Babies and Topical Steroid Withdrawal: Symptoms and Treatments

May 13, 2024

Featured image for “Babies and Topical Steroid Withdrawal: Symptoms and Treatments”

Topical steroid withdrawal in babies, also referred to as red skin syndrome (RSS) or topical steroid addiction (TSA), occurs when topical corticosteroids are abruptly stopped after prolonged use on a baby’s skin. This article provides comprehensive insights into this complex condition, with a focus on optimizing the reader’s understanding of the key considerations around using topical steroids on infants.

A Primer on Topical Steroids

Topical corticosteroids (TCS) are commonly prescribed to treat various inflammatory skin conditions in babies and children, such as eczema (atopic dermatitis). These topical steroids work by suppressing inflammation and immune responses in the skin.

When used properly under medical supervision, TCS are generally safe and effective for managing flare-ups and symptoms. However, problems can occur when:

  • Higher potency TCS are used incorrectly without breaks
  • TCS are abruptly stopped after prolonged periods of use
  • Babies and children have been using TCS continuously for many weeks/months

In such cases of overuse and improper administration, suddenly ceasing steroid treatment can result in rebound inflammation and topical steroid withdrawal (TSW) symptoms.

3 6

What is Topical Steroid Withdrawal?

Topical steroid withdrawal refers to a condition where the skin reacts adversely when topical corticosteroid medication is discontinued after a prolonged period of regular application. It is also known as:

  • Red burning skin syndrome
  • Topical steroid addicted skin

Some key points about TSW in babies:

  • Symptoms can vary from mild to quite severe
  • The general consensus is that TSW is uncommon in children under 18 years old
  • However, pediatric cases have been documented, so it remains an important consideration

Signs and Symptoms

When TSW occurs, the baby’s skin will show localised or widespread redness, inflammation, irritation, and sensitivity. Other common symptoms include:

Primary Skin Symptoms

  • Red, inflamed, burning skin
  • Flaking, peeling, shedding of skin
  • Oozing, weeping lesions
  • New rashes, hives, or eczema-like flare ups
  • Extreme dryness and skin sensitivity

Secondary General Symptoms

  • Fever
  • Chills
  • Fatigue
  • Lack of appetite
  • Swollen lymph nodes
  • Aches and pains

Symptoms typically set in within 1 to 4 weeks of ending long-term topical steroid use. However, onset can be delayed up to 3 months in some babies based on various individual factors.

What Causes Steroid Withdrawal in Babies?

The underlying trigger for TSW is sudden cessation of topical steroids after prolonged regular use over large surface areas. Several contributing factors for this occurring in babies include:

High Potency Steroids Used Incorrectly

  • Using prescription high potency steroids too frequently
  • Failing to take adequate breaks during use
  • Not following dosage guidelines

Prolonged, Continuous Steroid Courses

  • Extending topical steroid application for months without pausing
  • Constant reapplication to every minor skin flare up

Abrupt Stoppage After Overuse

  • Not tapering down potency and frequency gradually
  • Stopping steroids “cold turkey” after dependency develops

As a result, the baby’s skin adrenal axis functions become suppressed. When treatment stops, the skin struggles to manage inflammation on its own, triggering TSW.

Artboard 1 copy 101

Who Is At Risk of TSW?

Based on documented cases, the following groups of babies appear to be most vulnerable:

  • Those with underlying atopic dermatitis (eczema) or similar conditions requiring long-term topical steroid treatment
  • Infants who have used high potency prescription steroids extensively to manage flare ups
  • Babies treated with topical steroids continuously for over 2 months without adequate breaks

While less common, TSW has also occurred in a small subset of babies using low to mid potency over-the-counter options for extended periods.

Can TSW Be Prevented?

Preventative measures can reduce the risks of TSW considerably. However, total avoidance is difficult as moderated steroid use is sometimes medically necessary to control eczema and other skin diseases in babies. Strategies include:

Careful Administration

  • Using only low to mid potency TCS options
  • Avoiding higher strength prescription steroids if possible
  • Monitoring skin thickness and integrity

Limited Courses

  • Keeping TCS application to short 2 week bursts
  • Taking equal length breaks between courses
  • Stopping usage as soon as flares resolve

Gradual Withdrawal

  • Slowly tapering down frequency/strength if overused
  • Giving skin time to readjust with each reduction
  • Watching closely for rebound reactions

Seeking Medical Input

  • Having a dermatologist guide usage instructions
  • Adjusting approach based on skin recovery signs
  • Switching to non-steroidal treatment options

With prudent topical steroid administration guided by a doctor, TSW can usually be avoided in most babies.

How is TSW Diagnosed?

As symptoms of TSW can resemble other skin conditions like dermatitis, correct diagnosis involves:

  • Medical history – Duration of TCS use, potency, breaks between use
  • Physical examination – Assessing skin for key TSW indicators
  • Skin swabs – To rule out infections
  • Blood tests – For markers of adrenal insufficiency

Doctors need to rule out other potential causes before confirming TSW based on correlating medical history with the flare up timing, sites affected, and characteristic symptoms.

Artboard 1 80

Can TSW Resolve on Its Own?

Research indicates that around 77% of pediatric TSW cases recover within 3 months if the topical steroids are fully stopped. However, severe cases can take 6 to 12 months to resolve. Timeframes depend on:

  • Extent of skin surface impacted
  • Overall health and age of baby
  • Whether secondary infections develop

With appropriate supporting treatment, the skin eventually rebalances and symptoms subside for a majority of babies. However, the condition can persist long-term in a small subset of patients.

How is TSW Treated?

