Eczema: How to overcome topical steroid withdrawal / red skin syndrome

by Dr. Chris Reynolds

Introduction

“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. (Patient) Australia

Does that sound like a professional response?

Well, it seems that since the 1950’s, when topical steroids were first introduced, many doctors, including some dermatologists, have denied that topical steroids can damage and thin the skin, or that the often terrifying withdrawal symptoms – so-called “red skin syndrome” – is due to eczema, NOT TO TOPICAL STEROID WITHDRAWAL.

“It’s just your eczema playing up again. Let’s try something a little stronger.”

Hmm.

Topical steroid induced skin atrophy in an infant.
Topical steroid induced skin atrophy (thinning) in an infant.

How many patients have been told that ALL their symptoms are due to “eczema” and have little or nothing to do with topical steroids (TS). In other words, if there’s cracking or weeping of the skin, pain, infection etc. it’s okay to keep applying steroids.

“If it doesn’t settle down, we’ll use a stronger, (more powerful) drug to keep the “eczema” under control. We can even use immune-suppressant drugs to stop your symptoms.”

For example, cyclosporin and tacrolimus (which should be avoided at all costs) and other potent drugs that suppress the body’s immune system, robbing it’s ability to prevent infection, sometimes severely, and causing atrophy, (thinning of the skin) and compromise its ability to protect us from infection. In fact, many of these patients can suffer life-threatening septicemia (blood poisoning) and other withdrawal symptoms.

As most eczema sufferers outgrow the condition by the time they’re 20, how is it that so many nasty symptoms can persist, even into old age? 

Clearly, the skin damage is caused by topical steroids, not eczema.

Unfortunately, continued use of TS frequently leads to addiction which can last a lifetime even though “eczema” may have disappeared many years earlier. Fortunately, by using a wheatgrass extract, it has been possible to restore the skin to normal. It is invariably hard work and can take a year or more to win the battle, but many have succeeded. If the patient can tolerate the mental and physical stresses of withdrawal, the skin will eventually recover, the symptoms will cease and the patient will enjoy quality of life . 

Wheatgrass can assist this process considerably.

infantile eczema eliminated by wheatgrass extract
3 weeks later after once daily application of wheatgrass extract and no topical steroids. The damaged skin has almost fully recovered as have all other eczema rashes on the child’s body.

(View some examples)

Without doubt, TS revolutionised the treatment of eczema and eased much suffering – but there was a catch – atrophy (thinning of the skin with subsequent damage to the skin’s structure and function), and, worst of all, topical steroid addiction.

Our skin is an extremely complex protective organ with many important functions.

For instance it protects us from the onslaught of numerous microrganisms, (bacteria etc.) from injuries, the sun, wind and sea, and helps keep us warm. However, if you apply a topical steroid to the skin, even for a relatively short period of time, (days to weeks) thinning of the skin occurs and seriously interferes with it’s  protective functions.

For instance, damage to the ‘microcirculation’. Numerous tiny blood vessels and nerves control delivery of essential nutrients and oxyygen to skin cells and, when the skin is thinned or atrophied by topical steroids, these functions can be seriously compromised. The longer they are applied, the greater the damage and the longer it will take for the skin to recover if the topical steroids are ceased.

When they are stopped, rebound flares are inevitable. Also, pain-sensing nerve endings (nociceptors) that are confined mainly to the upper layers of the skin are exposed often causing severe, erratic and unpreditable pain. 

Other major “injury” is the destruction and/or damage to “front line” 
immune cells in the upper layer of the skin. These are very important “sentinels” that help protect the body from infection.  Without them, bacteria and other microorganisms expose the patient to infection which can severely worsen the patient’s condition requiring hospitalisation. 

So, the patient has but two choices: 

1. Go ‘cold turkey’ by ceasing use of TS, or,
2. C
ontinue using TS but suffer the consequences – often for many years. 

The first option could take 3 to 5 years for the skin to recover, but the withdrawal symptoms are often severe. The second option worsens the condition of the skin and only makes the first option more difficult and aggravates TS withdrawal suffering. 

The Body’s Immune System Is Also Damaged

That’s right. It’s not just the skin that is affected. There is a “whole body” or “systemic”effect as well, because TS penetrate the skin and find their way into the blood stream. This in turn compromises the patient’s “whole body” immune status which then reduces one’s ability to recover from TS damage. Even if the skin recovers, sudden eruptions such as burning pain, weeping skin, constant itching, scratching, dryness, recurrent bacterial infections, patchy discoloration, disfigurement, cracking and tightening of the skin etc. can continue for several years due not only to direct damage  but also by an unstable immune system. Urgent hospital admission for treatment of blood-poisoning with intravenous antibiotics is not uncommon and the severe stress involved and unsightliness of one’s skin can lead to adverse psychological effects such as depression.  View this article for more information.

In many cases, rebound “flares” come to control the patient’s life who is often considered as being “steroid-addicted”. To me, this is unfair, as it lays the blame on the patient for following doctors’orders. Perhaps therefore, we should ask why these drugs were prescribed in the first place. After all, topical steroids are standard drugs for the treatment of eczema, both infantile and adult. (For infantile eczema I recommend wheatgrass extract INSTEAD of TS without hesitation, simply because it almost always works and rids most children of eczema flares.) (See how wheatgrass can control infantile eczema without resorting to TS)

How wheatgrass can help you through topical steroid withdrawal

Wheatgrass and other cereal grasses have been the subject of extensive clinical and laboratory research since the 1930’s in the US and elsewhere. It has been proven highly successful for the treatment of burns, injuries, skin pathology, including TSW, and many other conditions.

