Babies have very sensitive skin and are vulnerable to the powerful effects of potent steroids; when parents stop using prescribed steroid creams because they’re concerned about the consequences of long-term steroid use, they sometimes see a rebound rash that is sorer than the eczema the creams were originally prescribed for.
It’s worth noting that there’s been very little research done on topical steroid withdrawal syndrome, and even less on TSW in children. It seems to be less common in babies than in the adult population, but because TSW is an under-recognised condition, and not something that all doctors will diagnose, it’s hard to be sure how many are affected.
The general consensus in the medical profession is that TSW has the following characteristics not associated with eczema, which mean it can be seen as a separate condition: widespread red or hyperpigmented skin, itchiness, burning pain, flaking, swelling, skin sensitivity, ‘red sleeve’, and/or ‘elephant wrinkles’.
If those symptoms apply to your baby, 2-3 weeks after stopping topical steroid creams, you have a reasonable case for it being topical steroid withdrawal syndrome, and not infantile eczema. But do check with your doctor and with experts at ITSAN first.
Please be sure that your baby hasn’t anything else going on: it's important to take skin rashes in babies very seriously; you will need to be sure that any rashes are viral or bacterial infections.
The main way of looking after a baby going through topical steroid withdrawal syndrome is to manage the discomfort of painful skin. Little ones too young to understand why they feel so sore will find it difficult to cope with either the burning sensations or the application of creams to soothe the stinging, so do choose your emollients carefully!
- Choose oil-based balms (like Skin Salvation) not water-based creams, as creams are much more likely to sting raw skin, and moisturise very frequently throughout the day.
- Find distraction techniques when your baby is feeling very itchy: singing together, patting instead of rubbing itchy areas, watching videos together, changing the scenery by putting the baby in a sling and going for a walk in the fresh air.
- Dress your baby in very light, breathable, cotton layers. Their temperature might fluctuate wildly and you need to be able to take clothes on and off quickly and easily.
- Use a fan to blow cool air round the room, if they’re overheating.
- Try overnight wet-wraps: see our info hub articles here.
- Bathe them: in oat baths (a handful of oats in an old sock and added to the bathwater!), or add a bit of cider vinegar, Epsom/Himalayan or Dead Sea salts, or a splash of Balmonds Bath & Body Oil to a lukewarm bath.
- Keep the house very clean to avoid irritation from dust; invest in a HEPA-filter vacuum.
- Make sure household detergents, washing powders, and any skincare you use is super gentle and hypo-allergenic
Current medical advice is not to use daily topical steroids continuously for more than two to four weeks; then the frequency should be tapered to twice weekly use.
Check out our TSW Info Hub for more information about Topical Steroid Withdrawal/RSS.
Skin Salvation is a safe, effective, non-steroidal, intensively hydrating emollient that works in four crucial ways to help you manage TSW or chronic dry skin:
- It is free from the preservatives, perfumes, parabens, essential oils, coconut oils, nut oils, soya, and other common irritants that can hurt so much when applied to such sore. sensitive skin.
- It nourishes depleted skin with the essential fatty acids, vitamins and other nutrients the epidermis needs to repair and regenerate.
- It uses beeswax to protect broken or raw areas by providing a fine, protective barrier over the skin - like a sticking plaster over a wound - reducing itchiness and stinging.
- It hydrates, softens and conditions severely dry, flaking or shedding skin.