com\/article.aspx?articleid=348509<\/a><\/li>\n<li>\u201cA prospective study of atopic dermatitis managed without topical corticosteroids for a 6-month period,\u201d Fukaya et al,\u00a0<em>Clinical, Cosmetic and Investigational Dermatology<\/em>, July 2016, Volume 9, Pages 151\u2014158\u00a0<a href=\"https:\/\/www.dovepress.com\/a-prospective-study-of-atopic-dermatitis-managed-without-topical-corti-peer-reviewed-fulltext-article-CCID\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.dovepress.com\/a-prospective-study-of-atopic-dermatitis-managed-without-topical-corti-peer-reviewed-fulltext-article-CCID<\/a><\/li>\n<li>Rosemarie Curley. \u201cA systematic review of topical steroid withdrawal in children diagnosed with eczema.\u201d PROSPERO 2015:CRD42015019001 Available from\u00a0<a href=\"http:\/\/www.crd.york.ac.uk\/PROSPERO\/display_record.asp?ID=CRD42015019001\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/www.crd.york.ac.uk\/PROSPERO\/display_record.asp?ID=CRD42015019001<\/a><\/li>\n<li>\u201cPrevalence of atopic diseases and the use of topical corticosteroids. Is there any connection?\u201d Alexander N. Pampura,\u00a0<em>Medical Hypotheses<\/em>, 2005;64(3):575-8.\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15617870\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15617870<\/a><\/li>\n<\/ol>\n<\/div><\/section>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"give_campaign_id":0,"footnotes":""},"class_list":["post-94","page","type-page","status-publish","hentry"],"campaignId":"","_links":{"self":[{"href":"https:\/\/www.itsan.org\/us\/wp-json\/wp\/v2\/pages\/94","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.itsan.org\/us\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.itsan.org\/us\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.itsan.org\/us\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.itsan.org\/us\/wp-json\/wp\/v2\/comments?post=94"}],"version-history":[{"count":72,"href":"https:\/\/www.itsan.org\/us\/wp-json\/wp\/v2\/pages\/94\/revisions"}],"predecessor-version":[{"id":12629,"href":"https:\/\/www.itsan.org\/us\/wp-json\/wp\/v2\/pages\/94\/revisions\/12629"}],"wp:attachment":[{"href":"https:\/\/www.itsan.org\/us\/wp-json\/wp\/v2\/media?parent=94"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}