The wheatgrass extract I recommend and use in clinical practice has worked well for numerous TSW patients since I began using it in 1995. It is derived from young wheatgrass sprouts at the stage of maximum therapeutical activity. These sprouts can easily be grown and juiced at home.

How does the extract help with TSW? I am not sure, but it seems the bioactives in wheatgrass, which are known to be potent healing agents e.g. for wounds, burns, psoriasis etc. in some way “notify” the brain of the TS damaged skin. The brain (central nervous system) then does what it can to effect repair. However, in TSW skin damage is virtually always severe, so it can take a year or more for recovery to occur.

Here are some examples demonstrating how quickly wheatgrass can heal damaged skin most likely by the process I’ve just described: 

However, it is important to know that although wheatgrass can help one through TSW by reducing pain, burning and itching to some extent, its most important function is to stimulate new growth of skin cells and repair the skin’s structure and functionality. But, with perseverance and applying a little wheatgrass extract once on alternate days your damaged skin will eventually recover more quickly than going ‘cold turkey’. In most of my cases it has taken about 12 to 24 months, but it can be done.

These pictures of a patient’s elbow will give you some idea as to how effectively wheatgrass can heal TS-damaged skin. The patient, who had been using TS for 30 years developed severe ‘elephant skin’ – a common “side effect” of TSW caused by damage to the skin’s structure. The skin has become lax, with large, flaccid “folds” developing.

In this case, her skin returned almost to normal in two months.

So, if wheatgrass can achieve this level of skin repair, there is no reason why it can’t repair ALL TSW damage. It is a difficult challenge that can be won. So try to persevere.

But wheatgrass is not a ‘quick fix’. It takes time – usually about 12 to 18 months – sometimes longer – for new skin to develop.  But that’s considerably better than the 4 to 5 years many patients are encouraged to endure by stopping all medications and going so-called ‘cold turkey’. With wheatgrass, even so-called “irreversible damage” can be repaired which is not the case if topical steroids are simply stopped altogether – a so-called “treatment method” often advised by some amateur therapists and medical professionals.

Somehow, the patient is expected to be “courageous” enough to survive an ordeal that would test the endurance of even the toughest. Indeed, because the skin structure and function has not been restored, ‘cold turkey’ patients may be left with permanently thinned and dysfunctional skin caused by topical steroids.

How to eliminate eczema & overcome topical steroid withdrawal

Infantile Eczema

My advice to parents of eczema-affected children is to avoid the use of topical steroids if at all possible. If the rash isn’t too bad and the child is not bothered by it, don’t apply anything. The child’s skin may not look 100 percent, but that won’t bother your child.

Also, avoid soap, baths (use a damp flannel for washing), and any other skin applications as they could irritate the skin. If you must “treat” your child, try to find an alternative, non-steroidal, natural remedy instead. My wheatgrass product – Skin Recovery Spray – works well for most cases of infantile eczema, but only apply a little on ALTERNATE days. Contrary to most other remedies, less is best with wheatgrass.

You can also use wheatgrass juice or grow your own wheatgrass and juice it in a blender. It will keep for weeks in the refrigerator. Many websites show how to do this.

Adult “eczema”/topical steroid withdrawal

As with infantile eczema, the aim is to stimulate skin cell growth and repair and subsequent recovery. The whole point of using wheatgrass is to ensure that by the time you have overcome withdrawal, that your (or your child’s) skin has completely recovered. This can take 12 months or more, (less in children) but it pays to be patient so you can get your life back.

Alternatively, you could locate a doctor to help you gradually reduce the amount of TS you’re applying to your skin. I have used this method successfully many times. However, this is not easy due to rebound flares, which may even require support from oral steroids from time to time, but if you reduce the dose gradually, it can work well.

Keep a diary

Keeping a record of your treatment enables you to follow your progress and keep your doctor informed. In the early stages it can be difficult to reduce even one application of TS, but if you persevere, you will eventually only need wheatgrass to keep your (or your child’s) skin, stable.

The ultimate aim should be to dispense with wheatgrass altogether. Also, if you’re still using TS, (hopefully only from time to time) use very small amounts and apply only to the most painful areas. Remember, every time you apply TS to the skin, it’s a backward step. Eventually, if you persevere, you can stop them altogether.

At the end of the day, it will be your courage that will pull you through. You may go through hell and back, but each day without TS helps your skin towards recovery. Try to look forward to the day when you are TOTALLY TS-FREE! Mark your calendar for 12 months and tick off the days. You may not be fully recovered by then, but you will be well on the way. You’ll know it and will feel proud of yourself for having persevered.

Try not to use any applications on your TS-affected skin other than wheatgrass and a damp sponge or towel. Because your skin’s immune status has been highly compromised it will be sensitised to almost ANY kind of application. e.g. soap, which removes the natural oils that help keep your skin moist, oils, cosmetics, shampoo – everything if possible except water.

Also, reduce hot water exposure, because it dries your skin by washing off sebum, the natural oily moisturiser essential for normal skin function.

5 minute showers and NO BATHS is my rule. (View this example)

Finally, you can contact me if you need assistance.

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