Skin: Eczema/Red Skin Syndrome. Topical steroid addiction

“Every time I see a doctor or dermatologist they don’t know what I am talking about - they say steroids just thin the skin. The most recent derm who I was told was one of the best in Sydney started off by saying that TSW is a "load of s**t" and doesn't really exist."

"I was so upset when she told me to just go back on steroids.”

Bev. Australia. 2012

Doctor in denial? Many doctors, even dermatologists, simply don’t believe topical steroid withdrawal frequently leads to rebound skin flares. The common response is that symptoms are due to eczema. If there’s a flare, keep applying steroids and if it doesn’t get any better, use a stronger one to keep it under control!

One reason doctors deny the existence of TSW is because they have no drugs available to counteract withdrawal symptoms. They therefore have no choice but to recommend ‘cold turkey’ and all the pain and suffering that leads to.

This may be the most popular method advocated by doctors, but unfortunately it frequently results in severe suffering by patients. It can be extremely difficult to tolerate withdrawal symptoms that might take more than 4 years to overcome.

Avoiding topical steroid withdrawal

Since topical steroids were first introduced in the 1950’s, many doctors, (myself included) denied that these drugs damaged or thinned the skin. In fact the withdrawal symptoms – such as the so-called “red skin syndrome” – was thought to be due to eczema when it was actually due to the side effects of topical steroids such as:

  • Thinning, cracking, weeping, infection and other damage to the skin.
  • Severe flares when the drugs were withdrawn or the dose reduced.

Unfortunately, these drugs can not only cause considerable damage (atrophy/thinning) of the skin, but they are also highly addictive. When trying to stop them, severe withdrawal symptoms can occur such as cracked, weeping skin, infection and pain. Unfortunately, only the use of more topical (or oral) steroids can stop the patient's suffering.

This condition is known as topical steroid withdrawal, (TSW), and was first recorded soon after hydrocortisone was found to improve eczema and other skin conditions in the 1950's. (Read about adverse effects of topical steroids). There is no doubt TSW exists in large numbers worldwide - wherever topical (or oral) steroids are accessible.

Why do topical steroids do so much damage?

The skin is a highly complex and sensitive organ with many important functions that can be damaged by topical steroids e.g.

  • Protection of the body from injury, bacteria etc.
  • Sensation of pain, touch, temperature, pressure, vibration.
  • Body temperature regulation.
  • Protection from infection by immune cells which, being very close to the skin surface, can be first to suffer damage by topical steroids. (See Blue arrow in Fig. 4.)
  • Maintenance of skin 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 resulting in dry, often cracked skin that is prone to infection. Ironically, topical steroids are often used for treating dry skin because it might assist recovery when in fact it does the opposite by drying the skin even more, predisposing it to crack formation and infection.

Fortunately, wheatgrass extract is a far safer and more effective way to treat these patients than using topical steroids. For example, this young child:

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-week 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.

Fig. 1. Topical steroid skin damage.  Note wrinkled, scaling. inflamed red skin.
Fig. 1. Topical steroid skin damage. Note wrinkled, scaling. inflamed red skin.
wheatgrass extract recovers infant's topical steroid damaged skin
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 absurd. Instead,  attempts should be made to wean them off these drugs as soon as possible.  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.

The majority of children outgrow eczema by the time they reach teenage. However, if they have been “treated” with TS, they can become so addicted that withdrawal flares develop soon after the steroids are stopped or reduced. It may be tempting then to recommend a stronger steroid, but this only aggravates and extends the period of suffering.

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

Wheatgrass eliminates Topical Steroid Withdrawal ("Red Skin Syndrome")

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

This young woman had suffered topical steroid damage from early childhood to her early 20’s. Then, regular wheatgrass extract application returned her skin to normal in ONE YEAR - a period of time that reflects how damaging topical steroids are to the skin.

Alternatively, had she gone “cold turkey” i.e. simply stopped using TS, it could have taken several years to overcome her addiction. This is a classic example of “Red skin syndrome” – just one of the negative effects of TS. It took a year of wheatgrass extract treatment to achieve recovery, but her determination to stop using the drugs and her courageous will and perseverance, worked well.

Adverse effects, like reddened skin, can occur soon after stopping or even reducing the topical steroid dose. The so-called “rebound” effect. Severe cases may sometimes require hospital admission for treatment of pain, septicemia (blood poisoning), depression and other complications.

Unfortunately, increasing numbers of elderly patients are seeking treatment for so-called “eczema” when in fact they are suffering from topical steroid addiction withdrawal. If the steroids are ceased, inevitably a flare will occur. Therefore it is advisable to reduce the dose gradually over several months.

You should also avoid using topical steroids for any type of skin condition.

