Red Skin Syndrome (topical steroid addiction) appears to be a real entity that we still need to learn more about. There is some information here: http://www.itsan.org/
However, given the description on the site, it seems that it can be very difficult to distinguish from eczema itself—this is part of what makes it so challenging.
Our goal is to help our patients and get them (and their families) some relief from the scourge of eczema.
We try to do everything in our power to calm the skin, restore it, and protect it: from healing oils, to dilute bleach baths, to tui na baby massage, our goal is to avoid if possible—or absolutely minimize if not—medications such as topical steroids.
For more mild disease, this is often possible. However, for more severe cases, using some topical steroids in a careful and safe manner seems to be necessary given our current knowledge of eczema, unfortunately.
The key seems to be to use them in brief bursts to help calm things down and then give the skin a complete rest. There is a need to break the scratch-itch cycle, and a need to kick out all of the inflammation in the skin so it can actually heal. We need to let it heal so that the bacteria can be fought off and rebalanced. And we need to give the patient (and their family) a break so everyone can sleep again, which is also incredibly important for health and healing. So many patients have poor sleep with eczema, up many times during the night scratching… it’s no wonder they have trouble healing!
Perhaps a good analogy is to painkillers like opiates (codeine, morphine, oxycontin, etc.): Painkillers are highly addictive and many people are addicted to them and have their lives ruined by them. However, it does not follow that people in pain should not be able to use them carefully and safely for short periods.
In fact, it is only the tiniest minority who becomes addicted to them. It would be unjust and unfortunate to deny the many patients in need from relief because of a small risk.
For those fortunate enough to not need these medications, totally avoidance may be possible. They are very lucky, indeed!
However, for patients who are truly suffering, medications of all sorts have been developed to ease suffering and give relief.
With proper guidance, respectful usage, and close monitoring, it seems that the vast majority of patients can use topical steroids briefly when needed, and then be steroid-free with very little risk and great benefit.
For those suffering with Red Skin Syndrome, we work to maximize all of our other non-cortisone treatments, from antihistamines to phototherapy and beyond—along with lots and lots of support—to help get you through it.