Hello everyone,

It’s been a great journey, but TSW Assist has come to an end. I will no longer be updating this website.

Before I go, I would like to share my book. ‘Taper’ is now available on Amazon.

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​Taper is a call to action for integrative health—inviting sufferers and health professionals to rethink TSW care.

The physical suffering of TSW can be mitigated.

Taper explores the iatrogenic illness of Topical Steroid Withdrawal (TSW) and the global tidal wave of awareness surrounding it. Jason shares his integrative approach to bypassing topical steroid withdrawal, while healing eczema. The book highlights the work of Dr Richard Aron, Dr Xiu-Min Li, Dr Marvin Rapaport, Dr Chris Reynolds, Dr Shi Zong Zeng, Sue Armstrong-Brown, Peerawat Jay, and other leading health professionals.

Taper delves into topical steroid withdrawal, eczema, community advocacy, the mental health crisis, and integrative treatments. It contrasts the experiences of cold-turkey TSW warriors with the medically guided path of tapering off topical steroids.

“I was bedridden for a long time from cold-turkey TSW. Through integrative health optimisations and slowly tapering off, I was able to bypass TSW. I wrote this book for anyone living in fear of a future with TSW. The physical suffering of TSW can be mitigated.”

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Why I’m Stopping TSW Assist…

Before I take a break from TSW Assist, I want to share the biggest challenge I faced with my own Topical Steroid Withdrawal journey, as well as running this website for the past four years.

The Cold Turkey vs. Tapering Dilemma

When people experience steroid-induced skin atrophy and TSW after long-term use, quitting topical steroids becomes a common choice. However, there are two main paths in the TSW community:

1. Tapering

The standard medical advice is to taper off steroids gradually. For many—including myself—this was extremely difficult.

“Gradually tapering off is essential compared with abrupt discontinuation, particularly if the medication has been used for an extended period “- (Safer & Zito, 2022)

2. Cold Turkey

The majority of the global TSW community chooses to quit steroids abruptly. Within days or weeks, their skin and overall health decline rapidly as they endure withdrawal head-on. Their suffering has been widely shared on social media, driving awareness and recognition of TSW worldwide.

TSW is no longer a stigma or hidden condition—it is now a global phenomenon with a community demanding recognition and support. Many who have endured the cold turkey path have healed after months or years of withdrawal. TSW Warriors who have chosen this path share their journeys to inspire hope in others.

At the heart of both approaches—whether tapering or cold turkey—is the same goal: healing.

The majority of the TSW community has chosen the cold turkey path.

I personally quit topical steroids cold turkey many times. It was brutal.  I was bedridden and isolated myself for a long time.

In the end, I actually went back on topical steroids aggressively, then tapered off slowly.

That might be triggering for a community that is largely anti-steroid, but it was my personal choice. By integrating various health approaches, I was able to approach eczema and TSW in a controlled way — mitigating and bypassing the devastating withdrawal effects.

As much as I want to help the cold turkey community, it’s no longer my place. The symptom management insights and data remain on TSW Assist, but cold turkey TSW overlaps with so many other factors:

• eczema
• HPA-axis dysfunction
• adrenal crisis
• anti-pharmaceutical perspectives
• alternative healing modalities
• metabolic health considerations
• chronic inflammation management
• and the psychological impact of long-term withdrawal.

The cold turkey TSW community has grown into a global network of some of the strongest people I know. Many have become my dear friends over the years.

For almost four years, I worked on TSW Assist at night and on weekends outside of my day job and family time. It was a passion project driven by a deep desire to help others. However, I no longer have the capacity to grow this website and continue finding insights into the complexities of cold turkey TSW. So, I’ve decided to stop running the survey for TSW Assist.

It was an ambitious project that successfully solved the challenge of crowdsourcing symptom management insights for Topical Steroid Withdrawal. Beyond the survey, conversations in TSW groups continue, with hot topic discussions on Cold Atmospheric Plasma (CAP), Cyclosporine, and Dupixent being the most common topics.

Thank you to everyone who has been part of this journey. The TSW community is one of the most resilient I have ever seen. I wish you all strength, healing, and peace on your paths forward.

I’m taking a break for now, but this not a goodbye!
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Sincerely,
Jason Vergara

Related Posts:

• View tapering insights from the survey
• Both Methods Explained: Cold Turkey Vs Tapering

The post Tapering Off Topical Steroids appeared first on TSW Assist | Topical Steroid Withdrawal Insights.

Exploring Current and Emerging Approaches to Topical Steroid Withdrawal

Topical Steroid Withdrawal (TSW) is an increasingly recognised iatrogenic condition that arises after prolonged or inappropriate use of topical corticosteroids (TCS). Although not formally included in major dermatological diagnostic manuals, growing clinical and patient-reported evidence has pushed it into the spotlight. People experiencing TSW face a complex array of symptoms including burning, erythema, swelling, skin sensitivity, insomnia, and psychological distress.

As of 2025, there remains no universally accepted or standardised treatment protocol for TSW. Most medical literature describes it as self-limiting, yet the recovery period can last months or even years, and supportive care is often essential. This article outlines the major categories of treatments currently being explored, ranging from symptom management and lifestyle-based interventions to immunomodulatory pharmaceuticals and experimental therapies. It aims to present an up-to-date, empathetic, and scientific overview of what is available today — and where the field may be heading.

Understanding the Nature of TSW

TSW develops following the cessation of topical corticosteroids, particularly after prolonged or high-potency use. Many people experience a rebound phenomenon: once the suppressive effect of the steroids is removed, the skin reacts with intense inflammation. This is compounded by the return of the original skin condition, often atopic dermatitis (eczema).

Because TSW is an iatrogenic reaction, it is biologically and clinically distinct from eczema, though the two frequently overlap. This distinction is crucial because treatments that help eczema do not always help TSW, and vice versa. Any approach to treatment must account for the sensitivity of TSW-affected skin, the heightened immune reactivity, and the systemic impact withdrawal can have on mental and physical health.

Supportive Care and Symptom Management

The mainstay of TSW care in 2025 continues to be supportive management — interventions aimed at easing symptoms while the body recovers naturally. These do not treat the root cause but can reduce suffering and help maintain quality of life.

Cold therapy
Many patients report that cold compresses, ice packs, or cool water immersion can relieve burning sensations and reduce inflammation temporarily. While this does not accelerate healing, it provides critical comfort during flare-ups.

Bath therapies
Dead Sea salt or magnesium salt baths are frequently used by people with TSW. Anecdotal evidence suggests they can soothe the skin barrier and reduce itching, though high-quality clinical trials are lacking.

Sleep and mental health support
Insomnia, anxiety, and depression are common in TSW. Cognitive behavioural therapy (CBT), mindfulness-based stress reduction (MBSR), and short-term use of sedating antihistamines or melatonin (under medical guidance) are often used to improve sleep and reduce psychological strain. Psychological support is considered a cornerstone of comprehensive care.

Barrier support
Some people tolerate bland emollients or natural oils, while others find that any topical product worsens their symptoms. This has given rise to the controversial No Moisture Treatment (NMT), which involves avoiding all moisturisers and bathing minimally to encourage natural barrier function. Evidence for NMT remains anecdotal, and dermatologists are divided on its safety and efficacy.

Nutritional and Lifestyle Interventions

Because TSW can trigger systemic inflammation and immune dysregulation, many patients experiment with dietary and lifestyle changes. While these are not proven cures, they can support general health and may reduce eczema activity, which can indirectly aid recovery.

Anti-inflammatory diets
Some evidence suggests that reducing processed sugar, dairy, and gluten while increasing omega-3 fatty acids (e.g. fish, flaxseed), fermented foods, and antioxidant-rich vegetables may benefit skin health. Clinical trials on diet specifically for TSW are lacking, but diet is widely discussed in patient communities.

Gut-skin axis support
Emerging research links gut microbiome dysbiosis to inflammatory skin diseases. Probiotics and prebiotic-rich foods are used by some people to support gut balance, although robust evidence in the context of TSW is not yet available.

Stress management
Stress can worsen both eczema and TSW symptoms. Practices such as yoga, meditation, and gentle physical activity are often incorporated to help modulate the neuroimmune system during recovery.

Traditional and Complementary Medicine

Traditional Chinese Medicine (TCM)
TCM views TSW-like presentations as an internal imbalance. Herbal formulas (such as those containing Scutellaria baicalensis, licorice root, or rehmannia) and acupuncture are sometimes used to relieve itching, promote detoxification, and calm inflammation. Several small-scale studies in eczema suggest potential benefits, but clinical evidence for TSW is still sparse. Care must be taken as TSW skin can be extremely reactive.

Naturopathy
Some naturopaths incorporate dietary changes, herbal supplements, and detoxification protocols. Common supplements used include evening primrose oil, vitamin D, and zinc. These approaches are largely based on theoretical mechanisms and patient experience, and should be used with caution under professional guidance.

While these approaches are not universally accepted in conventional dermatology, many patients report symptomatic relief and a sense of empowerment from using them — highlighting the importance of personalised care and shared decision-making.

Pharmaceutical and Immunomodulatory Treatments

Despite resistance to pharmaceuticals in much of the TSW community, some people with severe, protracted TSW consider systemic medications under specialist supervision. These are typically reserved for cases where inflammation is extreme or unmanageable.

