How do I know if I have Topical Steroid Addiction?

Note: Please read my first article on how topical steroids affect our skin first so that you may understand fully the explanations below.

This is a topic I feel strongly about, because TSA often goes unnoticed until it is too late. This is because the symptoms of eczema and symptoms of mild TSA are very similar, and the progress from eczema to TSA is gradual. People only find out their addiction to the creams when their symptoms go out of hand. If we knew how to spot TSA at an earlier stage, it would save many people a lot of suffering.

To determine if you have TSA, there are some key things to look out for

1) Duration of topical steroid usage: The skin can start developing some signs as quickly as two weeks of use
2) Potency of topical steroid usage: The higher the potency, the quicker TSA can develop
3) Any signs that the eczema is spreading, increasing in area compared to before using the creams
As mentioned by Dr. Rapaport: “I believe that the earliest manifestation of addiction is when the eczematoid rash spreads, even subtly, and more frequent applications of creams commence. The increased frequency of application is followed by stronger strength steroids that continue to be applied on a daily basis just to keep the worsening rash at bay. In pediatric patients addiction can occur in as little as three to four weeks.”
4) Warm, inflamed feeling and increased redness upon cessation of the creams
5) If you can’t go without the creams for more than a week or a month

At a later stage, topical steroids may not be able to continue to suppress the rash/wounds anymore and round/patchy wounds or rash can appear.

If you are unsure whether you are experiencing TSA or not, stop the creams completely just to be safe, and observe how your skin reacts. To observe the full withdrawal effects, it usually takes 2 months of completely ceasing usage.

Key differences between Eczema and TSW

Eczema and TSW are two very different conditions. There are a few key differences between both conditions:

1) In TSW, we look out for skin that is looking thinner and weaker than usual - the skin looks brittle and is very fragile.
2) Eczema flares can usually disappear quickly once the trigger is removed, while TSW flares take a long time due to the poorer skin cell regeneration rate.
3) Eczema usually happens in small localised areas and does not affect large areas of skin
2) Eczema does not ooze unless it is an infection

You may find a more extensive list of TSA and TSW symptoms here or on the ITSAN and Scratch That website.