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Topical Steroid Withdrawal (TSW)

Calm the Fire, Rebuild from Within

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You’re not imagining it. If your skin worsened after stopping steroids—or requires stronger doses for the same effect—you may be experiencing TSW. At Cleanbody, we support you with a root-cause plan that calms inflammation, protects skin, and helps your body recover safely.

What Is TSW?

TSW

TSW can happen after frequent or prolonged use of topical steroids. When you stop, the skin and nervous/immune systems can rebound—causing burning, intense itch, redness, oozing, swelling, and insomnia. TSW is challenging but temporary. With the right internal support and barrier care, healing is possible.

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Quick Checklist (common signs):

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  • Burning, stinging skin (not just itch)

  • Diffuse redness that spreads beyond original rash

  • “Red sleeve” / “headlight” patterns

  • Swelling, oozing, sheet-like flaking

  • Emollient intolerance, severe sleep disruption, low mood​

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Not sure if it’s a flare or TSW? We’ll help you sort it out in an Eczema Evaluation.

Why Our Approach Works (Cleanbody Method)

TSW isn’t only skin. It’s a body-wide stress response. We use the Cleanbody Method to address why your skin can’t settle:

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1) Evaluate

  • Review your history, steroid exposure, and symptom timeline

  • Targeted labs (gut/microbiome, toxins, nutrients, hormones/stress)

  • Daily journaling inside the Cleanbody app (sleep, itch, triggers)

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2) Optimize (5 Pillars)

  • CleanFOOD (lower histamine/inflammation, stabilize blood sugar, replenish nutrients)

  • CleanMIND (nervous system regulation for itch/sleep and improved adrenal function)

  • CleanENVIRO (reduce irritants/mold/toxins that perpetuate flares)

  • CleanROUTINE (sleep/wind-down routines, gentle skin habits)

  • CleanFIT (circulation/lymph support without overtaxing)

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3) Support

  • Targeted supplements (anti-inflammatory, barrier nutrients, gut support, adrenal support)

  • Herbs/homeopathy when appropriate

  • Gentle detox/drainage (timed correctly—never too soon)

  • Skin barrier care: simple, non-sensitizing topicals (e.g., CleanSKIN system), baths, compresses, no moisture treatment

  • Stepwise plans for tapering/transition off medications safely in collaboration with your prescribing clinician

  • Dr. Fong may prescribe non-steroidal or supportive medications to help manage symptoms during this process when needed

What You Can Expect (Phases of TSW Healing)

TSW

The Stages of TSW

The healing process of TSW is not linear; it comes in cycles. The body needs time to repair its immune, hormone, and nervous systems. Here are the four stages simplified for ease of understanding:

 

Stage 1: Inflammation:

  • Characterized by redness, warmth, pain, swelling, and weakness. Blood rushes to affected areas in preparation for healing.

  • What we do at this phase: Stabilize – Sleep, itch/burn relief, barrier protection, nervous-system and hormone support

 

Stage 2: Exudation, Oozing, and Scab Formation:

  • Pus formation occurs, and crusts or scabs form to protect wounds and allow new skin to develop.

  • What we do at this phase: Support Healing – Continue Sleep, itch/burn relief, barrier protection, nervous-system and hormone support

 

Stage 3: Proliferation and Flaking:

  • Skin cells migrate to wounds, proliferate, and flake off as new layers form beneath the surface.

  • What we do at this phase: Replenish – Replenish key nutrients to help new skin formation

 

Stage 4: Remodeling:

  • Wounds contract, collagen forms, and the skin returns to normal strength and elasticity.

  • What we do at this phase: Start Cleanse & Rebalance – Address Microbiome, toxin load, and immune modulation (if needed)

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​Stage 5: Clear Skin:

  • Hormones and skin have normalized and now it is all about maintenance.

  • What we do at this phase: Sustain – Expand foods, rebuild resilience, maintain clear, calm skin

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Healing is rarely linear—we guide you through the waves with weekly touchpoints and protocol adjustments. The photo above is of a real TSW Cleanbody patient healing over the course of only 4 months!

