Topical Steroid Withdrawal – TSW – The Difficult Process of Recovery - 2/8

Topical Steroid Withdrawal – TSW – The Difficult Process of Recovery – 2/8

My “White Paper” appearing in Blog 28 discussed topical steroid addiction (TSA). What follows is a description of the patient’s process after the diagnosis of topical steroid addiction is made when he/she must totally withdraw from topical steroids to be cured. The patient completely stops using any and all steroids. Usually within days flares of redness and some edema occurs. The beginning of topical steroid withdrawal (TSW) is initiated and ultimately the Red Skin Syndrome (RSS) will be full-blown.

The human condition is such that pain and effort are not just symptoms which can be removed without changing life itself.

Hannah Arendt

Full-blown Red Skin Syndrome is manifested symptomatically by severe itching, burning, pain, edema, oozing of the skin, anxiety and frequently psychological depression. This can last anywhere from months to years depending upon the length of time steroids were used. The symptoms, the clinical rashes, the skin biopsy, the severe erythema do not correspond with any atopic dermatitis (eczema) findings. It is a different diagnosis entirely. It is not “bad or chronic eczema” it is Red Skin Syndrome and must be treated differently. Total withdrawal from topical steroids is the cure for Red Skin Syndrome and Red Skin Syndrome is the correct name for what has been diagnosed as bad or chronic eczema.

Because of the severity of the problems of Red Skin Syndrome many patients necessitate withdrawing from school or work for up to a year. There is a total inability to function. Others continue to work or go to school but they function at a very low level with severe symptoms 24/7. All necessitate professional medical support. Sadly, they do not obtain this support from our fellow physicians – instead they are met with obstinate arrogance worldwide. These physicians demand that their patients take more and more topical and systemic steroids. The suffering patients have had nowhere to turn for help and have initiated “self-help support groups” for comfort. Since no real medical help can be afforded in these groups the patients languish in a sea of patient suggested foods, bath products, creams, vitamins, Eastern medical procedures and an array of avoidances – all giving false hope because none address the problem. Conventional medicine has turned its backs on these patients who are in their dreadful state because of the arrogance of their doctors’ misguided management.

Despite having evaluated, examined, studied, diagnosed, treated and cured approximately 3200 patients over the last 30 years, despite 7 peer reviewed papers in the finest English speaking journals, despite numerous patient support groups, despite search engines listing TSA, TSW and RSS the number of severely affected patients has increased exponentially. I still treat 5-20 new patients every month who come from all over Southern California, many distant and near states in the USA, and from around the world. Most recently patients have flown in from Korea, Sweden, Singapore, Texas, Pennsylvania, Washington and various Canadian provinces. They come to see me in Los Angeles because their local treating physicians will only treat them with steroids despite overwhelming evidence that these medications severely worsen the problem. It is the ethical and moral responsibility of the medical community to acknowledge that Red Skin Syndrome exists and will cease to exist when topical steroids are withdrawn. Often the easy path is not the right path. Withdrawal is not easy but it is the right and only path to cure for patients already afflicted with RSS. When physicians change their course of treatment and stop prescribing topical steroids for lengthy and for early stage eczema then Red Skin Syndrome will finally be eradicated.

By Dr Marvin Rapaport, MD|2021-10-19T03:16:49-07:00November 11th, 2015|Information on Red Skin Syndrome, Topical Steroid Withdrawal, White Paper|Comments Off

About the Author: Dr Marvin Rapaport, MD

In 1978 I initiated and set up the contact and photo dermatitis clinic at UCLA. There was a need to evaluate a large group of patients who exhibited severe eczematoid rashes, especially on the face. Patients were referred from all over Southern California. All patients underwent a lengthy history and examination. Further evaluations included blood studies, allergy patch testing, special sunlight (photo) testing and skin biopsies. From the start it was apparent that most patients experienced a mild dermatitis on various parts of the body that progressively worsened. Their histories always included numerous doctor visits, multiple physicians, and therapy consisting of an increasing amount of corticosteroids. My testing failed to reveal any specific culprit chemicals, cosmetics, perfumes, workplace or recreational exposures. It became increasingly clear that the physician’s therapy, the corticosteroids, was invariably causing the problem. I wrote 7 scientific articles that were published in the most august peer-reviewed dermatologic journals and I gave many lectures at various dermatology meetings. To this day an unfortunate reluctance exists on the part of most physicians to accept this simple concept.