The Hidden Cost of Skin Conditions
This is an article I had published in Hypnotherapy Today Magazine, aimed at raising awareness of TSW (Topical Steroid Withdrawal) and other skin conditions, within the mental health space.
When you see someone with red, dry, itchy skin, you might think “that must be annoying”. But the reality runs so much deeper. Severe eczema, psoriasis, acne, Topical Steroid Withdrawal (TSW) and vitiligo can affect every part of someone’s life. The ripple effect reaches further, impacting relationships, loved ones and colleagues.
As a Solution Focused Hypnotherapist specialising in skin conditions, I want to raise awareness of the emotional trauma that often accompanies these chronic skin conditions. TSW in particular remains widely unrecognised and frequently undiagnosed, which is why awareness among therapists is so important.
Currently, the main approach for skin conditions like eczema, is to prescribe steroid creams or oral steroid tablets. And if these don’t work? Stronger steroids. For longer.
This was also my experience. I underwent phototherapy at the hospital, three times a week for three months, while using the strongest steroid creams. What I didn’t realise was that the very thing I was being prescribed was causing even more damage. My body had become dependent on steroids.
The steroid creams we apply to our skin (the largest organ we have) may temporarily relieve the issue, but a portion is being absorbed into the bloodstream. I developed Topical Steroid Addiction (TSA). I eventually weaned off all steroids and began the long journey through Topical Steroid Withdrawal (TSW). On average, withdrawal takes between two and five years. I’m now around five years steroid-free, using immunosuppressant injections to manage the symptoms.
I first learnt about TSW through the wonderful skin community on Instagram. Today, patient advocacy discussions are growing across all major social media platforms. Although the condition (previously unnamed) was first documented in a dermatology journal in 1969 (Sneddon, I.; Adverse effect of topical fluorinated corticosteroids in rosacea, Br Med J, 1969) and described as “addiction” ten years later (Kligman & Frosch, 1979), it remains a debated and often controversial topic within the medical community.
In early 2021, the UK’s National Eczema Society and the British Association of Dermatologists (BAD) released a joint position statement officially acknowledging TSW - a huge step for our community. Following further protests and petitions, in September 2021 the Medicines and Healthcare products Regulatory Agency (MHRA) recognised TSW reactions and required all topical steroid products to include warnings about potential withdrawal reactions in their patient information leaflets.
We’ve come a long way in the last five years, but there is still no universally agreed-upon diagnostic criteria.
Symptoms of Topical Steroid Addiction (TSA):
- Skin flares quickly between steroid applications (rebound effect)
- The flares spread to new areas that weren’t impacted before
- A shift from itching to burning, stinging and very painful skin
- Steroids no longer clear the flare up
- Hypersensitivity to environmental irritants
- Rashes appear more like flaking sunburn
Symptoms of Topical Steroid Withdrawal (TSW):
- Burning sensations, severe inflammation, excessive skin flaking/shedding
- Wrinkling, thin skin that breaks easily, scaring, potential oozing
- Insomnia, fatigue, lack of temperature regulation, potential hair loss
- Shaking, shivering, shooting nerve pain, may experience skin infections
- “Red sleeves” (on lighter skin tones) - inflammation on the arms, ending sharply at the wrists
- Compulsive skin picking and itching
- Skin cycles between red, swelling, dry, shedding and repeats
- Often bed/sofa bound for long periods and unable to work
Understandably, mental health can decline rapidly. Anxiety, depression, grief, loss of identity, isolation, panic, fear, even suicidal thoughts – these are all common experiences for those navigating TSW and other severe skin conditions.
Before TSW, I was a marine biologist and behavioural researcher, working offshore and in labs. During the worst stage, I became mostly bed-bound for six months and was unable to work for a year. In the midst of this, a friend suggested I try hypnotherapy - specifically to help with the panic attacks I’d developed around getting dressed, and a phobia of showering or bathing. It was transformational. That experience inspired me to become the hypnotherapist I could see the skin community so desperately needed.
This niche may sound very specific, but it’s far from rare. Over half the population experiences a skin condition (British Skin Foundation). As therapists, it’s vital we recognise that these conditions can be profoundly traumatic and ensure our clients receive the understanding and support they deserve.
Sadly, the skin community often experiences medical gaslighting. Even now, I’m still encouraged by dermatologists to use steroids. People of colour, meanwhile, are statistically more likely to have eczema yet less likely to receive appropriate care (Lusignan et al., The Epidemiology of Eczema in Children and Adults in England, 2020). This disparity is thought to arise from differences in skin-barrier function, higher rates of gene mutations, and diagnostic delays caused by variations in how eczema presents - commonly described as red and inflamed, but it often appears dark brown, purple, or grey on darker skin. It’s another reminder of how vital awareness and education are in this space.
As their therapist, you could be the only professional who truly validates their experience.
Research from ITSAN shows that 89% of patients and caregivers report limited effectiveness from available treatments. Suicide risk management in dermatology is described as “essential yet often overlooked” by Dr Lipner, Associate Professor of Clinical Dermatology in New York. Acne, psoriasis and dermatitis or eczema are all linked to a higher risk of suicidal ideation (Islam, R. et al., A Clinical Review of Suicide Risks in Dermatology, 2025).
The statistics are honestly shocking. Half of all adults with eczema experience anxiety and/or depression (British Association of Dermatologists), and yet 64% of dermatology patients and caregivers are never referred to any form of mental health resources (National Eczema Society).
While people can see the red, inflamed skin (often knocking confidence and self-esteem), they can’t see the physical pain that comes with many skin conditions. I asked some of my clients if they could describe it:
“Like fire ants crawling all over your body.”
“The worst sunburn, all over, constant. So tight that any movement could cause your skin to tear.”
“As if there are spiders running up and down your body, but their legs are needles.”
“Anything that touches you feels like burning acid.”
Another challenge the skin community faces is the invisible aftermath of a flare. Once our skin clears up and we look ‘normal’, society expects us to instantly bounce back - to be social again, full of energy and confidence, productive at work. They don’t see the fear which lingers. The anxiety, panic and hypervigilance surrounding… well, everything. Plus, we are often left with the lingering habit of itching, or worse, dermatillomania – compulsive skin picking.
The primitive brain is stuck on high alert, seeing threats everywhere. Food, clothes, fragrances, sweating, movement, certain environments - any of these could trigger another flare. The temptation to stay isolated in a bubble of perceived safety can be overwhelming.
For years I avoided white clothing (it shows the blood stains from scratching) and black clothing (it shows the skin flakes from shedding). I avoided bedding, towels or clothes not washed by myself in fragrance-free detergents. I avoided lifts in case someone next to me was wearing perfume, and public transport in case I couldn’t control my body temperature. I feared physical intimacy – the idea of cuddling someone who wasn’t using my allergy-safe shower products would send me into panic.
The physical appearance of someone with a skin condition (or any illness), doesn’t always reflect their mental health. Even after the skin recovers, they might still be grieving the time, opportunities or relationships lost along the way.
For many clients, hypnotherapy is the missing piece! Stress is one of the biggest triggers for flares, so helping the nervous system find balance can make a huge difference. Cortisol triggers histamine, which fuels the itch sensation, increasing pain and slowing healing. Hypnotherapy can be a space where their pain is finally seen, validated, and soothed. While we can’t change the condition itself, we can help clients change their relationship with it. This is a key part of the process - never trying to ‘fix’ the skin but concentrating on changing how the skin condition dictates their life.
My work focuses on helping clients rebuild trust in their themselves and their bodies, and confidence in who they are beyond their skin. As hypnotherapists, we’re in a unique position to bridge the gap between mind and body. Supporting clients with chronic skin conditions takes awareness and sensitivity, but it is so rewarding. Hypnotherapy was shown to reduce itching, and improve both sleep and mood, in adults and children with extensive dermatitis – results which maintained up to two years later (Stewart, A & Thomas, S; Hypnotherapy as a treatment for atopic dermatitis in adults and children, 1995).
We may not heal the skin itself, but by helping clients address the emotional trauma beneath it, we can restore confidence, and spark real change — far beyond the surface.
Resources to learn more:
‘Preventable: Protecting Our Largest Organ’ and ‘Still Preventable: TSW’ are the only documentaries on TSW and can be found on Youtube by @BrianaBanosPreventable.
International Topical Steroid Awareness Network (ITSAN) is the only non-profit charity organisation for TSW.
Itch ‘N’ Bitch is a community for all skin conditions, providing support, meet-ups and advocating opportunities.