Is Medication Keeping You Stuck?

While topical steroids and biologics can temporarily calm inflammation, they often lead to rebound flare-ups once stopped.

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If you’re currently using these medications, our team will work closely with your prescriber to ensure a safe, gradual transition while we strengthen your body’s natural ability to heal.

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In some cases, if you are working with Dr. Fong, she may prescribe non-steroidal or supportive medications to help manage symptoms during this process — always with the goal of helping your skin restore balance naturally from within.

Real TSW Patients. Real TSW Results.

FAQ

Safety Note

If you have fever, extensive infection, or severe depression/suicidal thoughts, seek urgent medical care immediately. We can coordinate integrative support alongside your medical team.

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Is this TSW or an eczema flare?
We assess history, patterns, and response to moisturizers/meds. An Evaluation clarifies next steps.

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How long does TSW last?
It varies—weeks to months, and sometimes years if you do not support your body to heal. Our focus is to shorten and smooth the course by rebuilding internal balance.

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Can I do this while on meds?
Yes. We build your foundation first and coordinate tapering with your prescriber when appropriate.

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Can babies and children experience TSW?
Yes. Children who’ve used topical steroids can experience rebound flares after discontinuation. At Cleanbody, we use a gentle, whole-body approach — supporting detoxification, nutrition, gut balance, and skin barrier repair — to help your child heal safely and comfortably.

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What kind of support will I have during TSW recovery?
You won’t go through this alone. Our team has helped many patients — including Dr. Fong herself — navigate TSW recovery. You’ll receive personalized guidance, emotional support, and step-by-step protocols to help your body and skin stabilize and rebuild from the inside out.

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Won’t TSW just heal on its own?
Some people eventually see improvement without intervention, but the process can take months or even years and often involves painful cycles of flare-ups. At Cleanbody, we help you heal faster and more comfortably by identifying and addressing the internal imbalances that drive inflammation, so your skin can truly recover and stay clear.​​

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Not sure if it’s TSW or eczema?

If you suspect you’re experiencing Topical Steroid Withdrawal, our team can help you find clarity. During your Eczema Evaluation, a Cleanbody Practitioner trained by Dr. Fong will assess your history, symptoms, and skin patterns to determine whether you’re in TSW — and help you choose the best path for healing.

References:

  • Tan SY, Chandran NS, Choi EC. Steroid Phobia: Is There a Basis? A Review of Topical Steroid Safety, Addiction and Withdrawal. Clin Drug Investig. 2021 Oct;41(10):835-842. doi: 10.1007/s40261-021-01072-z. Epub 2021 Aug 18. PMID: 34409577; PMCID: PMC8481181.

  • Brookes TS, Barlow R, Mohandas P, Bewley A. Topical Steroid Withdrawal: An Emerging Clinical Problem. Clin Exp Dermatol. 2023;llad161. doi: 10.1093/ced/llad161.

  • Fukaya M, Sato K, Sato M, et al. Topical steroid addiction in atopic dermatitis. Drug Healthc Patient Saf. 2014;6:131–8. doi: 10.2147/dhps.s6920.

  • Sheary B. Steroid Withdrawal Effects Following Long-term Topical Corticosteroid Use. Dermatitis. 2018;29(4):213–8. doi: 10.1097/DER.0000000000000387.

  • Hajar T, Leshem YA, Hanifin JM, et al. A systematic review of topical corticosteroid withdrawal (“steroid addiction”) in patients with atopic dermatitis and other dermatoses. J Am Acad Dermatol. 2015;72(3):541–549.e2. doi: 10.1016/j.jaad.2014.11.024.

  • Hwang J, Lio PA. Topical corticosteroid withdrawal (‘steroid addiction’): an update of a systematic review. J Dermatolog Treat. 2022;33(3):1293–8. doi: 10.1080/09546634.2021.1882659.

  • Sheary B. Topical corticosteroid addiction and withdrawal – An overview for GPs. Aust Fam Physician. 2016;45(6):386–8.

 

Medical Disclaimer: The information provided in this guide is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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