Dupilumab (Dupixent)
Originally developed for moderate-to-severe atopic dermatitis, dupilumab blocks the IL-4 and IL-13 pathways involved in type 2 inflammation. While not approved specifically for TSW, some case reports describe improvement in TSW-like symptoms with its use. Results are inconsistent, and more research is needed to clarify its role.

Cyclosporine and methotrexate
These systemic immunosuppressants are sometimes used short-term to control severe skin inflammation. However, they carry significant side effects and are generally considered last-resort options. Their use for TSW remains controversial and off-label.

Topical calcineurin inhibitors (TCIs)
Tacrolimus and pimecrolimus are non-steroidal topical immunomodulators used for eczema. Their use in TSW is debated: some clinicians avoid them altogether, while others may cautiously use them on limited areas to control inflammation during withdrawal. Research on their safety in TSW is limited.

Importantly, any use of pharmaceutical agents must be carefully weighed against the risk of prolonging steroid dependence or triggering flares. Many clinicians prefer a watchful waiting approach.

The Role of Tapering

A Gradual Approach to Discontinuing Topical Steroids

One of the most debated topics in 2025 is whether tapering off topical steroids reduces the risk or severity of TSW. Some dermatologists advocate a slow taper — gradually lowering potency and frequency over months — to give the skin and immune system time to adjust.

“Gradually tapering off is essential compared with abrupt discontinuation, particularly if the medication has been used for an extended period “- (Safer & Zito, 2022)

Others argue that tapering may simply prolong steroid exposure and delay recovery, and that “cold turkey” withdrawal is ultimately faster. There is currently no high-quality comparative research proving which method is superior. Most clinicians agree that the decision should be individualised, based on factors such as potency and duration of prior steroid use, patient mental health, and availability of support.

What is clear is that abrupt cessation of very high-potency steroids after long-term use can provoke dramatic rebound inflammation, so medical oversight is essential in either approach.

Research and Future Directions

In 2025, research into TSW remains in its infancy but is expanding. Recent focus areas include:

Defining diagnostic criteria
Proposed by experts like Dr Belinda Sheary, these include essential features (history of long-term TCS use, erythema, burning) and key signs (elephant wrinkles, red sleeve, oozing, edema). Consensus guidelines are still being developed.

Barrier repair technologies
Novel topical formulations (lipid nanoparticles, ceramide-rich creams) are being tested to accelerate barrier recovery without using steroids.

Cold Atmospheric Plasma (CAP)
A newer area of experimental dermatology involves the use of cold atmospheric plasma — ionised gas at near-room temperature — to promote wound healing and reduce microbial load on the skin. Early laboratory studies suggest CAP can stimulate skin cell regeneration, modulate inflammatory pathways, and enhance barrier recovery without thermal damage. While CAP has been trialled in chronic wounds and atopic dermatitis, its application to TSW remains medically unstudied. Nonetheless, its anti-inflammatory and barrier-supporting properties make it a potential avenue for future TSW research.

Immune modulation
Biologics targeting other pathways beyond IL-4/IL-13, such as JAK inhibitors, are being explored cautiously in severe, chronic cases.

These early efforts underscore a growing recognition of TSW within dermatology and the need for rigorous clinical trials.

Moving Forward with Compassion and Caution

TSW can be an isolating and exhausting journey. People navigating it often feel betrayed by the medical system that once reassured them of the safety of topical steroids. This emotional context shapes treatment choices and makes trust-building essential in clinical care.

For now, the mainstay of TSW management remains supportive care, patience, and addressing the underlying eczema if present. Treatments must be personalised, trauma-informed, and approached collaboratively between patient and clinician.

There is still no definitive cure for TSW, and many treatments remain experimental or controversial. Yet as awareness grows in 2025, new approaches are emerging — from biologics and barrier repair therapies to microbiome-based interventions.

While there is no one-size-fits-all path to recovery, ongoing research and open dialogue between the medical community and those with lived experience are slowly illuminating the way forward. With time, care, and compassion, hope continues to grow for safer and more effective treatments for TSW.

From Jason:

After sharing my story of tapering off topical steroids, I’ve received a few heartfelt messages from the community asking me to elaborate on the finer details. This has evolved into a book that I’ve been working on for a long time. 

I hope that my story can help anyone who’s on a similar journey.

The post Topical Steroid Withdrawal (TSW) Treatments in 2025 appeared first on TSW Assist | Topical Steroid Withdrawal Insights.

The decision to discontinue topical steroids, whether abruptly or through gradual tapering (also known as weaning), is deeply personal and often shaped by a combination of medical advice, individual experiences, and symptom severity. For those trying to come off topical steroids, the medical advised route generally recommends tapering as a way to minimise acute withdrawal symptoms, with strategies such as decreasing the potency of the steroid, reducing frequency of application, or allowing for steroid-free periods.

Despite these recommendations, many patients report difficulties with tapering, leading some to opt for an abrupt cessation, also known as the cold turkey method. Each approach comes with challenges, and there is no universally accepted strategy that guarantees a smooth recovery.

The impact of social media on the advocacy and awareness of TSW, has created a plethora of shared stories of suffering across Instagram, Facebook, and TikTok. Many sufferers advocate for the complete cessation of topical steroids without tapering — influencing a global reach of shared experiences.

Whether tapering or cold turkey; both approaches aim toward the same goal—healing—but the paths to get there are often uncertain.

Medical Advice Favours Tapering

The general medical advice for discontinuing topical steroids after long term usage follows a tapering strategy.

Gradually tapering off is essential compared with abrupt discontinuation, particularly if the medication has been used for an extended period (Safer & Zito, 2022).

This means gradually reducing the potency, application frequency, or both. A common example includes moving down the “topical steroid ladder,” where a patient starts on a high-potency steroid and slowly transitions to lower-potency options. Some dermatologists recommend spacing out applications—reducing daily use to every other day, then weekly, with intermittent steroid-free breaks in between.

Tapering is not exclusive to topical steroids; it is a common practice in medicine for safely discontinuing various pharmaceutical medications. Gradually reducing the dosage over time helps the body adjust and reduces the risk of withdrawal symptoms or rebound effects. This approach is widely recommended for medications such as opioids (OxyContin, Vicodin, Dilaudid), stimulants (Adderall, Ritalin), dopamine agonists (ropinirole, pramipexole), and oral steroids like prednisone. In each case, tapering allows the body to recalibrate its physiological responses, minimizing potential side effects and ensuring a smoother transition off the medication.

On paper, tapering is intended to prevent the skin and body from experiencing an acute rebound effect, where the sudden absence of steroids causes inflammation to flare up dramatically. In theory, tapering should allow the skin to adapt gradually, giving the body time to recalibrate its immune response. However, the reality for many TSW sufferers is different. The strategy of tapering doesn’t always provide the relief it promises. For some, tapering can prolong the suffering and worsen the symptoms, making the process feel endless and discouraging.

Why the TSW Community Struggles with Tapering

Many people in the TSW community report that tapering is not just challenging but sometimes impossible. There are several reasons why the tapering approach is difficult in practice:

1. Dependence and Rebound Flares
   The skin becomes dependent on topical steroids over time, making tapering a slow, agonizing process. Even a slight reduction in usage can trigger severe flare-ups of both the underlying skin condition and the withdrawal symptoms, often resembling the symptoms of —red, burning skin, swelling, and intense itching. When tapering leads to these rebound flares, it can be emotionally exhausting, and many sufferers abandon the attempt.
2. Lack of Clear Guidelines
   Tapering protocols can be vague, and patients may not be given concrete, actionable plans to follow. Dermatologists may provide guidance, but each person’s skin responds differently, leaving many sufferers in a frustrating trial-and-error process. The unpredictability of symptoms adds to the emotional burden, with people questioning whether they are doing it “right” or if they should have stopped altogether.
3. The Psychological Toll
   For those who are emotionally overwhelmed by their condition, tapering may feel like a series of setbacks rather than a gradual improvement. Each flare can feel like a personal failure, reinforcing the belief that the process isn’t working. This psychological burden pushes many towards seeking more drastic solutions—like quitting abruptly through the cold turkey approach.

Survey Insight:

View more Tapering Insights from the survey

Why Many Opt for the Cold Turkey Approach

Faced with the uncertainty and lengthiness of tapering, many sufferers choose to quit topical steroids abruptly. Online communities on Instagram, Facebook, and TikTok advocate for the complete cessation of topical steroids. Stopping topical steroids abruptly through cold turkey approach, while more extreme, offers a sense of decisiveness. Here’s why it appeals to so many:

1. Taking Back Control
   Quitting cold turkey allows sufferers to take ownership of their healing process. For many, it's a way to say, “Enough is enough.” After years of feeling dependent on steroids and the emotional rollercoaster that comes with tapering, the prospect of going cold turkey offers clarity—a single, definitive decision to stop the cycle.
2. A Clean Break
   Many believe that abruptly quitting is the only way to truly detox the body from steroids. Instead of dealing with tapering-induced rebound flares, they choose to face the withdrawal head-on. The suffering is intense, but for many, it’s a way to get through the worst and emerge on the other side without prolonging the process.
3. Influence from the TSW Community and Social Media
   The growing presence of the TSW community on social media platforms has also played a significant role in promoting the cold turkey approach. Testimonials from those who’ve successfully quit steroids offer hope to those considering the same path. The community provides a sense of solidarity and empowerment, reinforcing the belief that healing is possible when topical steroids are stopped entirely. Sufferer-led advocacy and successful healing stories have paved the path for the cold turkey method.

