Herbs and Herbal Formulas for Topical Steroid Withdrawal

January 31, 2025

Introduction to Topical Steroid Withdrawal

Red burning painful skin from months or years of using topical steroid creams.  The creams are no longer “working” and so you decide to stop using them, but then the burning and pain set in.  Why does this happen and how can you get relief?  

Hi, I’m Selima Harleston-Lust, clinical herbalist with over 12 years experience and co-founder of Iwilla Remedy where I’ve taught over 6,000 people how to use herbs skillfully to invigorate, restore, and nourish their bodies. 

Today we’ll talk more about this condition that is not widely recognized by the medical community and I’ll demonstrate 2 formulas, one for topical use and 1 for internal use that can calm the skin on the outside as well as support the skin on the inside.  

Overview of Condition

First of all, what are topical steroids and how do they work?  Topical steroids, also known as topical corticosteroids, are medications applied directly to the skin to reduce inflammation and irritation. They are commonly used to treat conditions like eczema, psoriasis, and atopic dermatitis (chronic, itchy inflammation of the skin).  Topical steroids work by reducing redness and swelling (inflammation) by narrowing the blood vessels in the affected area.  They also suppress the immune system response on the skin and speed up the healing process by reducing symptoms  such as heat, itchiness and soreness.  Topical steroids come in different strengths ranging from mild to very potent.  Potency increases with the concentration and form (ie) ointment vs. cream of corticosteroids within the solution.  

Topical steroid withdrawal (TSW), also known as red skin syndrome or topical steroid addiction, is a condition that can occur after discontinuing prolonged use (3 months) of topical corticosteroids, especially those of medium to high potency. It is characterized by a range of symptoms, including burning, itching, redness, peeling, and swelling of the skin.  These symptoms can be more severe than the original condition being treated and may spread to areas not previously treated with steroids. However, TSW symptoms tend to appear in the areas where steroids were most frequently applied (commonly the hands, neck, and face).  

Along with these skin or topical symptoms there are also systemic symptoms that can occur due to higher potency steroid usage and the skin barrier function is already compromised due to the originating condition (ie) eczema, psoriasis, etc.  These include suppression of the hypothalamic-pituitary-adrenal axis (HPA axis), Iatrogenic Cushing’s syndrome which is a hormonal syndrome caused by prolonged exposure to high levels of cortisol in the body, growth retardation in infants and children, and vision and eye problems.  

The exact cause of TSW is not well understood, but it is believed to result from rebound vasodilation (when blood vessels previously constricted by meds or other factors suddenly expand after the meds are stopped) and skin barrier dysfunction after stopping the medication. The condition is more likely to occur with long-term use of higher potent steroids, especially on sensitive areas like the face and genitals.  Overall, individuals with prolonged and potent topical steroid use (as is often the case with conditions like eczema and psoriasis) , particularly AFAB people and those with atopic dermatitis are most susceptible to TSW.

Treatment typically involves discontinuing the use of topical steroids and allowing time for the skin to heal, which can take from weeks to years.  TSW typically progresses through four stages of healing which is why it can take weeks to years to heal, but generally significant improvement occurs within 3-4 months. The first stage is the Inflammation stage which is characterized by intense skin inflammation that may include redness, swelling, burning and itching.  The second stage is the Exudation/Oozing stage.  Here the skin may ooze, weep and form crusts which increases the risk of infection.  The third stage is the Proliferation stage where the skin attempts to heal itself by producing new skin cells leading to thickened and scaly skin.  Itching and discomfort may accompany this process as well.  The last stage is the Remodeling stage where there is gradual improvement of symptoms.  Redness and inflammation decrease significantly but some residual dryness and sensitivity may persist.  

Treatment can also include additional testing.  We know through a holistic lens that often skin problems are a sign of an internal imbalance specifically in the gut.  This could be food allergies or sensitivities, infections, good and bad bacteria imbalance, etc.  Another way to support your healing during and after withdrawal is to get testing done to see if you have any of these.  With the intent purpose of identifying, eliminating and then calming the response within the body. 

