Tag Archives: alternative treatment

Night Itchies and Cortisol Levels

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The itching that inevitably comes with Steroid Withdrawal seems to amplify at nighttime is a regular visitor, although unwelcomed! It was much worse in the earlier months, but is still very present in my 5th month. The itchiest spots are the folds of my arms, wrists, neck, inner calves & inner thighs, ears and jawline. These are also my worst, most damaged areas. The itchiness was so intense before, like down-to-the-bone deep down itching. I’m not sure if the term “itching” gives the horror of the experience justice. The only thing I could do was scratch to give myself some relief. I attempted to push through the itching and not scratch for a few minutes in hopes it would pass. I couldn’t do it for more than 3 minutes — and this took all the will power I could muster. I’m entirely grateful those days are gone.

The itch at present is still pretty bothersome. It’s been getting worse as the warmer days of summer are coming. I have been using 3/4 sleeves and light scarves to mask my skin. I guess the good news is I think that I think things are looking better than they do. I’ve left the house with short sleeves thinking it’s no biggie and then realize how ragged it really looks when I’m out and about. I also get itchies when I’m stressed out, so keeping myself in check with deep breaths helps me regain control. I try to keep the itching at a minimum at night in a couple different ways. 

Dr. Rapaport has attributed the night time itch to lowering cortisol levels. In general, cortisol levels are at its peak around 9am and is at its lowest at midnight. This change throughout the day and night is caused by the amount of sunlight our bodies are receiving — aka circadian patterns. Here’s a chart showing this:

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Cortisol levels are highest during the daytime when our bodies are synhesizing UV rays for its production

The actual episodic bursts throughout the day correlate to our eating patterns (amongst other things). Levels increase soon after we’ve eaten, so snacking throughout the day is also a good idea. 

I also use something called Licorice Root. it’s a herb that prolongs the half-life of cortisol — or in simpler terms, keeps up your cortisol levels up. A naturally-occuring chemical found in Licorice Root called glycyrrhizic acid that prevents the breakdown of cortisol, which is done through enzymes (don’t ask me what kind of enzymes!). I’ve tried Licorice in tea form, pill form and tincture form. Pill form is the easiest – just pop ’em in and go. I don’t enjoy the taste of licorice so tea is a slow and painful way of getting it, although you can blend it with another herbal tea. Tincture is probably the best way to digest it, as tinctures are the most readily processed way to consume herbs for medicinal use. It has more “bio-availability.” I take LR throughout the evening. I start as early as 4:00pm and as late as 6:00pm depending on how I’ve been snacking and how bright it’s been outside (and well how mindful I am). 

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Licorice Root helps to keep up cortisol levels at night

Rapaport recommends antihistamines, particularly Atarax, to reduce itching and help with sleep. I personally use Benedryl, which didn’t work until month 4. Before that, I’d take it (more than the recommended dose) and I’d feel drowsy, but still too itchy to settle into bed.  Often I’d be up for 35 hours at a time. Those were the most bleak of times. I wasn’t sure how i was going to get through it. Now, I can manage sleeping at regular hours, but only with antihistamines. I’ve gone without a couple times and it was a total fail. The itch kept me up for most of the night. So for now, I will continue to use Benedryl alongside Licorice Root and regular snacking throughout the day (no problems with that!).

Even though I take Licorice Root, to say that I don’t itch at all would be false. Much of the itching happens when I get a deep nerve itch and I tend to it. Tending to it (ie. scratching) and applying pressure to the skin to relieve it produces a reaction in your body creating histamine and causing further itch.  However, I have noticed an overall pattern of more intense nerve itching when I’ve forgotten to take LR. 

Happy healing and less itchy days! xo.

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A Little Rant and Literature

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I think that it’s important that anyone using corticosteroids know about the possibility of addiction, especially since it’s likely that their doctors know about the influence on the HPA axis (Hypothalamic–Pituitary–Adrenal axis — pretty much your adrenal glands which produce your body’s natural corticosteroids), though not its extent of influence.

But first – a rant. From the stories I’ve read from ITSAN members, it’s unfortunate how complacent so many derms and MDs are with the the medical knowledge they attained in school insofar that they’re willing to turn down medical literature written by other doctors offered by patients in their practises. This is where I get aggravated…

The fact is that doctors are people too, so I can understand why someone would be hesitant to read medical literature that has not yet been widely accepted. The ironic thing is that it takes individual doctors to create awareness, so who’s waiting for who? There’s also the issue of pharmaceutical sway on doctors.

There’s enough people who say that it’s illegal for doctors to accept payment from drug companies for prescribing their product, but where there’s loopholes, there’s advantages. Dr. Irene Abramovich in West Hartford, CT was paid large amounts of money by Janssen Pharmaceuticals to speak on their behalf. $47,000 in 2010 for “speaking and travel.” Abramovich was also the state’s top prescriber of Invega in 2010 and 2011, and in the top five for Zyprexa in 2008 and 2009. See: http://www.articles.courant.com/2012-07-30/health/hc-doctor-prescribers-20120730_1_second-highest-prescriber-top-medicaid-prescribers-pharmaceutical-companies

Oh, but she’s a psychiatrist right? What else is she going to do? She’s just doing her job, you say? Get out of here and don’t talk to me… Here’s some lit I found on steroid addiction. Read and evaluate for yourself.

Adrenal Suppression From Topical Corticosteroids Surprisingly High

By By Alicia Ault. Reviewed by Zalman S. Agus, MD. I think what’s most interesting about this article is that the panelists of this meeting looked at honest, raw data of side effects from studies done and made judgements based on that information, rather than generalizations of its benefits.

Topical corticosteroid addiction may be to blame when ‘rash’ defies treatment

By Paula Moyers. This article is interesting as it describes how my eczema has progressed to a tee with the use of steroids. I was on a mild steroid since age 6 (26 now) and started more serious dosages about 7 years ago. The most dramatic change happened 3 years ago when I was using it to control allergic skin reactions to cat dander.

Eyelid Dermatitis to Red Face Syndrome to Cure – Clinical experiences in 100 cases

By Dr. Marvin Rapaport. Luckily I still have access to Western University’s journal database, so I was able to get a hold of Dr. Rapaport’s article on the relationship between perioral and facial eczema and steroid use. Hopefully, I don’t get slaughtered for sharing Rapaport’s academic work freely. Dr. Rapaport is not the greedy type who writes scripts of an extra buck anyway (I wouldn’t be here if he was!).

Rebound Vasodilation From Long-Term Corticosteroid Use

By Dr. Marvin Rapaport. This is a short one going over how steroids affect the nerve endings, thus how and why we itch so badly after coming off steroids. This “rebound” is a symptom of withdrawal from steroids.

Corticosteroid Addiction and Withdrawal in the Atopic

By Dr. Marvin Rapaport. This goes over how steroid addiction and withdrawal progresses over time. The great news here is that we may be able to have near-normal skin (and life!) once our bodies have expelled the steroids completely out of our system. Before I started Clobestol, my skin was 95% normal, barely flaring or itching.

Serum Nitric Oxide Levels in Red Patients

Another one by Dr. Marvin Rapaport. He distinguishes between true eczema patients and steroid-induced eczema patients by looking at nitric oxide levels in individuals. Very interesting as he’s able to quantify what true eczema looks like.