What Is the Difference Between Eczema and TSW?

If you have eczema, it can cause itchy, red, or flaky skin. However, for some people stopping eczema treatment can cause similar symptoms. This reaction is called topical steroid withdrawal (TSW).^1,2

TSW is also called red skin syndrome or topical steroid addiction. It is caused by the body’s reaction when you stop applying steroids to your skin.^1,2

What is TSW?

Topical corticosteroids are a type of steroid that is applied to the skin. They are used to treat many different conditions, including eczema. TSW is a bad, and sometimes long-term, reaction some people have when they stop taking topical steroids.

Other things that can trigger TSW are:^1-3

• Using smaller amounts of steroids
• Using lower-strength steroids
• Using steroids less frequently

Symptoms may appear weeks after using steroids and last for months. Symptoms of TSW include:^1-3

• Red skin like a sunburn, especially on arms or legs
• Skin that is dry, flaky, shedding, sensitive, burning, oozing, or wrinkly and thin
• Hair loss
• Tiredness
• Emotional effects and depression, if TSW lasts for a long time

What is eczema?

Eczema is a skin condition that is caused by an overactive immune system. The immune reaction causes the inflammation that leads to eczema symptoms. Symptoms of eczema can be similar to TSW. Symptoms may include:⁴

• Skin that is dry, itchy, flaky, crusty, scaly, or leathery
• Swelling
• Bumps or rash on the skin

What are the differences?

Eczema and TSW have different causes. Eczema is a skin condition that is based on the immune system. For some people, genetics play a part in their eczema. TSW is a reaction to no longer using steroids. But the symptoms of both conditions can be similar. Some people may mistake the symptoms of TSW for worsening eczema.^1-3

Here are some of the differences between the 2 conditions:^1-3

• TSW may cause skin symptoms in places you never had eczema before.
• TSW may feel like burning or stinging, while eczema may feel more like itching.
• TSW can look less like a rash and more like flushed skin or sunburn.
• TSW can cause more evenly red skin instead of patchy red skin. This is sometimes called the red sleeve, because the entire arm is inflamed.
• TSW symptoms can be more severe. Some people may get so sick that they have to stay in bed all the time.

Can you have eczema and not have TSW?

We do not know why some people experience TSW. It is possible to stop steroids and not have a reaction. Additionally, not everyone with eczema will use topical steroids. So you can have eczema and never experience TSW. It is possible that having eczema makes the skin more susceptible to TSW. However, this is not proven.^1-3

Can you have TSW and not have eczema?

Anyone who uses topical steroids can have TSW. Not everyone that uses topical steroids has eczema. You can experience TSW even if you:^1-3

• Have no history of eczema
• Use steroids for other conditions or cosmetic uses
• Are a caregiver who applies steroids to other people and do not wash your hands after

If you are worried about TSW, talk with your dermatologist. Follow instructions for taking steroids, especially the amount to use and when to take breaks. Do not use steroids to treat conditions like acne, and do not apply steroids to your face.^1-3