The cold-turkey route has paved the way for unique support treatment methods from health practitioners such as Dr. Marvin Rapaport, Dr Kenji Sato and NMT, Cold Atmospheric Plasma Clinics for TSW, and more.

The Challenges of Both Approaches

Whether you taper off or stop topical steroids abruptly, the journey managing and underlying skin condition and TSW can be incredibly difficult. Both choices present unique challenges:

1. The Long Haul
   Tapering off can stretch over months or even years, with flare-ups along the way that make it hard to gauge progress. Meanwhile, the cold turkey approach may come with an unknown duration and an intensity that can feel unbearable.
2. Social Isolation
   Both approaches require enormous patience and mental strength. The visible symptoms of TSW—red, peeling skin, swelling, and intense itch—can lead to social withdrawal and isolation. Many sufferers feel misunderstood, unsupported, and alone, regardless of which path they choose.
3. Relapses and Setbacks
   Even with careful planning, relapses are common with both methods. For those tapering, a relapse may mean going back to a higher dose, undoing progress. For those who quit cold turkey, setbacks can trigger doubt and fear that healing may never come.

The Role of Social Media

Social media platforms have become a double-edged sword in the TSW journey. The impact of social media on the advocacy and awareness of TSW, has created a plethora of shared stories of suffering across Instagram, Facebook, and TikTok.

Many sufferers advocate for the complete cessation of topical steroids without tapering — influencing a global reach of shared experiences. On one hand, the online TSW community offers connection, validation, and a sense of belonging. People share their stories, offer tips, and provide emotional support to one another. For many, these online spaces are a lifeline, especially when conventional medical advice fails to address their struggles.

However, social media can also amplify anxiety and pressure. Success stories of those who healed after quitting cold turkey can make others feel as though they’re not doing enough if they attempt tapering. The constant comparison can create unrealistic expectations and guilt. Additionally, misinformation spreads easily, with sufferers trying unproven remedies or extreme methods based on anecdotal advice.

Lack of Support Leads to Self-Experimentation

A major reason why TSW sufferers often take matters into their own hands is the lack of medical support and understanding. Many dermatologists and healthcare providers are either unaware of TSW or dismissive of it as a condition. This gap in care leaves sufferers without the guidance they need, forcing them to become their own health advocates.

As a result, people experiment with both tapering and cold turkey approaches, hoping to find what works for them. The absence of reliable medical advice adds to the emotional weight of the decision-making process, with sufferers constantly questioning whether they are making the right choice.

The Shared Goal of Healing

At the heart of both approaches—whether tapering or cold turkey—is the same goal: healing. People experiencing TSW are seeking freedom from the painful cycle of dependency on steroids, hoping to reclaim their health and well-being.

As TSW has gained significant attention in the media over the past few years, efforts to better understand both the underlying skin conditions treated by topical steroids and the withdrawal effects associated with their discontinuation have increased. The choice to stop using topical steroids—whether through gradual tapering or abrupt cessation—is a deeply personal one, influenced by a mix of medical guidance, individual circumstances, and symptom severity.

While doctors typically recommend tapering to mitigate acute withdrawal symptoms, many patients struggle with this approach, prompting many to choose the cold turkey method. Both strategies come with unique challenges, and no single path guarantees a straightforward recovery. Ultimately, both tapering and abrupt cessation share the same goal: healing.

From Jason:
I've received a few heartfelt messages from the community asking me to elaborate on the finer details of my journey of tapering off topical steroids. This has evolved into a book that I’ve been working on for a long time. 

"Taper" is now is available. I hope that my story can help anyone who's on a similar journey.

The post Cold Turkey vs Tapering Off Topical Steroids? Both Methods Explained appeared first on TSW Assist | Topical Steroid Withdrawal Insights.

The idea of “healing TSW naturally” is a question often posed in communities of those dealing with Topical Steroid Withdrawal (TSW). But what does healing naturally mean? For most, it refers to the use of non-pharmaceutical methods or products—typically those derived from natural ingredients such as plants, minerals, or other earth-based compounds.

This concept stems from a desire to avoid synthetic or pharmaceutical treatments, particularly among those who feel their condition has been worsened by the use of pharmaceutical topical steroids. However, healing TSW naturally is more complex than simply turning to natural products. It invites a broader discussion about TSW itself and its connection to eczema, the most common underlying skin condition for many TSW sufferers.

What Does “Healing Naturally” Mean?

When discussing natural healing, there is often a focus on using non-pharmaceutical methods to address symptoms or conditions. The term “natural” generally refers to remedies derived from herbs, plants, essential oils, minerals, or lifestyle changes. The idea is to avoid synthetic medications, which some believe may only address symptoms rather than the root cause of the condition. For many going through TSW, natural healing is about allowing the body to rebalance itself without relying on topical steroids or other pharmaceuticals that can further complicate the healing process.

But what makes this question even more complicated is that when we talk about healing TSW, we may also be talking about healing eczema. This brings us to a crucial distinction that many in the community are aware of but is not always discussed openly.

The Nuances of Healing TSW vs. Healing Eczema

TSW is a result of withdrawing from topical steroids, but it often goes hand-in-hand with a return of the original condition: eczema. So, the question of how to heal TSW naturally can actually be broken down into two parts:

1. How to heal TSW naturally? – focusing on managing the symptoms of steroid withdrawal.
2. How to heal eczema naturally? – addressing the root skin condition that may have been suppressed for years by steroid use.

While both are related, they are not the same. Healing eczema naturally is a different conversation from healing TSW naturally, though they share some overlapping strategies.

When someone starts experiencing TSW, they often face a hybrid of the two conditions. They are not only battling withdrawal symptoms like burning, swelling, and flaking, but also the return of their underlying eczema, which can look worse than ever because the skin may have been reliant on topical steroids for so long.

Diagnosis for TSW

There is no widely agreed-upon set of diagnostic criteria for topical corticosteroid withdrawal. However, recent literature has identified key features that include:

• Frequent and prolonged use of topical steroids on the affected area.
• Frequent and prolonged use of topical steroids on sensitive areas like the face or genitals.
• Symptoms such as burning, itching, and rapid development of redness (erythema) within days to weeks after discontinuing topical steroids.
• Commonly associated factors like a history of atopy, especially atopic dermatitis, prior use of oral prednisone for skin issues, skin sensitivity, excessive skin shedding, oozing skin, swelling (especially around the eyes or ankles), and specific skin changes like “elephant wrinkles” on the elbows and knees (extensors) or the “red sleeve sign.”

Suggested Diagnostic Criteria for TSW: A Starting Point for Discussion and Future Research

Dr. Belinda Sheary, an Australian medical doctor renowned for her extensive publications on TSW since 2016. According to Dr. Sheary, TSW can be considered when the following essential criteria are fulfilled, the diagnosis becomes more likely when more of the key diagnostic criteria are also present.

Essential Criteria

1. History of long-term regular topical corticosteroids (TCS) use (months to years) where TCSs were initially effective, but over time, either increased amounts or potencies (or both) were required to reduce severity of skin symptoms
2. Itch
3. Erythema

Key Diagnostic Criteria

1. History of atopy, especially atopic dermatitis
2. History of TCS use on the face, especially potent TCSs
3. History of oral prednisone use for skin symptoms
4. Burning pain on the skin
5. Skin sensitivity to previously tolerated skin products
6. Excessive skin exfoliation (“shedding”)
7. Oozing skin
8. Edema, especially of the eyelids or ankles
9. “Elephant wrinkles” of the extensor elbows and anterior knees
10. “Red sleeve” sign

Additional Supporting Features That May Be Present

1. Sleep disturbance
2. Mood disturbance
3. Skin pain, other than burning pain
4. Papules and pustules
5. Headlight sign

How to Heal Eczema Naturally?

Before diving into natural remedies for TSW, let’s explore what healing eczema naturally entails. After all, if TSW is part of a longer-term eczema problem, addressing the eczema may ultimately help with the healing process of TSW as well. Here are several natural methods often used for managing eczema:

1. Dietary Changes

There is growing evidence that diet can impact skin health, particularly for those with inflammatory conditions like eczema. Research has shown that eliminating common triggers such as dairy, gluten, and processed sugars can reduce flare-ups in some people. In contrast, adding anti-inflammatory foods such as fish (high in omega-3s), high-protein foods, and fermented foods like kimchi or kefir can support skin health.

2. Moisturizing with Natural Oils

Many people with eczema have found relief using natural oils instead of conventional moisturizers. Coconut oil, shea butter, avocado oil, and jojoba oil are also popular choices for keeping the skin hydrated without synthetic ingredients.

3. Probiotics

Another potential natural solution is taking probiotics, which support gut health. Since there is a known link between gut health and skin health, taking a daily probiotic may help manage eczema symptoms from the inside out.

