What is Red Skin Syndrome?

What Is RSS?

RSS (Red Skin Syndrome), also known as Topical Steroid Addiction (TSA) or Topical Steroid Withdrawal (TSW), is a debilitating condition that can arise from the use of topical steroids to treat a variety of atopic dermatitis, post-surgical wound healing, cosmetic application, post-tattoo healing, post-depilation healing, etc.  RSS is an iatrogenic condition, which means it is a condition caused inadvertently by a medical prescription treatment or misuse of over-the-counter cortisone topical products. Not everyone who uses topical steroids will develop RSS.

(Topical steroids are also called topical corticosteroids, glucocorticosteroids, and cortisone. They come in many different preparations including creams, ointments, oils, gels, and lotions. Some are sold over-the-counter; others need a doctor’s prescription.)

Who is affected by RSS?

RSS effects thousands of people around the world, of every age and background. It is unclear why some people experience RSS secondary to topical steroid therapy and why others do not.

RSS can arise from topical steroid use in people with no prior skin condition; such as with cosmetic use for skin bleaching or to treat acne, or in the case of caregivers who neglect to wash their hands after applying topical steroids on someone else.

What are the symptoms of RSS?

RSS is characterized by red, itchy, burning skin that can appear after ceasing topical steroid treatments, or even between treatments. In RSS, topical steroids are effective for a period of time to treat the skin condition. As time passes, however, applying topical steroids results in less and less clearing. The original problem escalates as it spreads to other areas of the body. In the case of eczema, this “progression” is often mistaken for worsening atopic dermatitis.

What are Topical Steroids?

Topical steroids are prescribed for use on “particular spots” of the skin and are not meant for application to the entire surface of the skin, injection or to be taken by mouth. Some examples of topical steroid preparations used on the skin are: creams, ointments, oils, gels, sprays and lotions.

Topical steroids are also called topical corticosteroids, glucocorticosteroids, and cortisone. Topical steroids act in a complicated way with the endocrine system, immune system and blood vessels in the skin to treat inflammation.

Are Topical Steroids hormones?

Corticosteroids, often known as steroids, are an anti-inflammatory medication prescribed for a range of conditions. They are a synthetic, or man-made, version of hormones normally produced by the adrenal glands. Steroids mimic natural hormones produced in the body, including glucocorticoids (such as cortisol) and mineralocorticoids (such as aldosterone).

Topical steroids can reduce inflammation (redness and swelling), suppress the immune system, and narrow the blood vessels in the skin. Their main purpose is to reduce skin inflammation and irritation.

How do they work?

Topical steroids are absorbed into the cells of the skin. The mechanism of the anti-inflammatory activity of the topical steroids, in general, is unclear.  It is believed that topical steroids stop skin cells from producing various inflammation-causing chemicals that are normally released when the skin reacts to allergens or irritation.

These inflammation-causing chemicals, including prostaglandins and leukotrienes, cause blood vessels to widen (vasodilate) and signal other inflammatory substances to arrive. This results in the affected area of skin becoming red, swollen and itchy. By preventing these inflammatory chemicals from being released in the skin, topical steroids reduce inflammation and relieve related symptoms such as itchiness.

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