My Student's Story

One of my students in my signature herbal mentorship program, Herbal Medicine for the Soul shared her experience with TSW. 

She had been using topical steroid creams for most of her life, starting at the age of 7 or 8, as a treatment for eczema. Her daily routine involved applying creams, gels, and ointments in an effort to find any relief. During the pandemic in 2020, she was unable to secure a specialist appointment for refills, so stopping the steroids led to her experiencing topical steroid withdrawal (TSW). Her skin became red, hot, and thin, frequently cracking and becoming infected, with wounds that oozed blood or pus. Her sheets and clothing were often covered in skin remnants. She was bedridden for about six months, suffering from extreme fatigue, swollen lymph nodes, and muscular pain lost a considerable amount of weight.

Today, after simplifying her skin care routine, adding supplements and herbs she’s longer with active TSW.

Her story is incredible and if this is what you’re going through, I hope it shows how healing is possible with the right tools.

Emotional Support

With TSW it is important to note how much of an emotional toll this process takes on a person’s mental health.  Many times they are unable to work or even function in their normal day to day routines for weeks or months.  Finding a support group for you is very important.  This may include family, friends, a therapist through 1:1 talk therapy, other individuals in the medical community (ie) naturopathic doctor, herbalist, acupuncturist, etc.   Also, because this isn’t vastly recognized in the medical community it’s hard to advocate and ask questions.  I encourage you to ask your provider about the medications you are being prescribed or have been prescribed.  Use your resources to learn about them also if needed.  But please know that you are seen and heard!  You are not crazy!  

Herbs and Herbal Actions

As shared by my student, TSW typically creates hot burning dry skin so we need cooling moisture rich herbs that will provide relief and ease pain.  Another important action is wound healing during withdrawal and during a flare.  Wound healing herbs bring fresh blood and therefore nutrients to the surface so the skin can regenerate. These herbs are often also antimicrobial which helps the body destroy or resist infective microorganisms. Reducing inflammation both internally and externally is key to easing pain and promoting healing.  Some examples of these herbs are aloe vera, burdock and dandelion root, turmeric root, licorice root, clove, milky oats, and calendula.  

Aloe vera gel, from inside the leaf, applied topically can be very soothing and moisturizing to the skin. It rejuvenates the skin and provides much needed relief from the hot burning sensation.  

Milky Oats are cooling, moisturizing and soothing to the nervous system.  We have many nerves in our skin and milky oats calms the nerves and nourishes them to ease pain.  You can take this as a tincture internally, you can take an oat bath with milk and honey to feel that cool moisturizing effect externally.  

For this video we’ll be using calendula, clove, lavender, turmeric root, milk thistle, licorice root and rose.  I’ll be demonstrating 2 formulas, one for topical use and one for daily internal use to support the body both internally and externally.  

Formulas for Topical Steroid Withdrawal

For topical steroid withdrawal we want to focus on reducing inflammation, promote skin healing through tissue regeneration and antimicrobials, support the liver and detox pathways, and support the stress response.  TSW takes a toll on a person’s mental health so adding a bit of nervous system support can be very helpful. 

Topical oil recipe
1.75 oz Calendula
.5 oz Clove
.75 oz Lavender
12 oz Coconut oil or oil of choice

For our topical formula we’ll be using Calendula, Clove and Lavender infused in coconut oil in a 1:4 ratio.

(1.75 oz by weight of dried calendula)  Calendula is a powerful skin ally!  It soothes skin irritations by healing wounds from cracked dry itchy skin, reduces inflammation and can prevent infection. It also tones the skin while facilitating tissue repair through carotenoids.  Calendula is a very cheerful brightly colored plant so it will bring a bit of sunshine to our formula.  

