Topical steroid withdrawal occurs when a patient ceases the application of topical steroid creams on their skin. When this happens, the patient undergoes a withdrawal process which affect his or her physical, psychological and hormonal systems.
Before we go deep into the nitty gritty, here are some key resources to put this topic in context. (and to give it some legitimacy)
Paper titled “Review: Steroid Addiction“. This paper provides a great general review on the adverse effects of topical steroids. The paper talks about studies that show some insight into the mechanism of steroid rebound phenomenon. The paper concludes that such steroid rebound phenomenon (what we call as Topical Steroid Withdrawal) can occur in any chronic dermatoses which has been under long term treatment with topical steroids. This is the paper to read if you are prescribed with any types of topical steroids.
Paper titled “The red skin syndromes: corticosteroid addiction and withdrawal“. This paper has colored pictures to describe some of the withdrawal effects patients go through upon topical steroid withdrawal. This paper also studies the levels of Nitric Oxide in affected patients, concluding that affected patients has a higher NO level compared to normal healthy individuals. NO levels subside after long periods of withdrawal, correlated with a progress in their skin condition. Another definitive paper on how topical steroids can be the sole cause of your skin problem.
Topical steroid creams have side effects in that they can cause atrophy (physical damage) and destroys the barrier function of the skin. Upon withdrawal of the drugs, a rebound phenomenon is generally observed. Severity and duration of rebound phenomenon (topical steroid withdrawal symptoms) post withdrawal is dependent on the overall duration, potency, frequency of topical steroid creams used.
Rebound phenomenon may appear on body areas not previously exposed to topical steroid creams.
Secondary damage to the body can come in the form of systemic HPA-axis or adrenal suppression.
The exact mechanism of topical steroid addiction and withdrawal process is still not entirely known. There are a good number of hypothesis described in Dr Fukaya’s book that could possibly explain the mechanism. However, nothing concrete has been medically established thus far.
Certain physical/skin/blood markers are definite: NO levels and IgE (and therefore correlated inflammatory markers like Th2 cytokine) levels are higher than healthy controls in TSA patients. Application of topical steroids reduces langerhans cells . Skin cortisol levels may be suppressed due to topical application.
Extra caution has to be exercised when using topical steroid creams, given the risk of their adverse side effects.
Simply because nothing offered by conventional medical treatment – the prescription of topical/systemic corticosteroids – works any more. There are also increased awareness of this topic and increased numbers of people who have successfully recovered from their uncontrollable skin conditions by going through topical steroid withdrawal.
In short, topical steroid withdrawal works for people who have been dependent on long term topical steroids prescriptions.
Topical steroid withdrawal also makes sense as a default treatment procedure of steroid-induced dermatitis. When a drug is responsible for creating the mess, the cure is to stop using the drug. (If only more doctors are aware of this simple concept, many people would not have to go through the horrendous withdrawal process.)
Common symptoms experienced (and not exhaustive) are:
Burning red skin, oozing, puritus (systemic itchiness), flaking skin, dry skin, thinned skin, inflamed skin, edema, temperature dysregulation, insomnia, weight loss, hair loss, swollen lymph nodes, nerve pains, hypopigmentation, hyperpigmentation, tachyphylaxis, photosensitisation, hypertrichosis, stretch marks.
The tricky part about these physical symptoms is that they often resemble typical rashes and eczema symptoms (but they are not). Dr Rapaport mentioned in his youtube video that vasodilation occurs in steroid withdrawal but not in atopic eczema. Less experienced doctors who have limited experience in seeing real atopic patients may have difficulty in assessing and diagnosing the skin symptoms, and thus the quality of medical treatment prescribed may be doubtful.
In my personal description of the physical symptoms – if the descriptions of Hell are true, then experiencing topical steroid withdrawal is Hell. You will experience constant inflammed skin with a burning sensation. Flare ups occur everywhere on your body. You are constantly itchy and your skin is broken, weeping, oozing. You become debilitated if you have a body-wide withdrawal.
Topical Steroid Withdrawal symptoms pictures from paper “The red skin syndromes: corticosteroid addiction and withdrawal”
Topical steroid side effects from paper “Adverse effects of topical glucocorticosteroids”
Steroid withdrawal and recovery pictures from Dr Fukaya’s book “Atopy Steroid Addiction in Japan”
We have established that topical steroids can affect our systemic hormonal system by affecting our HPA-Axis. From wikepedia HPA Axis page:
The HPA axis is involved in the neurobiology of mood disorders and functional illnesses, including anxiety disorder, bipolar disorder, insomnia, posttraumatic stress disorder, borderline personality disorder, ADHD, major depressive disorder, burnout, chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and alcoholism.
In short, impairment to our HPA Axis function will play a big part in our daily lives, from the basic management of stress, to our behaviours, to our sleep, to our way we communicate with others and so on and so forth.
This should give you enough pause and signal a red flag – that the seemingly innocent usage of topical steroids can potentially result in such lifelong systemic effects that can influence WHO and What you can become.
Through my personal research and physical experimentation, it is my opinion and understanding that the recovery process can be optimized. My personal perspective and concept of recovery is this: A return to a baseline healthy physical/blood/biochemistry/physiological markers.
For example, we do know that NO and IgE levels are crazily high upon starting the withdrawal process. Then my question is “Is there a way to make lifestyle changes, so that these levels can return to normal quickly snail farm donde comprar?”
As extracted from Wikepedia on the topic of Health Effects of sun exposure:
According to the experiments of Dr. Richard Weller, the skin acts as storage for nitric oxide, NO, which is released to the blood upon UV exposure.
Is there a coincidence that Dr Rapaport advises his patients to get more sun, and that empirically, many of the TSW patients in my network, including myself, reported feeling better with improved skin when they get more sun exposure?
The same idea can be made for returning our IgE levels to baseline levels. IgE is related to the broad concept of inflammation, in which there are tons of information available on the internet. General inflammation markers can be easily influenced by making lifestyle changes in our diet and through exercising.
If we can make lifestyle changes to influence or skew these physiological biochemistry markers to our advantage, then all the more we should do it, so that we can recover in the best optimal manner.
The problem we face now is that we have a limited understanding and lack of knowledge of what actually happens during topical steroid withdrawal (save for a few good resources listed above). If we can know more blood markers associated with Topical Steroid Withdrawal, we can have more options to influence them. It is my hope that with more research, we can know more interesting information on Topical Steroid Withdrawal, leverage on these new information, and connect more dots to achieve an “optimal toolbox for TSW recovery”
I have written an ebook on “7 Actionable Tips For Better Skin Today” and it is available at my Eczema Magazine Portal (EczeMag.com) for free. These actionable tips are my efforts to optimize my recovery, based on my concept mentioned above. In short, it is a holistic lifestyle management on these 4 areas – diet, fitness, psychology and the environment. All you need to do is to subscribe to Eczemag.com weekly newsletter and you will receive the ebook link.
Most people I know recommend going cold turkey as the best option for their skin. Given what I have researched and through some of my reader’s feedback, I am beginning to think twice about the cold turkey option.
Suppose our goal is to shift our current state of health (some degree of topical steroid dependency) to a state of recovery. Is there a best/optimal way to do this? How do we define the best and optimal way? Is going cold turkey the fastest way to achieve our goal? Do we define fastest recovery as optimal recovery, or do we define comfortable recovery (with as little withdrawal effects as possible) as optimal recovery?
The reasons I ask this question is because when most people who are dependent on topical steroids go cold turkey, they almost invariably experience a very difficult withdrawal process – a hard landing. And so I thought, is there anyway we can achieve our recovery goal in a more comfortable way, and at the same time, perhaps faster too? Comfort and speed of recovery may not be mutually exclusive.
My idea came from my earlier mention concept of recovery “a baseline level of healthy biochemical physiological markers”. Suppose, this scenario:
Person A has some degree of topical steroid dependency, and he decides to get into better shape and wishes to stop relying on the constant need for TS application.
Instead of going cold turkey immediately, can he prepare himself first by altering his lifestyle factors so as to reduce his inflammatory markers and NO levels (and other associated markers with topical steroid withdrawal) to healthy levels. By doing so, he could and may prime his body to go through the withdrawal process, and perhaps experience a lesser degree of “hard landing”. While priming his body, he can slowly taper the usage of topical steroids, instead of going full cold turkey.
Of course, the above scenario could apply to people with some moderate degree of topical steroid dependency. There are also people who reach the point of being allergic to topical steroids and have a high dependency on them, until they can no longer tolerate the application of these creams. Perhaps going cold turkey may be a better option for this group, but honestly, I do not think that is a definitive answer.
My point is that, we should not just go through topical steroid withdrawal without considering making good lifestyle changes that can push our recovery to a more optimal manner – faster, more comfortable, less painful, less debilitating. Doing so requires more information and knowledge on this steroid rebound phenomenon.
Visit this page “TSA Related Blogrolls” for a collection of personal blogs.There are plenty of bloggers documenting their personal recovery journey with pictures of their skin condition, most of them gradually improving in the absence of topical steroids.
If you would like to add your blog to this website, drop me a message!
Start by creating awareness and sharing information on topical steroid withdrawal and the potential dangers of topical steroids to the public. Getting people to know about this condition is a first step. Getting more doctors to acknowledge this condition will be awesome, as these people provide frontline medical care to the public. By acknowledging this condition, quality and correct healthcare options can be provided to topical steroid dependent patients.
Share this blog as well as other blogs listed in my blogroll to the public, friends, family and especially people with eczema and skin conditions that require the use of topical steroids.
Participate in my FB discussion group to learn more about this topic and generate ideas for better skin improvement.
Please feel free to share and use this resource in anyway you like. (All I ask is a simple credit link back to this original resource page. Thank you!)