4. Traditional Chinese Medicine (TCM) and Acupuncture

Acupuncture and herbal medicine, staples of Traditional Chinese Medicine (TCM), have been used to treat eczema for centuries. TCM views eczema as a manifestation of imbalance within the body and aims to treat both the symptoms and the root cause. Acupuncture, in particular, may help reduce inflammation and relieve itching, while Chinese herbs, such as licorice root or Chinese skullcap, are thought to help detoxify the body.

5. Naturopathy

Naturopathy often involves a combination of dietary changes, herbal medicine, and lifestyle adjustments to help manage eczema. Natural remedies such as evening primrose oil, fish oil supplements, or vitamin D can support skin health.

How to Heal TSW Naturally?

Healing TSW naturally is more complex and nuanced. It is an iatrogenic syndrome and more research is needed. The skin is going through a massive detoxification process and can be extremely sensitive to even natural products. Healing TSW is not just about treating the skin; it’s about managing a wide range of systemic symptoms that can come with withdrawal.

Some people experience chronic-fatigue, insomnia, anxiety, and depression during TSW, which makes the healing journey much more involved than eczema alone.

Here are a few approaches that people in the TSW community have found helpful to manage some symptoms, although more research is needed in this area.

1. Cold Compresses and Ice Packs

When the skin burns, using cold compresses or ice packs can help reduce inflammation and offer temporary relief. This method is often reported as a quick fix for itching and burning sensations, which are common in the early stages of TSW.

2. Dead Sea Salt Baths

Dead Sea salt baths are thought to soothe the skin and help reduce inflammation. The high magnesium content in these salts may support the skin’s barrier function. Some anecdotal reports suggest that regular salt baths can help reduce the itch and tightness associated with TSW.

4. No Moisture Treatment (NMT)

The No Moisture Treatment (NMT) is a controversial method that involves avoiding all moisturizers and allowing the skin to heal on its own. The theory is that the body will naturally regulate its moisture levels, and introducing external moisturizers may prolong the healing process. However, this approach is difficult and not well-studied, with anecdotal success and mixed results. It requires strict medical supervision in a clinical setting. This method is only applicable for people who have stopped all usage of topical steroids entirely, rather than tapering off.

 Related Post: Cold Turkey Vs Tapering Off Topical Steroids

5. Traditional Chinese Medicine (TCM)

Just like for eczema, TCM can be applied to TSW. Herbal formulas designed to detoxify the body may help speed up the withdrawal process, while acupuncture can relieve some of the more uncomfortable symptoms, such as burning and itching.

6. Naturopathy

Naturopaths may recommend lifestyle changes, such as dietary adjustments or supplements, to support the body’s natural healing process. They may also suggest specific herbs or vitamins to help reduce inflammation, support detoxification, or soothe the skin.

Pharmaceutical Considerations

In the contrast of healing TSW “naturally”, it’s also important to address what it means to heal "unnaturally." TSW, being an iatrogenic condition—meaning it is inadvertently caused by the topical steroid medications meant to treat the eczema —has understandably led to a strong anti-pharmaceutical sentiment within the TSW community. This frustration is not just directed toward topical steroids but often extends to all pharmaceutical interventions. Many who suffer from TSW feel deeply let down by conventional medicine, and the resulting disillusionment can lead to outright rejection of pharmaceutical treatments, even when some may be beneficial in certain cases.

The emotional and psychological complexities of living with TSW, including feelings of betrayal by the medical system, often shape a firm opposition to any form of pharmaceutical medicine.

This resistance can cloud constructive discussions about the potential benefits of certain medical treatments. While it’s crucial to respect the reasons for this mistrust, it is also important to recognize that some pharmaceutical options are discussed within the TSW community as potential treatments, even if they remain controversial. Medications like Dupixent (dupilumab) and cyclosporine, for instance, are often considered by those struggling with severe cases of TSW or eczema, as these drugs can target immune system pathways involved in the inflammatory process.

Although these treatments can be helpful for some, they are not without risks, and the decision to use them requires careful consideration. In online forums, discussions about these options are often heated, reflecting the tension between seeking relief and fear of medication.

Ultimately, navigating the use of pharmaceutical treatments within the TSW community requires a balanced, informed approach, recognizing both the valid concerns and the potential benefits.

Is Healing TSW Naturally Possible?

Healing TSW naturally is not a straightforward process, and it can be tempting to look for a one-size-fits-all solution. But the truth is, healing TSW—and eczema, for that matter—is highly individualized. Natural healing methods can be effective, but they require patience, research, and a willingness to explore various options safely. Always consult a healthcare provider when trying new treatments, even natural ones, to ensure they are appropriate for your specific situation. Although not defined as natural healing, non-steroidal pharmaceutical medications to treat eczema are being considered and discussed within online communities.

The distinction between healing eczema and TSW is crucial, and while the lines can sometimes blur, understanding the nuances of each can guide you toward the right path. Ultimately, a natural approach is about working with your body, rather than against it, to achieve long-term health.

The post Healing Topical Steroid Withdrawal With Natural Remedies – The Nuances of Eczema and TSW appeared first on TSW Assist | Topical Steroid Withdrawal Insights.

Earlier this year, I visited the Cold Atmospheric Plasma (CAP) Clinic for TSW in Bangkok. The following recount is from a chapter in my new book Taper.

On my quest to explore modern treatments for TSW, I encountered hundreds of social media posts and patient narratives that led me to CAP. This innovative treatment was being utilised to aid people coping with TSW. I was captivated by numerous testimonials from people worldwide receiving CAP therapy at clinics in the United Kingdom and Bangkok. In February 2024, driven by hope and curiosity, I flew to Bangkok to learn more.

From the moment I stepped into the clinic in Bangkok, I felt a warming sense of community. The waiting room was busy with patients, each sharing their stories of battling eczema, skin atrophy, and severe withdrawals from topical steroids.

Every person I met—wrinkled, peeling, red, and hunched over—reminded me of my former self. It was like looking into a mirror of my past struggles. Many had uprooted their lives, relocating to Bangkok indefinitely to undergo continuous CAP treatment. Among them were some teenagers accompanied by their parents, all united together by a collective hope for healing and shared suffering caused by their skin condition.

I met Jordan, a fellow Aussie who had been undergoing CAP therapy at the clinic for the past two months. Jordan had ceased using topical steroids altogether and had endured immense suffering over the past few years. I had been following his journey on Instagram, witnessing one of the most severe cases I had ever seen, with his entire body covered in open sores, dry scales, and his skin burning a bright red. Jordan is one of the most well known advocates in the TSW community, sharing his story in interviews with the ABC and 7NEWS. Despite his condition, Jordan exuded creative energy and excitement. He was working on a documentary in a back room, interviewing all the patients who came to the clinic to share their journeys. He interviewed me as well, and it felt like a therapy session. Jordan asked me personal questions about my journey, and I found myself sharing deeply emotional stories and experiences that I had completely forgotten. It was a cathartic experience for me.

I also met Aliya, who was undergoing CAP treatment at the clinic. Aliya worked remotely as a consultant for the Canadian government and was able to continue her work while receiving CAP therapy in Bangkok. It was her second visit to the Bangkok clinic, and she intended to stay indefinitely. Aliya had made the difficult decision to cease using topical steroids completely after chronic skin complications after prolonged topical steroid usage. 

She shared how, when she began CAP treatment, her neck had been covered in thick, hardened skin that severely restricted her movement. Observing her skin health on that day we met, the skin on her neck looked quite healthy. I couldn’t imagine how much pain and recovery she had gone through.

After spending some time in the front office, exchanging stories of our skin struggles, I finally met Jay. He entered through the front door and greeted me warmly.

Peerawat Jay and CAP Therapy for TSW

Peerawat Jay is a practitioner who has been dedicated to treating TSW people for 15 years in both Thailand and Singapore. He pursued a four-year preclinical M.D. program at Mahidol University from 1995 to 1999, where he graduated with first-class honours and received the prestigious Rockefeller Scholarship. Following this, between 1999 and 2004, Peerawat engaged in Ph.D. coursework and research. Unfortunately, due to financial constraints, he was unable to complete his dissertation by 2005, resulting in his discontinuation from the clinical portion of the program.

In 2004, Peerawat began working at an aesthetic device company that ran a clinic specialising in laser therapy for aesthetic purposes. During his tenure, he noticed that certain laser treatments could potentially thin the skin, leading to redness and sensitivity. Motivated to address this issue, he collaborated with his father-in-law, Dr. Chanchai Chutsirimongkol M.D., to develop a device aimed at reversing skin thinning and promoting skin regeneration.

As Peerawat treated more patients with skin thinning issues, he observed that prolonged use of topical steroids exacerbated some cases. Collaborating with Dr. Chanchai, they devised a treatment strategy that effectively reversed these conditions, deepening Peerawat’s understanding and expertise in managing TSW. Over the years, his experience with increasingly severe cases has significantly broadened his knowledge and refined his treatment approaches.

Despite the controversial nature of TSW treatment, Peerawat’s dedication to the field only grew stronger. He travelled to Singapore to share his expertise and ensure the ongoing availability of effective treatments for TSW. Currently, based in Thailand he continues to support a global community of sufferers, collaborating closely with a team that includes Dr. Chanchai Chutsirimongkol M.D., Dr. Sirayut Benjaoran M.D., Dr. Sarintip Tangyoosuk M.D., Dr. Wattanapak Khamphui M.D., and Dr. Achjima Tangkul M.D. Together, they strive to provide relief and solutions for individuals affected by TSW.

