Eczema starts with a built-in weakness — think of your skin as a concrete wall poured with a slightly bad mix or missing rebar. That leaves microcracks. Triggers from outside (chlorine, hard water, soaps, pollution) and inside (gut, stress, hormones, food reactions) exploit those cracks and cause flares. Steroids work fast because they slap a sealant on the wall and quiet the alarms — but they don’t repair the concrete. Removing the sealant without addressing the triggers and the alarm system can explode back into chaos (that’s what people call TSW). The real day-to-day win is consistent barrier repair to protect the skin from damage caused by external and internal stressors.
The house concrete-wall analogy — the one picture to keep in your head
Imagine a concrete wall that’s supposed to be solid and waterproof:
-
Genetics = how the wall was poured and reinforced. If the mix was off or rebar was missing, tiny microcracks exist from the start. That’s the underlying cause: a genetically weaker barrier.
-
Barrier = the waterproof membrane/paint. This is what keeps water and chemicals off the concrete. If it’s thin or damaged, the wall soaks through.
-
External triggers = storms, acid rain, sandblasting. Chlorine, hard water, fragranced products, VOCs, pollution, rough scrubbing — these hit the outside and widen cracks.
-
Internal triggers = moisture or salts inside the wall. Gut inflammation, food reactions, hormones and stress create internal pressure that pushes through cracks.
-
Microbes = mold/biofilm on wet spots. Bacteria like Staph aureus cling to damp, cracked areas, accelerating damage.
-
Steroids = a high-grade temporary sealant/tarp. They quiet alarms and reduce inflammation but do not replace the concrete.
-
Biologics = rewiring the alarm system. They reduce the tendency of the immune system to overreact.
-
Barrier repair = re-cementing joints, reapplying the membrane, and daily maintenance. This is the structural work that protects the wall from storms and internal stressors.
The wall is the underlying cause, the storms and internal stressors are the triggers, and consistent maintenance is the long-term solution.
How triggers actually cause flares — outside and inside
External triggers (storms) — chlorine, hard water, soaps, strong cleansers, fragranced products, pollution, heat/cold changes, sweating. On normal skin these are often fine. On a porous wall they chip paint, dissolve waterproofing, and widen microcracks until leaks appear.
Internal triggers (pressure from inside) — gut inflammation, food reactions, stress hormones, immune hyperactivity. These increase systemic inflammation or local immune sensitivity and push problems outward through the cracks. In other words: they make your skin’s alarms more likely to fire — and alarms cause redness, itch, swelling.
Important: Triggers do not create the cracks. They exploit them. That’s why someone with strong skin can tolerate the same exposures without eczema.
Microbes: the amplifiers of flare-ups
When the skin barrier is damaged—cracked, dry, or inflamed—tiny living organisms on the skin can multiply and worsen irritation. This keeps the area inflamed and triggers the immune system, making symptoms like redness, itching, and soreness worse.
Antibiotics or antiseptics can clean the surface, but they don’t re-pour concrete. They remove a key amplifier so repairs can work better.
Steroids: why they help, and why stopping them can blow up things (TSW)
What steroids do (in plain terms)
Topical steroids are powerful anti-inflammatory medicines. They:
-
Turn down immune overreaction – they quiet the hypersensitive “alarm system” in eczema, stopping the redness, swelling, and itch that define flare-ups.
-
Calm inflammation fast – by reducing the chemicals that cause swelling and irritation, flare-ups settle quickly.
-
Temporarily improve the barrier – by slowing skin cell turnover and reducing inflammation, steroids help the skin hold water better and feel less irritated, though this is not a permanent repair.
What steroids do NOT do
-
They do not repair the underlying skin barrier. Cracks, dryness, and weak spots remain.
-
They do not change genetic predisposition or the skin’s inherent sensitivity.
-
They do not remove the root triggers—like irritants, allergens, or internal immune tendencies—that cause eczema in the first place.
Why stopping steroids suddenly can cause intense rebound (TSW explained)
If the tarp has been on for a long time (long or high-potency steroid use), two things can happen inside the wall-and-alarm system:
-
The alarms get used to being silenced. The immune system’s “volume knob” effectively shifts — it’s been artificially lowered for a long period.
-
The wall still leaks. The structural cracks are still there, so even small drips occur under the tarp.
When the tarp is removed abruptly:
-
The alarm system switches back on — and it can overreact. Imagine every tiny drip sounding all the alarms at once.
-
The immune response becomes chaotic: burning, intense redness, widespread oozing or swelling, and raw pain. That overwhelming, multi-system alarm flare is what many people call Topical Steroid Withdrawal (TSW).
