174: When Topical Steroid Withdrawal Gets Complicated

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The topic of topical steroids is a tricky one… very controversial these days for some who’ve discovered that their body has become addicted.

As you know, I’ve covered Topical Steroid Withdrawal (TSW) in multiple episodes of the Healthy Skin Show.

Today’s episode is a focused on my own personal insight as a clinical nutritionist directed specifically to support those who find themselves in TSW.

There are some common assumptions that float through the TSW community that I’ve found to be unfortunately concerning. These assumptions have at times ended up creating an even worse state of health for a client because the advice they were given was not appropriate for them (and at times, inaccurate).

While I realize that TSW is not an official medical diagnosis leaving people to essentially self-diagnose, there is a greater risk of misstep because of the complexities not just of the human body, but also because of the lack of medical support.

Advocates do and share what they can, but there can be significant gaps in knowledge that many of us who work with individuals in this community are hoping to fill with new research and clinical experience.

I’d like to help you avoid some pitfalls that I commonly see by sharing some pearls from my clinical practice where I work with TSW clients in addition to my ongoing research.

The intention is to offer a perspective that could open up new avenues for you of working on your skin and ultimately your health.

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In this episode:

  • Elimination diets + Topical Steroid Withdrawal
  • Nutrient deficiencies in clients with TSW
  • Could something else be making your TSW experience WORSE?
  • Hidden reasons driving intense itchiness associated with TSW
  • Staph infections + Topical Steroid Withdrawal


Clients with TSW tend to have a crazy amount of nutrient depletions that can be very challenging to correct.

Extreme itchiness typical of TSW could be from other issues like a hidden gut infection (like H.pylori or Blastocystisis homonis), mold exposure or zinc deficiency.

Sad woman with topical steroid addiction

When Topical Steroid Withdrawal Gets Complicated (FULL TRANSCRIPT)

Welcome back to episode #174 of the Healthy Skin Show!

In today’s episode, I want to share with you some thoughts I have about Topical Steroid Withdrawal… and a few things that can complicate your case that I find often get overlooked.

In a nutshell, lengthy exposure to steroids from various medications can cause the body to end up in a state of steroid addiction that can trigger horrifying systemic effects lasting from months to years.

You heard me right… while the name (Topical Steriod Withdrawal) suggests that the problem results solely from exposure to topical steroids, it’s not exactly accurate.

All steroid exposures count!

I’m not going to go in-depth on the in’s and out’s of Topical Steroid Withdrawal (also known as TSW) since I’ve covered this in multiple episodes that you can check out HERE.

But what I would like to do is address some assumptions that I have seen quite a bit within the TSW community that can cause someone to end up suffering for longer than absolutely necessary.

Let me be clear — I believe in TSW and I also work with TSW clients.

And so my desire to share this is rooted in wanting to hopefully spare someone going through this from any additional unnecessary suffering.

Healthy food

Diet Eliminations + Topical Steroid Withdrawal

As a clinical nutritionist, Topical Steroid Withdrawal creates a complicated mess for your body beyond just the skin and hormonal issues.

Every single client that I’ve supported with TSW also has a crazy amount of nutrient depletions that can be very challenging to correct (as compared to a client who doesn’t have TSW).

I share this because it’s REALLY common for TSW clients to read online that they should do food sensitivity testing and try different elimination diets.

There can be an over-fixation on food exacerbating the symptoms.

Is it possible that certain foods could make what’s happening in the TSW process worse?


I would never make the case that you should eat all the junk that you want without repercussion. That’s just silly!

Obviously pre-existing allergies (legit IgE allergic reactions to food) should be avoided and I’d also recommend removing gluten since it causes increased gut permeability.

With that said, I do not recommend restrictive elimination diets.

As I’ve shared in previous episodes of the Healthy Skin Show, excessive elimination diets create their own challenges that can drive long-term food fear and make your nutrient status + health worse.

And consider that even without TSW, most people with chronic skin rash problems already have nutrient deficiencies present.

So eliminating MORE food only makes things worse.

This is because the smaller your diet becomes, the fewer nutrients you’re consuming. That can exacerbate or even create nutrient deficiencies.

(Remember — your body doesn’t make most nutrients it needs to thrive… it must absorb them from your diet.)

And it can drive gut microbiome diversity into the ground — which isn’t good either.

You’re better off getting help from a nutrition professional like myself who can review your labs to see what your body needs (that may be larger therapeutic doses) to help you on your journey.

Because if you only fixate on food, you can also end up developing an eating disorder in the process of trying to heal from TSW.