(.5 oz by weight of dried clove)  Clove’s primary action via volatile oils in this formula is to reduce itching which can be a maddening symptom of any skin condition but especially one with dry irritated skin. It also helps reduce infection and stimulates the blood vessels under the skin to dilate and promote healing and regeneration of skin tissue. Clove is also known for its analgesic or pain relieving properties.

(.75 oz by weight of dried lavender)  Lavender is familiar to most!  It has a wonderfully calming scent that can bring instant relief when inhaled and applied topically due to its high volatile oil content.  It also helps prevent infection and soothes irritation and redness.   

(12 oz of coconut oil)  Here we are using coconut oil.  Other alternatives are jojoba oil because it is similar to the skin’s sebum, absorbs into the skin quickly and is good for sensitive skin.  Another option is a combination of grapeseed oil and castor oil.  Grapeseed oil is used to thin the castor oil for better absorption.  Castor oil is great for all skin types, although it is very thick and needs time to absorb into the skin.

Combine these into the LEVO pod cover and place in the LEVO machine.  Set the timer to activate and wait. Grab a cup of tea or a good book. 🙂   When done, dispense your oil into a glass jar, cover and label.  Use your infused oil as often as needed for relief and healing.  

Double boiler method: 

Place herbs and oil in a double boiler pot.  If you don’t have a double boiler pot you can use a glass bowl on top of a pot filled ⅓ to ½ of water.  Turn the stove on low and let them cook for 1-4 hours stirring occasionally.  Then turn off the heat and let it cool.  Once cooled, strain using a mesh strainer or cheesecloth.  Bottle in a glass jar, label and store in a cool dark place.)

Herbal capsule recipe
16 grams Turmeric root - powdered
16 grams Milk Thistle seed - powdered
4 grams Licorice root - powdered
4 grams Rose - powdered
1 gram Black Pepper - powdered

The second formula I’ll be demonstrating in this video is one for internal use.  We’ll be making capsules to take daily to support liver function, reduce inflammation and ease stress.  

(Grind 16 grams of turmeric root)  First is Turmeric root!  A powerful herbal ally to reduce inflammation through the constituent curcumin.  It also supports the detox processes in the body and reduces pro-inflammatory molecules through its antioxidant actions.  

(Grind 16 grams of milk thistle seed)  Next is Milk Thistle seed.  This is a great herb to support all functions of the liver.  Silymarin, a primary constituent in milk thistle, provides nourishment for the liver tissue, protects liver cells from damage and stimulates regeneration of already damaged liver cells.  This is very important because the liver has been processing the various steroid medications absorbed through the skin over a long period of time which can put excess strain on that liver.  Milk Thistle is very gentle and can be used by many.  

(Grind 4 grams of licorice root)  Now we have Licorice root, a wonderful addition to support stress and ease exhaustion.  It is cooling and moistening and has strong anti-inflammatory actions because of the triterpene found in its roots.  In this formula we are using licorice to support the stress response, to help the body become more resilient to stressors.  Licorice does this by supporting the adrenal glands and endocrine system. If you are hypertensive, leave licorice out of the formula.

(Grind 4 grams of rose petals)  Last, but not least is Rose.  Rose is a beautiful heart opening and heart supportive plant emotionally.  It is also cooling and moistening and the tannins in rose help reduce redness by reducing inflammation.  It is antimicrobial and nervine, which means it supports the nervous system by calming the nerves providing a sense of ease.  Rose brings love and comfort to this formula on an emotional level to create balance.  

(Grind 1 gram of black pepper)  We add a little bit of black pepper because it contains piperine, which enhances the absorption of the turmeric, specifically the curcumin which has the inflammation modulating properties.  

We combine all these into a bowl and mix thoroughly.  Then we pour the mixture into the capsule machine to make our capsules. We are using gelatin capsules. This makes 100 capsules that are approximately 500 mg each.  Suggested dosage is 4 capsules daily, preferably in the morning.  

Now you have 2 formulas to support you during Topical Steroid Withdrawal.  I hope this was helpful and thank you so much for joining me! 

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