As no TCS medications can be used during this withdrawal phase, treatment focuses on managing symptoms through:

Soothing Itchy, Inflamed Skin

  • Oatmeal or vinegar baths
  • Wet wraps & cold compresses
  • Antihistamines (sedating options)
  • Lower potency topical creams

Preventing Infection

  • Antiseptic liquid washes
  • Oral antibiotics if infected
  • Avoiding scrubbing & wounds

Controlling Pain & Discomfort

  • Low strength oral steroids
  • Soothing gel packs & icing
  • Lidocaine ointments
  • Hydroxyzine for itching

Healing Damaged Skin

  • Hydrating & moisturizing intensively
  • Wound care for oozing areas
  • Living in high humidity environments

With these comprehensive supportive treatments, cases of TSW in babies can usually be managed effectively until balance is restored. However, the process till resolution is often slow and difficult depending on severity.

What is the Prognosis for Babies with TSW?

The prognosis for TSW is generally positive, with most infants recovering in 6 months or less. However, babies seem to experience worse and more extended TSW compared to adults and older children. Considerations include:

Timeframes Vary Substantially

  • Mild cases – Resolve in about 1 to 3 months
  • Moderate cases – Take 3 to 6 months to clear
  • Severe cases – Can persist for 12+ months

Risk of Skin Infections

  • Open wounds vulnerable to bacteria
  • Can prolong healing trajectory

Potential for Permanent Skin Damage

  • In rare cases with severe body surface involvement
  • Requires ongoing wound and scar care

So while many babies fully recover without complications following appropriate treatment, a subset do experience lasting issues from TSW such as skin discoloration and increased sensitivity.

Artboard 1 81

Can TCS Be Used Again After TSW?

Once the withdrawal phase has fully passed, low to mid potency topical steroids can be gradually reintroduced under medical guidance if needed to manage future eczema flares. However, avoidance is recommended where possible to prevent recurrence of addiction. Approaches include:

  • Trying non-steroidal medications first
  • Using only for limited 2 week bursts
  • Monitoring skin closely when applying TCS
  • Rotating different steroid strengths

With controlled TCS application and proactive flare prevention, many babies manage eczema effectively after recovering from TSW without requiring further steroid courses.

Warning Signs to Watch Out For

Seeking prompt medical advice is crucial if babies show the following worrisome indicators after stopping topical steroid use:

Skin Reactions

  • Intensifying redness & inflammation
  • Rapid sloughing off of skin
  • Weeping, oozing fluid
  • Bleeding, damaged skin

Infection Signs

  • Honey-colored crusting
  • Skin swelling & pus
  • Fever onset

Other Organ Issues

  • Marked fatigue/lethargy
  • Refusing feeds or vomiting
  • Swollen glands or joints
  • Unusual pains or stiffness

Rapid specialized intervention can shorten TSW duration and prevent secondary issues. Don’t hesitate to ask your doctor if any concerns arise following TCS cessation.

You Asked: 5 Key Questions Answered

Is topical steroid withdrawal common in babies?

TSW is considered uncommon in children under 18 years old based on medical literature, with only around 7% of reported TSW cases occurring in pediatric patients. However, incidence is still poorly understood.

How do I differentiate TSW from eczema?

It can be tricky distinguishing TSW red, inflamed skin from eczema flares. Key TSW indicators include onset of rashes within 1 month of stopping steroids rather than without an identified trigger. TSW also tends to cause more generalized body skin sensitivity rather than isolated rash patches.

Can I use natural creams to treat TSW?

Yes, plant-based anti-inflammatory creams with calendula, coconut oil, oatmeal, etc. can help soothe and reduce TSW skin sensitivity when applied gently. However, take care checking any products for potential allergens. Avoid harsh ingredients.

Will my baby’s skin ever be the same again?

For a majority of infants, the skin fully recovers to its baseline state after the post-TSW skin regeneration phase. However, some babies do experience lasting damage, especially if the skin barrier was compromised severely. Appropriate wound care and steroid avoidance minimizes long-term issues.

When should I seek emergency treatment?

If your baby develops signs like septicemia (fever with shivering, fast breathing, low alertness), cellulitis (expanding skin redness, swelling and pain), or intense dehydration, call emergency services or take them to an ER immediately, as escalated medical intervention is vital.

Conclusion & Next Steps

While the prospect of red skin syndrome and topical steroid withdrawal is reasonably rare and unlikely in most infants using topical steroids for eczema and skin issues, it remains an important possibility to be aware of. Seeking medical guidance on appropriate TCS usage right from the start as per approved guidelines is key to balancing effectiveness while minimizing dependency risks.

Have an open dialogue with your baby’s health providers if you have any questions at all about application routines, safe steroid potencies for their age, ideal treatment courses, and managing any reactions. Being alert and responsive to subtle skin changes after long-term topical steroid use ceases can make all the difference in staying ahead of potential TSW.


  • What is it? – Adverse reaction from stopping topical steroids after prolonged overuse causing skin inflammation
  • Who’s at risk? – Babies with eczema using high potency TCS continuously for months
  • Early signs – Redness, rashes, burning, itching within 1-4 weeks of TCS cessation
  • Diagnosis – From history and typical TSW symptoms arising post-steroid withdrawal
  • Prognosis – Up to 6 months severity-dependent, mostly resolves but can rarely persist
  • Treatment – Symptom support, wound care, preventing infections during withdrawal phase
  • Prevention – Guided, limited, low potency TCS use, tapering strength before stopping
Rate this post


Cold Plasma System

The world's first handheld cold plasma device

Learn More

Made in USA