Jay kindly invited me to observe the initial consultations for two new patients. One patient was a teenage boy from Thailand, and the other was a young woman from Perth, Australia. Both of them were accompanied by their parents. During the consultation, Jay meticulously explained his treatment protocol for TSW in depth. He was sincere and well-informed, using diagrams and charts to ensure the condition and the treatment plan for both patients and their parents.

The CAP treatment operates on three core principles aimed at regenerating skin affected by TSW:

1. Cellular Regeneration
   The therapy triggers growth factors in skin cells to enhance their regeneration rate39.
2. Bacterial and Fungal Eradication
   By interacting with pathogens on the skin, the treatment targets and eliminates harmful bacteria and fungi. This helps improve skin recovery and prevents infections that could worsen the condition 
3. Micro-Exfoliation
   The therapy includes a gentle micro-exfoliation process to manage hardened and damaged skin, facilitating smoother and healthier skin appearance

Jay recounted numerous cases of previous patients who had experienced symptoms such as hardened, oozing skin, and skin atrophy due to excessive use of topical steroids. He explained how damaged skin could result in heightened sensitivity to the external environment, as the epidermal layer becomes significantly compromised.

Jay also assists patients in identifying specific triggers in their lifestyles that can provoke flare-ups. Some patients uncover that environmental factors are significant culprits, ranging from dust mites to harsh chemical cleaning products. In one notable instance, Jay recounted how a patient experienced severe skin reactions due to the manufacturer’s perfume on a new leather sofa. Another patient said to have suffered flare-ups triggered by frequent exposure to printer ink at their job. I found Jay’s insights both profound and alarming.

Later in the day, I was fortunate to have lunch with Jay and Aliya. It became clear to me that CAP therapy was creating a profound movement within the TSW community. In our conversation, I asked Jay how I could help the community. He paused for a moment to think. He responded that he wanted people to learn as much as they could about understanding their external triggers in their environments. He shared that many patients left the clinic significantly improved after months of treatment, only to experience flare-ups upon returning to their home countries due to environmental factors at home or work. This underscores the need for more information and tracking around the long-term effectiveness of receiving ongoing CAP treatment.

CAP therapy can be beneficial for improving skin that has atrophied from long-term steroid use, focusing primarily on the skin cell regeneration, bacterial eradication, and micro-exfoliation. However, the underlying original skin conditions that were previously treated by topical steroids, such as eczema—which is often linked to genetic and environmental factors—may remain untreated by the CAP technology. This may explain why many people continue to experience flare-ups of their original skin condition after returning back to their homes and workplaces.

In my journey to find treatments and protocols for tapering off topical steroids, I learned that Jay’s CAP Therapy clinic in Bangkok only treats patients who have stopped using topical steroids completely. They do not treat patients who are still using topical steroids.

From Jason:

After sharing my story, I’ve received a few heartfelt messages from the community asking me to elaborate on the finer details of journey of tapering off topical steroids. This has evolved into a book that I’ve been working on for a long time. 

I hope that my story can help anyone who’s on a similar journey.

The post A Visit to The CAP TSW Clinic in Bangkok appeared first on TSW Assist | Topical Steroid Withdrawal Insights.

Below is a collection of powerful memoirs that chronicle the journeys of those who lived through TSW. Each book is a testimony to the power of perseverance and community, a reminder that no one has to go through this journey alone.

To Eczema with Love by Kelly Barta

Kelly’s book is a heartfelt letter to her former self and to anyone who feels lost in their battle with TSW. She shares her journey with grace and humour, bringing light to a dark time. This memoir will resonate with those who have felt frustrated, misunderstood, and desperate for relief, showing that love and acceptance are powerful forces for healing.

The Shape of Skin by Ruth Holroyd

Ruth captures the complex relationship we have with our bodies during illness. Through her battle with TSW, she reflects on how the condition changed her skin and the way she saw herself. This book is a poetic exploration of identity, loss, and the journey to rebuild self-love while navigating the physical and emotional pain of withdrawal.

Taper by Jason Vergara

Jason’s book explores a path less travelled and less shared on social media—tapering off topical steroids instead of quitting cold turkey. He takes readers through his personal journey with TSW, detailing the slow and deliberate process of tapering after twenty years of overuse. With candid storytelling, Jason offers a blend of insight, hope, and hard-earned lessons. He also delves into insights of creating TSW Assist, and the emerging protocols for TSW from unique health professionals. Jason reflects on the ongoing discourse between tapering and cold-turkey approaches on social media, and highlights the power of integrative health.

Curing My Incurable Eczema by Cara Ward

Cara’s journey is one of self-discovery and hard-fought healing. For years, she was told her condition was chronic, incurable eczema—until she discovered TSW. Through sheer determination and countless ups and downs, Cara found her way to wellness. This book is a raw and uplifting account of overcoming what was once deemed “incurable” and finding peace on the other side of TSW.

This is Not Eczema by Claire Oxenham

Claire’s story challenges the misdiagnosis and confusion that often plague TSW sufferers. In this deeply personal memoir, she details how she broke free from the cycle of steroids that worsened her condition. With emotional depth, Claire shares her healing journey, advocating for awareness and truth. Her experience will resonate with anyone who has ever felt unseen in the healthcare system.

Iron Skin by Brendan John Lee

Brendan’s story is as much about mental strength as it is about physical healing. His journey through TSW is a battle against despair, testing his resilience at every turn. With honesty and grit, Iron Skin explores how he rebuilt himself, layer by layer, using his inner strength to persevere through one of the most challenging times of his life.

Beyond the Itch: A Mother’s Story of Survival Through Topical Steroid Withdrawal by Melissa R.R.

Melissa’s memoir provides a heart-wrenching perspective of a mother living through TSW while balancing family life. Her story is a testament to survival, not just for herself but for her children. It’s a deeply emotional account of juggling motherhood with chronic illness, offering hope to others in the same fight.

These books are more than just stories—they inspire hope for better health. They reflect the reality of an iatrogenic illness that, for a long time, has been met with silence and misunderstanding. For anyone enduring the difficult path of withdrawal, these stories offer connection, understanding, and hope. You are not alone, and healing is possible.

The post Topical Steroid Withdrawal Books – TSW Healing Success Stories appeared first on TSW Assist | Topical Steroid Withdrawal Insights.

What is Cold Atmospheric Plasma therapy?

Cold Atmospheric Plasma (CAP) therapy is a relatively recent addition to the array of treatments available for wound healing and skin conditions. CAP refers to a physical plasma primarily composed of ionized gas generated at normal atmospheric pressure and ambient temperature. It encompasses multiple synergistically-acting components such as charged particles, electric currents, and ultraviolet radiation​ (1)​. This innovative therapy has emerged as an emerging method in dermatology, offering an alternative to traditional methods like oral or topical drugs, which can come with with systemic side effects and disease recurrence (​2)​.

History of Cold Atmospheric Plasma

Irving Langmuir was an American chemist and physicist who significantly contributed to the field of surface chemistry, earning him the Nobel Prize in Chemistry in 1932. He is also known for his work in plasma science and introduced the term “plasma” in 1928 to describe an ionized gas, laying a foundation for the development of plasma physics. Through his research, Langmuir helped in elucidating the behavior of electrons in ionized gases, which is fundamental to the understanding and applications of plasma, including its use in various medical and industrial applications.

The antimicrobial effect of Cold Atmospheric Plasma, which paved the way for its application in medicine, was discovered in the 1990s. However, it wasn’t until 2007 that the initial clinical trial utilizing a plasma device for facial rejuvenation procedures was conducted. This trial marked the beginning of CAP’s use in regenerative medicine, targeting the acceleration of acute and chronic wound healing by alleviating bacterial infection (​3)​.

The science behind CAP – How it improves skin conditions and wound healing

CAP therapy operates on a physicochemical approach based on ionized gases. This technology has already been employed in dermatology to promote wound healing, and it’s steadily gaining traction in the cosmetic field as well (​4)​. Its mechanism of action includes the elimination of bacterial infection, which is often a significant hurdle in the wound healing process. CAP’s capacity to reduce bacterial load in a wound initiates the healing process, a feature that has been showcased in various clinical settings including a case report where active wound dressings with cold plasma significantly improved chronic wounds​ (5)​.

Moreover, the interaction of CAP with living tissues generates reactive species which have cytotoxic and bactericidal effects, promoting cell proliferation and exhibiting anti-inflammatory effects. These properties make CAP a promising treatment for diseases involving chronic inflammation and bacterial infections.

The effectiveness and safety of CAP in treating skin diseases and promoting wound healing have opened new horizons in dermatology, marking a step forward towards establishing novel, non-invasive therapeutic approaches for managing skin conditions and improving patients’ quality of life.

