Chinese Medicine and Topical Steroid Withdrawal
As a practitioner of Chinese Medicine with a focus on dermatology, conversations around the use of topical steroids and topical steroid withdrawal have become more prevalent than ever.
Some of the most common inflammatory skin conditions I see in practice are eczema and psoriasis. Many people have lived with these conditions for years and have been regularly prescribed topical steroids as their primary form of treatment. In most cases, this is the first line of defense offered by dermatologists. If there is a suspected bacterial component, antibiotics are often prescribed as well.
What even are steroids?
Broadly speaking, steroids are a class of chemical compounds defined by a specific molecular structure in organic chemistry. They play a wide range of biological roles in the body. There are several types of steroids, including anabolic steroids, glucocorticoids, sex hormones, and other biologically important steroids such as cholesterol and bile acids.
For the purpose of this blog, I want to focus on glucocorticoids, a class of steroids that mimic endogenous adrenal hormones naturally produced by the body. The adrenal glands, located on top of the kidneys, produce cortisol, a corticosteroid often referred to as the stress hormone. Cortisol plays many important roles in the body, though it is most commonly discussed in relation to the stress response, or the fight or flight mechanism.
Some of the key actions of cortisol include:
Increasing glucose levels in the blood
Inhibiting the development of bone and connective tissue
Suppressing immune function and the inflammatory response
Impacting blood circulation
This is important to understand because synthetic steroids are widely used, often daily, to treat a broad range of conditions. Steroids may be administered via inhalers for asthma or other pulmonary diseases, injected into joints for acute or chronic pain, taken orally to manage inflammatory or autoimmune conditions, or applied topically as creams or gels for various skin disorders.
In many cases, steroids can be life-saving medications, particularly when inflammation needs to be reduced quickly or when someone is experiencing severe pain. However, when we look closely at how steroids function in the body, it becomes clear that long-term use can lead to side effects that are not always fully explained or discussed with patients.
Long-term topical steroid use and the skin
Individuals with chronic inflammatory skin conditions such as eczema or psoriasis are often prescribed topical steroids for extended periods of time. Over time, this can lead to several dermatological changes, including:
Slowing of skin cell division, resulting in thinning of the skin, also known as skin atrophy
Changes in pigmentation or discoloration
Sensory changes due to damage to superficial nerves
Decreased local immune function, leading to slower wound healing
Increased dryness due to impaired water retention in the skin
A rebound effect, where inflammation returns, often more intensely
These effects tend to develop gradually and can vary from person to person. But what happens when someone decides they no longer want to rely on topical steroids?
Topical Steroid Withdrawal (TSW)
There is a condition known as topical steroid withdrawal, or TSW, that has gained increased visibility in recent years, particularly through social media. Some individuals choose to abruptly stop using topical steroids and then experience a significant inflammatory flare.
What is happening here is not that the original inflammation has resolved. It has been suppressed. From both a biomedical and Chinese medicine perspective, the immune response is held down temporarily, but the underlying inflammatory process remains. In Chinese medicine terms, this inflammation, often referred to as heat, does not disappear. Instead, it retreats deeper into the body, becoming hidden while surface-level suppression continues.
Once the steroid is discontinued, this concentrated inflammation resurfaces, often more intensely than the initial presentation.
Common signs and symptoms of true topical steroid withdrawal may include:
Shedding or scaling of the outermost layer of the skin
Widespread redness, or erythema, often covering large areas of the body
Burning and itching sensations, sometimes accompanied by feeling chilled
Skin infections such as folliculitis
Fatigue
Rapid progression or spreading of skin symptoms
Emotional and psychological distress
How Chinese medicine can help
Chinese herbal medicine can be a powerful and supportive intervention for chronic inflammatory skin conditions and may also help manage symptoms associated with topical steroid withdrawal.
From a Chinese medicine perspective, treatment is not aimed at suppressing symptoms, but rather at addressing the underlying pattern causing the inflammation. Inflammatory skin conditions are often viewed as expressions of internal heat that has become trapped and is seeking an outlet through the skin.
While topical steroids are considered cold in nature, they do not truly clear heat from the body. Instead, they temporarily suppress its outward expression. Herbal medicine, on the other hand, can be used strategically to drain, clear, and resolve heat, allowing inflammation to be processed and released more fully rather than driven deeper.
This approach takes time, nuance, and individualized care, but it offers a pathway that supports the body’s natural healing processes rather than overriding them.
Chronic skin conditions can be complex, and quick fixes don’t always lead to lasting relief. If you’re interested in a more holistic approach, one that addresses inflammation at its root rather than simply suppressing symptoms. I encourage you to explore Chinese medicine and herbal therapy with a qualified practitioner. Feel free to contact me if you’d like to learn more about how this work can support your skin health.