Woman looking out

Is It ONLY Topical Steroid Withdrawal? Possibly Not.

The next problematic assumption is thinking that the only thing driving your poor quality of health is Topical Steroid Withdrawal.

Everything is blamed on TSW.

Even after it appears that most of the TSW symptoms have resolved.

And this mistake is rooted in the notion that there’s not much beyond allergens, food, and genetics driving skin issues.

If you’re not familiar with the 16 hidden root causes of chronic skin rashes, this will be an eye-opening process… likely helping you see what’s mostly overlooked by much of conventional dermatology at the moment.


I implore you to better understand this because you will discover that…

Eczema is not just triggered by poor genetics or some other random allergy that your doctor can’t seem to pinpoint.

Nor is psoriasis triggered simply because you like to eat tomatoes and other nightshades… or that your dad had it.

And having dandruff is not just because you’re using the wrong shampoo.

While there are certain instances wherein eczema or another skin condition can completely resolve once TSW resolves, that’s not the case for everyone.

Some people continue to suffer from issues long beyond TSW, unsure if what’s going on is from the TSW or if their eczema/psoriasis/etc. is back.

That’s because some hidden root causes will not magically disappear just because TSW is in your rearview mirror.

Hidden gut infections won’t just go away.

I’ve seen first-hand with clients going through TSW that the severe itching they had was not in fact from TSW as they had assumed.

Instead, we discovered through stool testing that it was the result of an H.pylori infection or a parasitic infection like Blastocystis Hominis. Addressing these issues dramatically decreased symptoms that they were initially blaming on TSW.

Other clients have pretty bad nutrient deficiencies that can trigger itching — like zinc deficiency or iron deficiency.

And still others had ongoing environmental exposures like mold that continued to drive them nuts.

Again, this underscores reaching out for help from a practitioner with experience in TSW so that you can identify if there are hidden challenges like this going on exacerbating things.

Woman learning from ipad

Staph Infections + Topical Steroid Withdrawal

The final point that I’d like to share is in regards to staph infections and Topical Steroid Withdrawal.

If you’re here listening to the Healthy Skin Show, then you’ve got to educate yourself on what the signs and symptoms are of a skin staph infection which I covered HERE.

I’ve found that a lot of people in our community don’t actually know what they are.

The reason is that severe staph infections can occasionally be confused for TSW, especially if your doctor has continued to only give you steroids for your skin…

OR if the topical antibiotics prescribed just don’t cut it (which can also happen).

Occasionally clients have found topical antibiotics not to be effective for a severe staph infection and require extensive courses of oral antibiotics (and sometimes may even require IV antibiotics).

Many of my TSW clients became frustrated with their doctor only suggesting more steroids and dismissing a more serious issue. Even when they begin developing a multitude of “weird” symptoms that baffled their doctor, but were indicative of TSW.

You end up feeling like you’re totally alone on your journey to deal with your skin.

And I understand that you might not want to go back to the doctor because you don’t want to be dismissed or handed more steroids.

But regardless of where you are on your journey, having a dermatologist to help you navigate certain issues can be helpful… and a skin infection can be one of those times.

Instead of assuming that the red, burning, itchy skin is TSW or the flare you’re experiencing is just because of TSW, it’s crucial that you rule out a staph infection.

To do this, request that your doctor do a skin culture.

The results of the test could give you some important clarity because IF you have a staph infection, you don’t want to let it go.

Staph aureus damages your skin barrier and can make your quality of life much worse… whether you’re in TSW or not.

So with all this said, my invitation here is to keep an open mind about what you’re going through and don’t be afraid to ask for help.

TSW is tricky because there’s no formal diagnosis so most people are left to figure it out for themselves. AND they’re left to deal with it themselves without much support from the conventional medical world at the moment.

But TSW isn’t always JUST TSW.

Yes, that can make it more complicated, but it also means there could be other things you can do to reduce the level of discomfort you’re in (though I feel it important to remind you that there aren’t any quick fixes).

I hope that this episode is helpful for those on the TSW journey so that you ultimately make your way back to a better state of health sooner rather than later.

Leave your thoughts + questions below so we can keep the conversation going!

If you know someone struggling with TSW, I encourage you to share this episode with them. This perspective might be different than what they’ve heard or read before especially since it’s coming from my direct clinical experience as a nutrition.

Thank you so much for turning in and I look forward to seeing you in the next episode!

Clients with TSW tend to have a crazy amount of nutrient depletions that can be very challenging to correct.