Dermatological benefits of Cold Atmospheric Plasma therapy

• Treatment of skin diseases
  CAP can potentially provide effective therapy for numerous skin diseases, paving the way for innovative dermatological treatments​(6)​.
• Bacterial eradication
  CAP has demonstrated substantial antibacterial properties, reducing bacterial load and thus aiding in the management of skin infections and inflammations.
• Enhanced absorption
  By creating minuscule openings between cells, CAP facilitates enhanced absorption, augmenting product efficacy and transdermal delivery.
• Accelerated healing
  CAP has shown to promote wound healing by reducing bacterial contamination, making it a viable option for managing acute and chronic wounds​(7)​.
• Skin regeneration
  CAP activates angiogenesis-related molecules in skin keratinocytes, fibroblasts, and endothelial cells, leading to increased production of collagen and elastin, which are crucial for skin regeneration.
• Microbial inactivation
  CAP acts as an antimicrobial agent, aiding in microbial inactivation, which is particularly beneficial in dermatological contexts where infectious microorganisms and disease processes complicate wound healing​ (8)​.
• Alopecia treatment
  It has been utilised to treat alopecia areata, demonstrating its potential in addressing hair loss conditions.
• Occlusion management
  CAP has been effective in treating vascular occlusion post dermal filler complications.
• Blood coagulation
  CAP accelerates blood coagulation, which can be beneficial in certain dermatological procedures or conditions​ (9)​.
• Technical versatility
  The technical versatility of CAP, including direct irradiation and indirect aqueous treatment, expands the scope and efficacy of dermatological treatments, allowing for a more tailored approach to individual patient needs​(10).

The rise of interest for CAP therapy for Topical Steroid Withdrawal

The emergence of Cold Atmospheric Plasma (CAP) therapy in treating patients suffering from Topical Steroid Withdrawal (TSW) is a beacon of hope for both sufferers and their caregivers. While there is no medical cure for Topical Steroid Withdrawal, novel specialist clinics are utilising CAP therapy to treat the wound healing associated with the TSW skin condition.

Social media, online forums, and support groups have facilitated the popularity and growth of interest of CAP therapy to treat topical steroid withdrawal over the past two years. But how did it come about?

Peerawat Jay is a Thai practitioner who has been treating patients with topical steroid withdrawal in Bangkok for 16 years. His unique CAP machines have gone through various iterations and calibrations to specifically treat TSW skin have resulted in successful patient care and outcomes. The specific CAP machines and their custom tailored approach for each individual patient has resulted in patient care and treatment outcomes over the past 16 years.

Related Post: A Recent Visit to The CAP TSW Clinic in Bangkok

Jay’s Ultra Pulse Contact CAP treatment is tailored for people battling Topical Steroid Withdrawal (TSW). It operates on three core principles to rejuvenate TSW-affected skin:

• Cellular regeneration
  • It triggers growth factors in skin cells, enhancing their regeneration rate, especially when hindered by long-term medication use.
• Bacterial and fungal eradication
  • By interacting with pathogens on the skin, it eradicates harmful bacteria and fungus, aiding in skin recovery.
• Micro-exfoliation
  • It performs a gentle micro-exfoliation to manage hardened skin, making it suitable even for sensitive and damaged skin​,

This treatment method that incorporates CAP technology as the primary driving force, has expanded into the creation of Skin Solace, a UK based Skin Clinic. Skin Solace was founded in 2020 by Louise King and Jing Rui who were previous patients of Peerawat Jay and long term sufferers of topical steroid withdrawal. The entrepreneurial pair had been influential advocates for topical steroid withdrawal awareness for many years and have evolved from advocacy to treatment.

Online testimonials and videos from patients of these two skin clinics have gone viral across Instagram, Tiktok, and Facebook groups. 

Considerations for Eczema

It is important to note the initial underlying conditions that was previously being treated by topical steroids, such as atopic dermatitis (eczema), a chronic inflammatory skin condition. CAP’s potential as a treatment for AD has been explored, with positive implications for treating TSW as well. By addressing microbial infections, immune system dysfunction, and skin barrier deficits – central events in AD pathogenesis – CAP therapy could offer a broader spectrum of treatment options for individuals suffering from various skin conditions including TSW (11)(12).

Receiving CAP therapy can be beneficial for improving skin that has atrophied from long-term steroid use, focusing primarily on the skin cell regeneration, bacterial eradication, and micro-exfoliation. However, the underlying original skin conditions that were previously treated by topical steroids, such as eczema—which is often linked to genetic and environmental factors—may be untreated once CAP therapy ceases.

Related: Initial Skin Conditions Before Using Topical Steroids

Are there other CAP clinics for TSW around the world?

CAP machines have been around for many years and lower strength machines are commonly found in cosmetic and skin aesthetic clinics around the world. These CAP machines are different in calibration and technology to the specific machines used in the two clinics mentioned above. This does not devalue their efficacy, but it should be informed that the machines were not intended originally for patients with topical steroid withdrawal.

The emergence of the beneficial outcomes of Ultra Pulse CAP technology from Skin Solace and Bangkok clinic for treating Topical Steroid Withdrawal skin is opening up a new door for new technological advancements, research, customisations into treatment opportunities that utilize Cold Atmospheric Plasma for wound healing.

Recently, there has been an increasing adoption of skin aesthetic clinics around the world promoting treatments for TSW using their own CAP machines. These machines may be calibrated differently than Peerawat’s CAP machines, and the difference of established treatment protocols or trained personnel could potentially result in different outcomes. Nonetheless, there is optimism toward the future advancements in this technology and its potential to benefit more people in need.

Over the next few years, we expect to see various Cold Atmospheric Plasma machines and brands enter the skin treatment market, treating a wide range of medical and dermatological conditions.

The dawn of specialised CAP clinics for TSW

The advent of clinics specializing in CAP treatment for Topical steroid withdrawal reflects a growing recognition of the therapy’s potential. 

New clinics utilising CAP for TSW are marking a significant stride towards tailored care for TSW patients​ with more specialised clinics soon to emerge to facilitate this demand.

The interest and ongoing research in CAP therapy could potentially lead to more refined treatment protocols, better understanding of its mechanisms, and broader application in treating a variety of skin conditions. As more clinics adopt this therapy, the wider population could gain access to this innovative treatment, improving the quality of life for individuals afflicted with TSW and other related skin conditions.

Through the combination of evidence-based science and clinical practice, CAP therapy could become a cornerstone in the management and treatment of TSW, offering hope for countless sufferers and their families.

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9576403/#:~:text=Cold%20atmospheric%20plasma%20,electric%20currents%2C%20ultraviolet%20radiation
2. https://www.frontiersin.org/articles/10.3389/fimmu.2022.868386/full#:~:text=The%20traditional%20therapies%20for%20skin,and%20effective%20functions%20in%20dermatology
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215620/
4. https://www.sciencedirect.com/science/article/pii/S0891584920312776#:~:text=Currently%2C%20a%20physicochemical%20approach%2C%20based,thus%20providing%20a%20new%20challenge
5. https://journals.lww.com/aswcjournal/Fulltext/2022/12000/Use_of_Cold_Plasma_in_Wound_Healing__A_Case_Report.12.aspx#:~:text=The%20concept%20of%20the%20fully,S%2C%20Helmke%20A%2C%20et%20al
6. https://onlinelibrary.wiley.com/doi/10.1002/jbio.202000415#:~:text=Cold%20atmospheric%20plasma%20,use%20of%20CAP%20in%20dermatology
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10219374/#:~:text=Cold%20atmospheric%20plasma%20,contamination%20and%20promote%20wound%20healing
8. https://link.springer.com/chapter/10.1007/978-3-030-49966-2_12#:~:text=The%20understanding%20that%20cold%20atmospheric,1%2C%2024
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7949367/#:~:text=1,accelerating%20blood%20coagulation%2C%20killing
10. https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.918484/full#:~:text=Cold%20atmospheric%20plasma,and%20practical 
11. https://www.medicalnewstoday.com/articles/using-coldwater-atmospheric-plasma-to-treat-atopic-dermatitis#:~:text=Researchers%20from%20the%20Institute%20of,a%20potential%20treatment%20for%20atopic
12. https://karger.com/iaa/article/doi/10.1159/000531967/862369/Cold-Atmospheric-Plasma-A-Promising-and-Safe

The post Cold Atmospheric Plasma Therapy – The Dawn of Specialised Clinics for Topical Steroid Withdrawal appeared first on TSW Assist | Topical Steroid Withdrawal Insights.

Understanding Biomarker Testing and Immunity

Biomarkers are measurable biological indicators—such as proteins, cytokines, or gene expression patterns—that reflect immune activity or dysfunction. In immunology, cytokines including interleukins (ILs), chemokines, and interferons play central roles in orchestrating immune responses and are increasingly used as biomarkers for disease monitoring and diagnosis. Studies in both infectious and inflammatory contexts have shown that blood-based biomarker analysis, such as cytokine profiling, provides valuable insights into how the immune system responds to stressors or pathogens, and can help identify immune imbalances that underlie chronic inflammation or autoimmune disease.​

Improving immune function is not about stimulating the system indiscriminately—it involves restoring balance. Chronic inflammation, allergic sensitization, and immune insufficiency can all stem from dysregulated communication among immune cells. Biomarker testing enables clinicians to pinpoint which pathways are overactive or suppressed, allowing for targeted strategies to rebalance immune activity.

