What is TSA, TSW and RSS

TSA and TSW

I have recently learned about something called TSA which is an acronym for Topical Steroid Addiction and TSW which is an acronym for Topical Steroid Withdrawal, which is where parents (and adults suffering from eczema) are concerned about the side effects of using topical steroids over a long period of time and therefore go down the terrible path of stopping the use of steroids and endure (or watch their little one's endure) eczema with no assistance from steroids. This process isn't pretty and the skin gets much worse before it gets better and finally gets to a point of levelling off, but can take years of itching, scratching, bleeding and re-infections. Basically, the medication that you have used to help your child, has made their skin worse and now you need to remove that same medication to make it better? It just didn't make sense to me. While I understand why people choose to go through TSW (I also like the natural route and don't like using long-term medication) I am glad that I didn't try to do this, as I don't think I could watch my child suffer and I cannot imagine our lives being worse than they were.


What does Wikipedia say?

Topical steroids are the topical forms of corticosteroids. Topical steroids are the most commonly prescribed topical medications for the treatment of rash, eczema and dermatitis. Topical steroids have anti-inflammatory properties, and are classified based on their vasoconstriction abilities. There are numerous topical steroid products.


RSS 

Topical Steroid Addiction (TSA) has been reported in long-term users of topical steroids (users who applied topical steroids to their skin over a period of weeks, months, or years). TSA is characterised by uncontrollable, spreading dermatitis and worsening skin inflammation which requires a stronger topical steroid to get the same result as the first prescription. When topical steroid medication is stopped, the skin experiences redness, burning, itching, hot skin, swelling, and/or oozing for a length of time. This is also called 'Red Skin Syndrome' (RSS) or 'Topical Steroid Withdrawal' (TSW). After the withdrawal period is over, the atopic dermatitis can cease or is less severe than it was before.

So many parents and potential patients of Dr Aron are concerned about TSA as the Aron regime is to use a VERY diluted mix of (the dreaded) topical steroid together with a topical antibiotic. BUT this method, steps down the number of applications of the diluted ingredients until the cream is no longer needed! This I believe, is indeed a much better way of stopping the steroids as no withdrawal is experienced.

Dr Richard Aron says:

"Red skin syndrome (so called). After prolonged use of steroids and multiple flares of the eczema the skin turns red and this erythema has been given the label of RED SKIN SYNDROME What is not at all understood is that the reason that this redness evolves is not because of the steroids themselves but because of the associated infection by STAPHYLOCOCCUS AUREUS . There is failure of doctors to recognise the place of Staphylococcus Aureus acting as a trigger and potentiator of the Atopic Eczema and therefore to treat it adequately, not with oral antibiotics, but with topical antibiotics in conjunction with, and simultaneously with, topical steroids and moisturiser. The red skin is NOT a syndrome but a SIGN of missed diagnosis and in consequence wrong treatment. I have labelled the sign, STAPHYLOCOCCAL BURN SIGN. It is remarkable how rapidly the red skin resolves and the sign disappears with appropriate therapy."

Would you like to go back to my posts regarding Dr Aron? Here are the links below:

The day I found Dr Richard Aron and our Healing Journey Began

3 Months after starting with Dr Richard Aron