How TSW looks and feels (common patterns)
-
Severe burning sensation more than itch (patients often describe intense burning).
-
Widespread redness that may flare beyond previous rash areas.
-
Skin becomes raw, weepy, or intensely scaly.
-
Symptoms can spread to areas not previously affected.
-
Can begin days to weeks after stopping steroids; the worst period can last weeks or months in some cases.
Not everyone who stops steroids will get TSW. The risk rises with:
-
Long-term continuous use (months to years).
-
Use of high-potency steroids on large body areas.
-
Use under occlusion (dressings) or on fragile skin (face, genitals).
-
Repeated cycles of heavy steroid application without proper barrier repair.
Why TSW is not the same as “steroids caused eczema”
Important nuance: steroids don’t create the genetic cracks. TSW is a rebound/overreaction of the immune system after prolonged suppression. The underlying structural weakness (the wall) was already there; the tarp masked the noise. When it’s removed, the system can overcompensate.
Practical, safe approach to steroids and withdrawal risk
-
Do not stop long-term steroids abruptly without medical support. If steroids have been used heavily, seek dermatologist guidance for a taper or supervised plan.
-
Use steroids as intended: lowest effective potency for the shortest necessary time, and use the steroid period to double down on barrier repair (moisturizers, gentle care).
-
If TSW occurs or is suspected: see a dermatologist. Management focuses on symptom control, aggressive barrier repair, and supportive care while the immune system rebalances. Some people need alternative topical agents, wound-care style dressings, or specialist support. This can take time; medical supervision speeds safer recovery.
If you suspect TSW — immediate safe steps
-
Seek a dermatologist — explain steroid history (potency, duration, body area).
-
Don’t attempt abrupt self-detox if steroids were used long-term — there are safer taper strategies.
-
Max out barrier repair: thick emollients, wet-wraps if advised, gentle cleansing. Barrier support is the one thing you can keep doing.
-
Symptom support: cool compresses, soothing emollients, and medical symptom management under supervision. Avoid random home remedies that can irritate.
-
Get psychological support if needed — TSW is painful and can be distressing; you don’t have to go through it alone.
(This is educational information — not a substitute for a medical plan. If you think you’re in TSW, contact a clinician.)
Biologics: targeting the root drivers of inflammation
Biologics (e.g., Dupixent) are medicines that block specific immune signals that trigger eczema flare-ups.
-
They do not change genetics or repair the skin barrier.
-
They stop key molecules (IL-4 and IL-13) from causing inflammation, so flare-ups happen less often and healing is easier.
-
For many people with moderate–severe eczema, biologics significantly reduce flares and improve skin recovery.
-
Even on biologics, daily barrier care is essential — the skin still needs maintenance.
Food & gut: why they sometimes matter — and when they don’t
Short clear rule: Food and gut problems can trigger flares for some people but they do not create the genetic cracks.
How food/gut can make things worse:
-
Gut inflammation or leaky gut can let food fragments or inflammatory signals into the body.
-
The immune system can interpret these as danger and crank up inflammation body-wide.
-
On porous skin, that inflammation shows up as redness/itch — a flare.
When to act on diet:
-
If there is a clear, repeatable link (e.g., eggs or dairy consistently trigger flares), investigate under clinician supervision.
-
True IgE food allergy requires testing and medical diagnosis.
-
Do not leap into extreme diets without guidance — removing important foods unnecessarily can harm nutrition and mental health.
Why moving countries can feel like a cure (and why it’s not magic)
Move to softer water, lower-chlorine supplies, cleaner air, or a different climate — and suddenly storms get gentler. The wall leaks less and alarms are quieter. That feels like healing. But the wall’s microcracks (genetics) remain. Return to the old environment and flares often come back. Environmental change is powerful relief — use it to repair the barrier while you have the breathing room.
Final, simple takeaway
You were built with the wall you have. Genetics create the cracks. Triggers — both outside and inside — make it leak. Steroids calm the leaks fast but don’t repair the structure; stopping them without repairs can cause a violent alarm rebound in some people (TSW). The daily, steady work of barrier repair is the true foundation that reduces how badly storms and internal stressors can hurt you.
Where aerbubblr and AE Shower Filter fit
-
aerbubblr Microbubble Showerhead makes the gentlest showers and less mechanically irritating. It helps to hydrate your skin and breathe. Thus helping your skin to heal.
-
AE Shower Filter removes >99% chlorine under real shower conditions.
Used together, they reduce major external stressors so skin barrier repair can actually work.