Why Your Skin Might Still Be Eczema—Even If You’re in the Middle of TSW

If you're in the middle of Topical Steroid Withdrawal (TSW), first of all—you’re not imagining it. What you’re going through is incredibly real. For many, it’s one of the most physically and emotionally challenging experiences of their life. So if you’re just getting through each day, that’s already a huge accomplishment.

But if you’ve been wondering:“Why is my skin still flaring?”,“Is this TSW, or is my eczema coming back?”,“Shouldn’t things be improving by now?”

You're not alone—and you’re asking the right questions.

Because here's the truth that’s often overlooked: TSW and eczema are not the same thing. And yes, they can absolutely happen at the same time.

Ending Steroid Use Doesn’t Mean the Eczema Is Gone

Topical steroids are designed to suppress inflammation, which is why they’re often prescribed for eczema. They can reduce redness, itching and swelling quickly—but they don’t actually treat the root cause. Instead, they turn down the volume on your body’s immune response.

Eczema (or atopic dermatitis) is a complex, chronic condition influenced by your genetics, immune system, skin barrier health, and environment. Steroids may hide the symptoms, but they don’t fix the underlying imbalance.

So when you stop using them, two things often happen at once:

1. TSW begins—your body rebounds after long-term suppression, with intense symptoms like burning, redness, flaking, oozing and swelling.

2. Your eczema returns—because the original condition was never fully addressed.

It’s a double impact. And it’s why many people feel confused or discouraged when they expect healing, but instead find themselves flaring again.

TSW Adds a Layer of Complexity

Think of eczema as a small fire that’s been quietly smouldering. Steroids throw a blanket over it—hiding the smoke, but not putting it out.

Eventually, you remove the blanket. The fire’s still there, and now, it’s flaring more intensely. On top of that, the skin under the blanket is damaged—that’s TSW.

So when people say, “This is just TSW,” that might only be part of the story.

How Do You Tell the Difference?

Truthfully, it’s not always easy. TSW and eczema can look and feel very similar. They both can cause:

• Red, inflamed skin

• Severe itching or burning

• Oozing or weeping

• Cracking, flaking, or peeling

• Pain, sensitivity, and emotional distress

And often, they feed into each other. Ongoing inflammation from eczema can make TSW worse, while the skin barrier damage from TSW can make eczema harder to manage.

The Role of the Skin Barrier

If you’ve lived with eczema, you may already have a compromised skin barrier. This natural barrier helps keep moisture in and irritants out. In people with eczema, it’s often genetically weaker and more prone to breakdown.

TSW can damage this barrier even further, leading to hypersensitivity and delayed repair. Even once TSW symptoms settle, that fragile barrier still needs long-term support.

Without the right care and lifestyle changes, flares can continue.

A Holistic Approach to Healing

At Healing Tree Acupuncture & Natural Medicine, we often see patients navigating both TSW and chronic eczema—sometimes without realising it. That’s why our approach is holistic, gentle, and personalised.

We support your skin and body with a combination of:

• Acupuncture to regulate your nervous system and calm inflammation

• Herbal medicine to strengthen internal function and improve skin resilience

• Natural, non-irritating skin barrier support for sensitive skin

• Targeted dietary advice to uncover potential food sensitivities

• Lifestyle guidance to help reduce stress and support long-term healing

We don’t use steroids or suppressive therapies. Instead, we focus on helping your skin heal from the inside out—by treating the whole person, not just the surface.

Final Thoughts: Healing Isn’t Linear

If your symptoms feel layered, confusing, or like they never end—it’s probably because they are layered. Stopping steroids doesn’t make eczema disappear. And TSW doesn’t mean the eczema is over.

But that doesn’t mean healing isn’t possible.

It means we need to take a step back, listen deeply to your body, and support it on all levels—physically, mentally and emotionally.

Because sometimes, your skin is not just reacting to the past. It’s still asking for help now. And that message is worth paying attention to.

If you're on this journey, whether you're mid-TSW, dealing with long-standing eczema, or just starting to explore your options—we’re here for you.

Healing isn’t just about what you stop doing. It’s about what you start giving your skin, your body, and yourself.