Dear A Midwestern Doctor: You Forgot the Skin

A response to recent articles on steroid harm — and why Topical Steroid Withdrawal can’t be left out of the conversation

When I saw A Midwestern Doctor’s recent article about the dangers of steroids and The Vigilant Fox breakdown of it in his recent article as well, titled “What Really Happens to Your Body After Taking Steroids” , I felt two things at once: relief and rage.

Relief, because someone with a medical degree (and two writers with a large platform) are finally saying what so many of us have screamed into the void for years: that corticosteroids aren’t safe, that they suppress symptoms rather than support healing, and that they’re over-prescribed. That the pharmaceutical and medical industries profit from chronic conditions by keeping patients sick and depending on them.

But then… a wave of anger and sadness hit me. Because although the article is one of the most in depth I’ve seen, especially recently… I guess a part of me was expecting to see Topical Steroid Withdrawal (TSW) at least mentioned. But it wasn’t. Not once.

And that hurt.

The TSW community has been sharing their stories and screaming out for help for over a decade, and it seems we are ignored time and time again.

Topical steroids are everywhere in dermatology. Not only are they available over the counter in varying doses made by different brands, but they’re also given out like candy for eczema, psoriasis, contact dermatitis — sometimes without even an actual diagnosis. We’re told they’re safe and to keep applying them – often for YEARS. And then when our skin starts to fall apart, we are just told it’s our fault. It’s either just “worsening eczema”, or we did something wrong, we used the steroids “inappropriately”.

They never tell us that prolonged use of topical steroids can lead to full out dependency. That the steroids can cause your body to stop producing its own cortisol and that your skin can burn, peel off, itch, thin, ooze – for years. That you can develop insomnia, nerve pain, infections, and psychological symptoms – all from the topical steroid use. And they certainly never tell us that people can go through years of debilitating withdrawal just trying to get off of them.

This isn’t an imagined story or a hypothetical scenario. It’s happening all around the world.

It happened to me.

It’s still happening to thousands around the world, and most are gaslit, blamed, or flat out ignored.

Resources like ITSAN (the International Topical Steroid Addiction Network) have documented countless patient experiences, and even the National Eczema Association has formally acknowledged TSW as a legitimate condition since 2021.

A 2015 systematic review in the Journal of the American Academy of Dermatology also documented the symptoms and clinical patterns of steroid addiction and withdrawal (Hajar et al., 2015).

So when a well-read Substack piece talks about the dangers of steroids, and leaves out TSW, it feels like a continuation of the same erasure we’ve faced for decades.

You can’t talk about steroid harm and ignore the skin.

You can’t call for safer alternatives and leave out the people who’ve been living in raw, burning skin for years — often in isolation, often with zero help.

I appreciate that more doctors are speaking up, and I want more people to question the system. But if we’re going to talk about healing, truth, and what’s really going wrong in modern medicine — then we have to talk about Topical Steroid Withdrawal.

Otherwise, it’s not the whole truth. It’s just another polished version of it, one that leaves out thousands of people, and more to come in the future.

We’ve been silent too long. And we don’t want to be left out of the conversation anymore.