Wheatgrass recovers topical steroid caused - "Elephant skin" & swollen limbs

This adult patient battled topical steroid withdrawal symptoms on and off for about 30 years. She then began applying wheatgrass extract over her inflamed skin areas. In this case, her elbows. Note the crinkled skin and how the ridges gradually reduce in size over a period of 2 months.

wheatgrass heals topical steroid damaged skin
30 years of regular topical steroid application has caused substantial damage to the skin’s structure – causing “elephant skin”. Considered "incurable”, it was restored by wheatgrass extract in 2 months.

In these two before and after photographs, the patient 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 applied wheatgrass extract regularly for several months, but the swelling persisted.

Then, her daughter persuaded her to stop ALL skin applications (moisturisers etc.) except the wheatgrass extract. About two weeks later, the gross swelling disappeared overnight, and she woke up the next morning in a very wet bed. Her skin then recovered completely and no longer required treatment. (View detailed account.)

TSW patients should if possible, avoid ANY kind of skin application other than wheatgrass extract. The skin may be dry, but that’s because topical steroids have thinned the skin so much that many of the tiny glands that keep the skin moist have been damaged or destroyed.

Wheatgrass extract can help overcome this problem.

immune cells in skin
In this cross section of the skin, note how close the immune cells are to the skin surface.

As the skin becomes eroded by topical steroids, it becomes open to infection and inflammation. Also, numerous pain and other receptors in the skin are laid bare which also causes pain, which can be severe. Because the skin's immune protection cells are close to the surface (See blue arrow -  Fig. 4 above), they are damaged by TS at an early stage. Continued use then essentially wipes out the skin's ability to protect the body from bacterial and other micro-organisms. Infection is very common and must be treated immediately it is detected. This is a good enough reason for a doctor to oversee the management of withdrawal effects and provide medical support e.g. for pain and infection. After all, TSW can sometimes be fatal, so best to take precautions.

Continued use of wheatgrass extract helps restore the structure and functionality of the skin's blood vessels, sweat glands, hair follicles, sebaceous glands etc. This will take time, sometimes 6 to 12 months, and considerable will power, depending on the degree of skin damage. Patience, courage and determination at this stage is essential, and in time, your skin will recover.

So, your aim should be to eliminate topical steroids from your life, and restore all skin functions. If you persevere, success can be achieved. TWICE WEEKLY APPLICATION OF WHEATGRASS EXTRACT IS SUFFICIENT. However, because the skin has been comprehensively damaged, it will take six to twelve months to return to normaL, so try to persevere.

Wheatgrass normally works well and is certainly more humane than going “cold turkey” - an often horrifying experience that should be avoided at all costs. Anyone who recommends this method must lack sympathy for these unfortunate sufferers. Wheatgrass is a far more humane way to solve the problem.

How to use wheatgrass extract for TSW

Although wheatgrass juice would most likely assist healing of TSW, I prefer to use my own extract (Dr Wheatgrass Skin Recovery Spray) which is derived from freshly cut wheatgrass sprouts, and is considerably more potent than freshly juiced wheatgrass.

1Topically (for the skin): Apply just a little Skin Recovery Spray over the worst affected areas onlyno more than twice a week. Say, Monday, Thursday - and persevere. Do not overtreat, not because it is dangerous, but because many years of experience have shown me that "less is the best approach."

Do not expect an overnight "cure", because the patient's skin, which is often severely damaged, must be restored to the point where it begins to heal visually. For severe topical steroid damage, this may take anything from two or three months to a year - but it will work if you persevere.

Try to be patient. Remember, damage has been done to a highly sensitive organ, your skin, which has multiple functions, all of which need to be recovered. All of them have to be restored to normal for the skin to return to normal .

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

Some additional advice:
Young children: Avoid soap and baths. They remove essential natural oil from the skin. Instead, wash with a warm, damp flannel.

Adults: Each day without TS is another 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.

If you require more information, please email me.

Some other treatment options

  • “COLD TURKEY” (i.e. Stop topical/oral steroids, sweat it out, and suffer immeasurably)
    This method, promoted by a popular non-medical website (for some inhumane reason), is by far the worst way of weaning a TSW sufferer off topical steroids. Mine is a much more humane approach. Withdrawal symptoms are frequently severe, so this process should never be attempted without qualified medical supervision.
  • GRADUAL REDUCTION OF TOPICAL STEROIDS This is another approach, but it requires regular monitoring and dosage review by a medical professional. I have used this method successfully many times in combination with wheatgrass. It can be very effective if the patient is able to persevere and use the wheatgrass extract.

POSTSCRIPT: Wheatgrass and other cereal grasses have been the subject of considerable clinical and laboratory research since the 1930’s.  It has been proven to be highly successful for the treatment of burns, injuries, skin pathology, and many other conditions.

Dr. Chris Reynolds.

>> View more cases of wheatgrass healing eczema and topical steroid skin damage

>> Return to Cases & Conditions

>> Read more about the dangers of TSW (Wikipedia)

Some other skin conditions that respond well to wheatgrass extract treatment: