Skin: Eczema/Red Skin Syndrome/Topical Steroid Withdrawal (TSW)

The most recent dermatologist - who I was told was one of the best in Sydney -started off by saying that TSW is a “load of rubbish, and doesn’t really exist.” I was so upset when she told me to just go back on steroids. Bev. Australia. 2012

Our skin is highly complex and has many functions

skin structure
  • The illustration above is a simplified diagram of the highly complex structure and functions of human skin. The three main layers of the skin (epidermis, dermis, and hypodermis) are indicated in red. Some of the skin’s important functions include:
  • Protection of the body from injury.
  • Sensation of pain, touch, temperature, pressure and vibration.
  • Body temperature regulation.
  • Protection from infection by immune cells, which, being very close to the surface of the skin, can be the first to suffer damage by topical steroids (See blue arrow in the illustration below).
skin structure and immune cells
  • Maintaining moisture. Together, the oils produced by sebaceous glands and sweat glands, keep the skin moist. However, topical steroids can rapidly damage or eliminate these most important functions which results in dry, often cracked skin that is prone to infection. Ironically, topical steroids are often used for treating dry skin in the hope it might assist recovery, when in fact it does the opposite by drying the skin. This then predisposes to cracked skin and infection.
  • Beyond protecting us from infection, cold and heat, there are many other functions our skin, which is the largest organ in the human body, has to perform. For instance, immune cells exist very close to the surface to help protect us from invading bacteria and other organisms. Then we have numerous nerve receptors that sense heat, cold, pain, vibration and so on. There are also hair follicles and sweat glands that help heat to escape from the body. Capillaries and small arteries bring oxygen and nutrients to the area and remove waste.

Skin functions are numerous indeed, but when topical steroids are applied regularly to the skin, in time, some or all of these functions begin to fail. For instance, reduction of blood supply, weakening of the skin's immune protection, and damage to sensory organs responsible for pain, pressure and temperature control.

A brief history of topical steroids

Since topical steroids were first introduced in 1951, many doctors were impressed at how rapidly they "normalised" even severe eczema by reducing itch, inflammation, itchiness and so on. But there was a trap. Some patients developed the so-called “red skin syndrome” which was initially thought to be due to eczema. Instead, it turned out to be due to withdrawal or reduction of topical steroids.

In addition to thinning the skin, topical steroids can be highly addictive (read about adverse effects of topical steroids). They can suppress the body’s immune system, making people prone to infection.

When bright red areas appear on the skin, particularly in the head and neck, as seen in this patient, this is known as the "red skin syndrome".

red skin syndrome healed with wheatgrass
Fig.1. Red skin syndrome (severe), recovered by wheatgrass extract.

This patient suffered severely from topical steroid withdrawal symptoms for several years. As well as redness and constant pain, she had marked fluid loss from her leaking skin. It took a whole year to wean her off the drugs using wheatgrass extract, but her skin recovered completely.

To my knowledge, there are no medications that can achieve such recovery. Unfortunately, many patients are urged by some "TSW experts" to simply "go cold-turkey" and put up with the pain and other withdrawal symptoms. Considering this method may continue for several years, the patient may suffer immeasurably from severe withdrawal symptoms such as severe pain, skin scaling, cracking, weeping and infection.

In my view, this "method" should be abandoned as the suffering it induces and associated risk of infection can put the patient's life at risk.

The usual medical approach to TSW

The orthodox medical approach is to use oral steroids such as prednisolone which reduce inflammation, but if the medication is stopped, severe rebound can occur. Concurrently, the patient can become addicted to the oral steroid which may complicate the situation when attempts are made to reduce the drug dosage. This may help ease pain and other symptoms, but does little or nothing to heal the damaged skin. This method may require many months or even several years of medical supervision.

Finally, it is important to be aware that some of these patients have suffered severely. It is important therefore to be aware of the seriousness of their condition and their urgent need for medical assistance.

Although there is no "quick fix" to the problem, perseverance with wheatgrass extract helps relieve pain and assists skin recovery as seen in Figure 1 above. Recovery may take six to twelve months, but in my own experience wheatgrass extract has helped many sufferers recover completely.

Case Study: Infantile eczema heals readily with wheatgrass extract

Many topical steroid addictions begin during infancy.

Figure 1 shows damaged skin on the elbow of an infant after only 2 months’ use of topical steroids.

Figure 2 shows the same elbow after three-weeks' treatment with wheatgrass extract only. This child was fortunate. Had the TS not been stopped and replaced with wheatgrass, he may well have become TS-addicted.

topical steroid withdrawal child
Fig. 1. Topical steroid skin damage. Note wrinkled, scaling. inflamed red skin.
topical steroid withdrawal child cured
Fig. 2. Significant skin improvement after 3 weeks application of wheatgrass extract.

The majority of juveniles outgrow eczema by the time they turn 20, but if they are still using TS by then, they may become addicted to them for life. Ironically, patients are being “treated” to overcome side effects caused by drugs meant to improve their skin. I find this approach rather absurd. Instead,  attempts should be made to wean them off these drugs as soon as possible.  Unfortunately, often stronger steroids are introduced at this stage to help prevent withdrawal effects, but this only aggravates the situation.

Topical steroids (TS) do a lot more damage than “thin the skin”. In fact, many children – even elderly adults – suffer from the side effects of these drugs, such as addiction and the pain and suffering of TS withdrawal when attempts are made to cease them.

Infancy is the best time to avoid or eliminate TS, because prolonged use can lead to addiction, permanent skin damage, and suffering for parents and child.

Instead, treat the eczema by applying a little wheatgrass extract over the worst affected areas just twice weekly, and persevere.

How wheatgrass helps overcome topical steroid withdrawal

As the skin gradually erodes due to continued topical steroid use, it becomes prone to infection and inflammation. Also, numerous pain and other receptors in the skin are laid bare which can produce severe pain. Continued use ultimately damages the skin's ability to protect the body from bacterial and other infections. Infection is a common complication and must be treated immediately. This in itself is sufficient reason to have a doctor oversee the management of withdrawal effects such as pain and infection. TSW is potentially dangerous and can sometimes be fatal. It should not be managed by the non-medically trained.

Even if hospitalisation is required, continued use of wheatgrass extract can help restore the structure and functionality of the skin's blood vessels, sweat glands, hair follicles, sebaceous glands etc. that are so essential for normal skin recovery. This will take time, approximately 6 to 12 months, depending on the degree of skin damage. Patience, courage and determination at this stage is essential, and in time, the skin will recover.

The foremost aim should be to eliminate topical steroids permanently and to restore all skin functions. If one perseveres, success can be achieved. ONCE WEEKLY APPLICATION OF WHEATGRASS EXTRACT IS SUFFICIENT. Don't overtreat. Also, because the skin has been comprehensively damaged, it will take six to twelve months for it to return to normal, so try to persevere.

Wheatgrass normally works well and is certainly more humane than going “cold turkey” - a potentially horrifying experience that should be avoided at all costs. Wheatgrass extract application is a far more humane way to help the patient's struggle through topical steroid withdrawal.

Some topical steroid caused skin side effects wheatgrass extract can overcome

Elephant skin: This patient battled topical steroid withdrawal symptoms on and off for about 30 years during which she developed severe elephant skin over her elbows - a common complication of prolonged topical steroid use that is considered to be "irreversible". After applying wheatgrass extract over the affected skin for two months there is significant improvement in her skin. Note how the deep ridges have reduced significantly in size in this short period of time.

wheatgrass heals topical steroid damaged skin
30 years of regular topical steroid damage restored by wheatgrass extract in 2 months.

Fluid retention: The patient pictured below had suffered for several years from grossly swollen legs and arms due to topical steroids interfering with her skin's blood and lymphatic circulation. (Fig. 4.) She had applied wheatgrass extract regularly for several months, which improved her skin's condition, but the swelling remained.

More as an afterthought, her daughter persuaded her to stop ALL skin applications (moisturisers etc.) but to continue the wheatgrass extract. About two weeks later, the gross swelling seen in the "before" pics below, disappeared overnight. When she woke that morning her bed was soaking wet from the fluid loss from her legs. Her skin subsequently recovered completely and no longer required treatment. (View detailed account.)

topical steroid withdrawal swollen leg
topical steroid withdrawal swollen arm

How to use wheatgrass extract for treating TSW

Although fresh wheatgrass juice can assist healing of TSW, I have observed many recoveries using my own extract (Dr Wheatgrass Skin Recovery Spray). This is considerably more potent than fresh juice.

1Topical use (for the skin): Apply just a little Dr Wheatgrass Skin Recovery Spray over the worst affected areas onlyno more than twice a week. Say, Monday, Thursday - and persevere. Do not overtreat because it is wasteful and unnecessary. Many years éxperience show that "less works best".

Do not expect an overnight "cure". It often takes considerable patience and courage (for both patients and carers) to overcome the symptoms of topical steroid withdrawal. Recovery from severe topical steroid damage could take anything from two or three months to a year - but perseverance will almost certaily win the day.

So, try to be patient. Remember, your skin is a highly complex and hyper-sensitive organ. It is going to take time to restore it to normal.

2. To strengthen the immune system, take wheatgrass juice or Dr Wheatgrass Supershots – just half a teaspoonful (2.5ml) twice weekly. Again, don’t overtreat.

Some additional advice

For infants and children: Avoid soap and baths as much as possible as they remove the skin's natural oil which is so important for recovery and protection from bacteria and other micro-organisms. Preferably, wash with a warm, damp, soap-free flannel.

Adults: Each day without TS is a major victory. Mark your calendar for 12 months and tick off the days. You may or may not be fully recovered by then, but you will be well on the way.

Some other treatment possibilities

  • “COLD TURKEY” i.e. Stop topical/oral steroids, sweat it out, suffer immeasurably and possibly endanger your life.
    This so-called method, recommended by a well known non-medicaly qualified website (for some inhumane reason), is without doubt the most inhumane way of weaning a TSW sufferer off topical steroids.
  • TSW IS A SERIOUS MEDICAL PROBLEM and should be managed as such. Withdrawal symptoms are frequently severe, so this process should never be attempted without qualified medical supervision. (Read American dermatologist Dr. Marvin Rapaport's view on this topic.)
    My wheatgrass extract approach will not stop withdrawal symptoms immediately, but over time it will help accelerate restoration of the patient's skin, but topical steroids will worsen the damage.
  • GRADUAL REDUCTION OF TOPICAL STEROIDS This is another approach, but it requires regular monitoring and review by a medical professional. I have used this method successfully many times, but in combination with wheatgrass. It can be significantly more effective if the patient is encouraged to include the extract in the treatment plan.

POSTSCRIPT: Wheatgrass and other cereal grasses have been the subject of considerable clinical and laboratory research since the 1930’s. My own clinical experience has shown how effective it can be for treating many other conditions.

Dr. Chris Reynolds.