Immune Biomarkers in Eczema and Skin Health

Atopic dermatitis (AD), commonly known as eczema, exemplifies a condition driven by immune system imbalance. It involves an overactivation of the Th2 (type 2 helper T cell) pathway, leading to increased production of cytokines such as interleukin-4 (IL-4), IL-13, and IL-31, which drive inflammation, itching, and barrier dysfunction. Recent studies highlight IL-13 as a key biomarker that not only reflects disease severity but can also predict response to biologic treatments like dupilumab, an IL-4/IL-13 inhibitor.​

Emerging biomarker-based diagnostics are helping to identify early indicators of eczema. A landmark Danish study demonstrated that non-invasively collected skin samples containing elevated levels of IL-8, IL-18, and thymus and activation-regulated chemokine (TARC/CCL17) can predict the development and severity of atopic eczema within the first two years of life. These immune-related biomarkers reveal subclinical immune activation well before visible skin symptoms appear—an insight that could lead to early intervention and prevention.​

In adults, biomarker mapping of gene expression in inflamed skin provides further insight into disease endotypes, or molecular subtypes. A 2024 study established a molecular “immune map” to classify inflammatory skin diseases such as psoriasis and eczema based on specific immune gene modules, improving the diagnostic accuracy of ambiguous skin conditions. This molecular profiling supports precision dermatology, where therapies are matched to a patient’s dominant immune signature.​

How Biomarker Testing Could Support Immune Resilience

By providing a window into the immune system’s function, biomarker testing can reveal micronutrient deficiencies, chronic inflammation, oxidative stress, and immune regulation issues that underpin eczema severity. For example, C-reactive protein (CRP) and pro-inflammatory cytokines like tumor necrosis factor-alpha (TNF-α) or IL-6 can signal systemic inflammation that may worsen skin barrier integrity.​

Addressing these imbalances through targeted nutrition, stress management, and microbiome-supporting interventions could help improve immune resilience. Biomarkers related to vitamin D, omega-3 fatty acid status, or gut-derived metabolites are also being explored for their links to skin immune regulation. Observing how these biomarkers shift over time offers a data-driven approach to evaluating the effectiveness of holistic or integrative therapies aimed at immune restoration.

Topical Steroid Withdrawal and Immune Dysregulation

Topical steroid withdrawal (TSW) represents a complex form of immune rebound and dysregulation that can occur when potent steroid creams used for eczema are suddenly discontinued. Research published by the NIH in the Journal of Investigative Dermatology highlights the biochemical roots of TSW, suggesting that chronic steroid use alters local and systemic immune responses, potentially affecting cortisol regulation and inflammatory pathways.​

The condition is characterized by intense redness, burning, swelling, and hypersensitivity of the skin—sometimes extending to areas not previously affected by eczema. Patients may also experience systemic symptoms such as fatigue, gland swelling, and disrupted thermoregulation. Although TSW is not officially classified as a distinct diagnosis, biomarkers could hold the key to distinguishing it from eczema flares and monitoring recovery.​

Early investigations have begun exploring immune markers associated with steroid-induced skin dysregulation. Patterns of altered cytokine expression and impaired skin barrier enzymes, such as reduced ceramide production and pH imbalance, have been linked to chronic steroid exposure. More recently, reports suggest that biomarker patterns in TSW overlap partially with those of severe eczema but may include distinct fingerprints related to immune suppression and adrenal axis disruption.​

Skin Diagnostic Advances and the Future of Care

Modern skin diagnostic tools increasingly incorporate biomarker analysis, combining genetic, proteomic, and transcriptomic profiling to reveal the underlying immune activity in the skin. Bioinformatics-based analyses have identified differentially expressed genes associated with immune cell infiltration in atopic dermatitis, providing opportunities for more personalized therapeutic choices.​

This precision extends beyond eczema: similar immune biomarker approaches are being used to monitor psoriasis, allergic dermatitis, and even response to immune-modulating therapies like biologics or systemic corticosteroids. As these technologies advance, clinicians will be able to distinguish between disease subtypes, track immune normalization, and reduce reliance on trial-and-error treatment.

In the context of eczema and TSW, diagnostics that can differentiate between active inflammation, barrier dysfunction, or steroid-induced immune suppression would be invaluable for tailoring care. Coupled with biomarker-guided immune support—through anti-inflammatory nutrition, microbiome modulation, or targeted biologic therapy—patients could achieve better, longer-lasting outcomes.

In Summary

Biomarker testing offers an innovative avenue for understanding immune system dysregulation at the molecular level. For those with eczema or topical steroid withdrawal, it opens the door to earlier detection, more precise diagnosis, and immune-targeted treatment strategies. Studies demonstrate that immune cytokines like IL-13, IL-8, IL-18, and TARC play central roles in eczema’s pathogenesis and could help predict disease onset or severity. Meanwhile, advanced skin mapping and non-invasive biomarker sampling represent significant steps toward truly personalized dermatologic care.

By revealing the body’s immune patterns, biomarker testing empowers clinicians and patients to not only treat symptoms but to address the root causes of immune dysfunction, creating opportunities for both skin healing and systemic immune resilience.

References

1. Gorelick J, Nguyen A, Schneider SK, Martel BC, Madsen DE, Armstrong AW. Biomarkers in Atopic Dermatitis: A Review of the Role of IL-13 and the Impact of Tralokinumab Treatment. American Journal of Clinical Dermatology. 2025;26(2):199–211. doi:10.1007/s40257-024-00913-9. [PMCID: PMC11850464]​

2. Sang J, Ye X. Potential biomarkers for predicting immune response and outcomes in lung cancer patients undergoing thermal ablation. Frontiers in Immunology. 2023;14:1268331. doi:10.3389/fimmu.2023.1268331.​

3. EADV (European Academy of Dermatology and Venereology). Non-invasive skin immune biomarker test helps predict development of eczema in babies: new study finds. 2022.

4. HealthCentral. Topical Steroid Withdrawal: Why It’s Not Just Eczema. 2025.

5. National Eczema Association. Topical Steroid Withdrawal (TSW): What We Know. 2025.

6. Nature Communications. Immune modules to guide diagnosis and personalized medicine in inflammatory skin diseases. Nature Communications. 2024;12(54559). doi:10.1038/s41467-024-54559-6.

7. PubMed Central. Key regulators and biomarkers of skin barrier function in atopic dermatitis. Scientific Reports. 2025;15(46250).

8. Frontiers in Allergy. Biomarkers to aid in diagnosis of allergic contact dermatitis. Frontiers in Allergy. 2025;6:1564588.

9. ScienceDirect. Laboratory biomarkers of an effective immune response. Journal of Allergy and Immunology Research. 2021;8(3):185–200.

10. Dermatology Times. Skin immune biomarker test helps predict eczema in infants. Dermatology Times. 2022.

11. Nance K, et al. Breaking the cycle: a comprehensive exploration of topical steroid withdrawal. Journal of Clinical Dermatology and Immunotherapy. 2025;30:11994697.

12. Bioinformatics‐Based Analysis. Reveals diagnostic biomarkers and immune infiltration features in atopic dermatitis. International Journal of Molecular Sciences. 2025;12051981.

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Topical steroids are commonly prescribed to manage inflammatory skin conditions such as eczema, psoriasis, and dermatitis. These medications are available in various formulations, including creams, ointments, gels, and solutions, each suited to different skin types and areas of the body.

The effectiveness of a topical steroid is determined by its potency, which reflects the concentration of the active ingredient required to achieve the desired therapeutic effect. Higher-potency steroids deliver stronger effects but carry a greater risk of side effects, especially with long-term use, while lower-potency options are typically considered safer and prescribed for extended application or use on sensitive areas.

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1. Tachyphylaxis

Tachyphylaxis is a rapid decrease in response to a topical steroid. In such instances, the dose of steroid used to keep psoriasis or eczema at bay suddenly becomes ineffective. Patients may be tempted to switch the steroid for a more potent one or use the same steroid for a more extended period. (1)

The tolerance range only increases if this happens and other adverse effects sprout.

2. Skin Atrophy

Overuse of topical steroids encourages skin thinning and atrophy. Vasoconstriction associated with steroid use causes a reduction in collagen levels, making the skin lose its plasticity. When the steroid is discontinued, a trampoline effect is witnessed. The blood vessels become far more dilated than they once were. This causes redness, blotching and sometimes the purple patches and spots associated with purpura and striae. (2)

Skin atrophy is associated with wrinkling and premature ageing of the skin.

Drying off skin is more prominent with facial skin and extremities (hands and legs). For this reason, potent steroids should not be used on the face, groin and other sensitive areas.

3. Stretch Marks

Topical steroids fight inflammation by inhibiting several pathways under the skin. Unfortunately, fighting swellings affect the blood supply to the dermis and epidermis. Prolonged use of steroids often decreases collagen, which shunts the firmness and plasticity of the skin. Thus when the skin is stretched, it does not retract as quickly as it naturally would.

When steroids are misused, stretch marks are more likely to form. (3) Depending on how long this misuse lasts, the stretch marks may be temporary, in which case the stretch lines disappear when the medication is discontinued, or at least four months after it was first sighted or permanent.

4. Steroid Rosacea

In the attempt to reduce inflammation on the face, a severe adverse reaction may occur. Steroid rosacea is an inflammatory condition experienced on withdrawal of a topical steroid.

It may resemble an allergic condition, but a closer examination reveals acne lesions like pustules, cysts and papules. (4) It may be triggered by a sudden cessation of steroid use, especially after using a medium or high potency steroid on the face.

To prevent such outbreaks, some doctors have advised to taper the dosage of a steroid slowly before completely discontinuing use.

Patients with outbursts of steroid rosacea admit to frequent use of a steroid before discontinuation. Unfortunately, this may be iatrogenic (caused by either the physician or the patient). In any case, close monitoring and slow withdrawal should be considered.

5. Glaucoma

The risk of glaucoma was formerly only attributed to the use of systemic steroids; however, recent evidence shows that due to the high absorption of topical steroids through the skin, applying a steroid to the skin around the eye may cause glaucoma. (5)

In glaucoma, the intraocular pressure is significantly increased by fluid retention. This may eventually damage the optic nerve and cause blindness.

Steroids play a part in the progression of glaucoma by encouraging water retention, locally and systemically. Thus, when applied close to the eye, it directs retained water to the organ.

Regular eye function tests are recommended for elderly patients who must use steroids.

6. Blindness

Topical steroids applied too close to the eye increase the risk of glaucoma and cataracts. In glaucoma, an increase in the volume of vitreous humour causes damage to the optical nerve, leading to blindness. (6) In cataracts, however, the reason for the clouding of the lens has not been identified. Gene transcription of epithelial cells is a probable mechanism, but more studies are necessary before a conclusion can be made.

The risk of blindness, although rare, remains with both topical and systemic steroid use.

7. Increased susceptibility to bacterial and fungal infections

Topical steroids identify inflammation as their primary enemy. Since inflammation is one of the most important defence mechanisms of the body, a topical steroid can render it difficult to defend itself from pathogens. (7)

When the inflammatory pathways remain suppressed for too long, the user is more likely to fall victim to bacterial and fungal infections. In cases where a topical steroid was used to treat a fungal skin disease, the condition only worsened and spread faster than a common fungal disease. This is because the steroid aided the infection by blocking the inflammatory pathways.

Before purchasing any over-the- counter steroid medication for a rash or other similar disease, it is essential to classify the condition as inflammatory, allergic, bacterial or fungal. This may better inform the choice of a topical treatment.

8. Ulceration on skin

The loss of blood supply seen in atrophy is also responsible for the formation of ulcers. Typically, after atrophy occurs, cells lose their intercellular substance, and the dermal matrix is broken. The dehydrated, parched skin is brittle and can be easily injured. When injuries occur, they can take twice as long to heal. Bacteria and fungi can easily infect these open sores, and these cause the wounds to spread, worsening with time. (8)

High cortisol levels in the blood aid this process by delaying wound healing. If they heal, they form a network of scars and dark purplish blotches.

9. Exacerbation of Herpetic Ulcers

The presence of immunosuppressive medication can be detrimental for when treating Herepes. A new herpes virus may penetrate the initial wound site in this short period of reduced inflammation, initiating a cascade of reactions. Keeping the immune system as active as possible prevents viral replication. (9)

10. Allergic Reactions

There is a possibility of allergy to topical steroids and the other ingredients used in the topical formulation. A patch test is vital in people with chronic skin conditions who are forced to use several steroids. (10)

With allergic reactions, immediate cessation of the topical steroid should diminish the symptoms.

11. Cushing’s syndrome

One of the primary ways steroids prevent inflammation is by releasing a class of hormones called Stress hormones. These hormones, cortisol and cortisone, are also present in the adrenal gland. Steroids stimulate the adrenal gland to back them up by producing an excess of these hormones. (11)

In Cushing’s syndrome, fluid retention causes oedema, obesity and high blood pressure. The signs and symptoms of Cushing’s syndrome include moon face, poor wound healing, stretch marks, ulcers, buffalo humps, amongst others. (12)

It may resemble diabetes by suppressing insulin sensitivity. It can worsen pre-existing obesity and hypertension by causing hyperlipidaemia and hyperglycemia.

12. Adrenal suppression

Topical steroids hijack the physiologic hypothalamic control of the adrenal glands. When there is an inflammatory condition, this may be a benefit. However, if a topical steroid is used for too long and the adrenal gland remains under control, it may lead to adrenal insufficiency when the steroid is finally ceased. (12)

In this case, neither the steroid nor the hypothalamus will stimulate the adrenal gland to produce corticosteroids.

Adrenal insufficiency can be a life-threatening condition(13)

13. Topical Steroid Addiction & Withdrawal

Topical Steroid Addiction can be described as the increased tolerance of the body to higher doses of topical corticosteroids and the onset of adverse effects upon cessation, causing serious withdrawal effects. These adverse effects are often much worse than the initial condition (such as eczema and acne) the steroids were being used to treat.

Signs and Symptoms of Topical Steroid Withdrawal

The most common symptom of topical steroid withdrawal (also known as Red Skin Syndrome) is a rebound of the underlying skin disease, followed by redness and an associated burning or stinging sensation. It can be difficult to determine if the rebound of the underlying skin disease means the patient requires different treatment to it is a case of topical steroid withdrawal.

There are certain things to look out for to determine if it is a case of topical steroid withdrawal:

• The patient experiences burning or stinging sensation rather than itching
• Rebound is worse than the original presentation of skin disease
• Symptoms extend further than the area of initial treatment and are different from the original presentation of skin disease
• Sites of visible inflammation (i.e. redness, darkening of the skin, or other change in color like pink or purple depending on the skin tone) are coalescent with the rest of the skin, not patchy.
• There has been a prolonged, frequent use of topical steroids.

Other symptoms of topical steroid withdrawal include:

• Skin flaking
• Edema
• Pus secretion from blisters caused by eczema (skin weeping/oozing)
• Skin peeling
• Hard bumps beneath the skin
• Pus filled bumps beneath the skin
• Skin alternates between redness, swelling, skin flaking, and secreting pus
• Lymph node enlargement
• Hair loss, both on the head and the body
• Fatigue
• Depression and Anxiety
• Insomnia
• Altered thermoregulation. The patient complains of feeling too cold or hot.
• Chills
• Skin hypersensitivity to water, fabric, movement, creams, temperature, etc.
• Red sleeves. There is redness of the arms and legs, excluding the palms and soles of the feet.
• Zaps of stabbing, squeezing, cold or prickly pain known as zingers
• Dryness and irritation of the eye
• Skin atrophy
• Changes in appetite
• Hot skin
• Hives
• Scabs
• Vision impairment, light sensitivity

Our Mission at TSW Assist

Our mission here at TSW Assist is to gather insights of medications, products, routines, supplements, and therapies that can help manage the symptoms experienced during withdrawal period from topical steroids. There is currently no cure for topical steroid withdrawal but these insights come directly from other people with TSW who have had success in symptomatic relief during their withdrawal period.

References

1. du Vivier, A., & Stoughton, R. B. (1975). Tachyphylaxis to the action of topically applied corticosteroids. Archives of Dermatology, 111(5), 581-583.
2. Lehmann, P., Zheng, P., Lavker, R. M., & Kligman, A. M. (1983). Corticosteroid atrophy in human skin. A study by light, scanning, and transmission electron microscopy. Journal of Investigative Dermatology, 81(2), 169-176.
3. Ud‐Din, S., McGeorge, D., & Bayat, A. (2016). Topical management of striae distensae (stretch marks): prevention and therapy of striae rubrae and albae. Journal of the European academy of dermatology and venereology, 30(2), 211-222.
4. Leyden, J. J., Thew, M., & Kligman, A. M. (1974). Steroid rosacea. Arch Dermatol, 110(4), 619-622.
5. Razeghinejad, M. R., & Katz, L. J. (2012). Steroid-induced iatrogenic glaucoma. Ophthalmic research, 47(2), 66-80.
6. Phulke, S., Kaushik, S., Kaur, S., & Pandav, S. S. (2017). Steroid-induced glaucoma: an avoidable irreversible blindness. Journal of current glaucoma practice, 11(2), 67.
7. Pariser, D. M. (1991). Topical steroids: A guide for use in the elderly patient. Geriatrics, 46(10).
8. Adams, B. B., & Sheth, P. B. (2002). Perianal ulcerations from topical steroid use. CUTIS-NEW YORK-, 69(1), 67-67.
9. Thygeson, P., Hogan, M. J., & Kimura, S. J. (1960). The unfavorable effect of topical steroid therapy on herpetic keratitis. Transactions of the American Ophthalmological Society, 58, 245.
10. Tatu, A. L., Ionescu, M. A., & Nwabudike, L. C. (2018). Contact allergy to topical mometasone furoate confirmed by rechallenge and patch test. American journal of therapeutics, 25(4), e497-e498.
11. BORZYSKOWSKI, M., Grant, D. B., & Wells, R. S. (1976). Cushing’s syndrome induced by topical steroids used for the treatment of non‐bullous ichthyosiform erythroderma. Clinical and experimental dermatology, 1(4), 337-342.
12. Güven, A., Gülümser, Ö., & Özgen, T. (2007). Cushing’s syndrome and adrenocortical insufficiency caused by topical steroids: misuse or abuse?. Journal of Pediatric Endocrinology and Metabolism, 20(11), 1173-1182.
13. Böckle, B. C., Jara, D., Nindl, W., Aberer, W., & Sepp, N. T. (2014). Adrenal insufficiency as a result of long-term misuse of topical corticosteroids. Dermatology, 228(4), 289-293.

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