Tag Archives: Steroids

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.

Lotions and Potions

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I came to conclude that I’ve grown dependent on steroids after numerous trials with alternative and natural treatments. Although some things have helped with the condition of my skin, no single treatment has resolved my itchy, hot, irritable skin. I’ve spent too much time and energy into researching for the causes of my curs’d skin, but I’m not yet ready to lay down my armour and accept that my life will be ruled by how my skin feels. For those who have skin issues, you know exactly what I mean. You feel like going for a bike ride? You can’t! Because — very predictably — you flush/sweat too easily, fall into an itching fit and must hasten home to a cold shower.

Below is a list and brief description of things I’ve tried to resolve my skin issues, which is what I now realize to be steroid-induced eczema. I gave most things a chance, as long as it made sense and was meant to resolve eczema. Although some things have helped (i.e. moisturizing with grape seed oil), the underlying symptoms of whatever-the-f&(% is going on with my skin was/is very present. Some of these things I continue to use as it minimizes any flare ups or keeps my skin in good condition, while some other things I no longer bother with as it wasn’t worth while (i.e. too much money and unsuccessful).

I moisturized incessantly with different types of oils.

I thought that if I brought moisture back into my skin, it would be happy and functioning. Dermatologists believe that eczematous skin does not function properly because the skin cells are not as “dense” as normally functioning skin (this has been called the Defective Skin Barrier Theory). As a result, moisture retention in eczematous skin is lesser than those who have normal skin. I thought, “If I could get my skin to act normally by adding more moisture, maybe…”

Neem oil, jojoba oil, emu oil, grape seed oil, almond oil, castor oil, sea buckthorn, oregano oil, coconut oil… All in 3-4 week rotations throughout the year to give each oil a chance to reap its benefits. While these all had their benefits and disadvantages, my skin was always thirsty for more. The redness, irritation, itching wouldn’t give out with all the loving I gave my skin. I’ve been using coconut, castor and grape seed oil for months now. I liked the emu oil, but have decided against it for ethical reasons. They kill emus for their oil.

Some people going through TSW complain of a metallic smell from their skin, which has been attributed to fungi growing on the skin, so using the coconut oil for its antifungal properties isn’t a bad idea. I use it for this reason. Castor oil is too thick and heavy, and would take ages for it to sink into the skin. I like the grape seed oil because it’s fairly lightweight and inexpensive. Jojoba oil is nice but over my budget. Coconut oil is also pretty expensive if you get the raw, unprocessed, extra virgin version, so I compensate by using it only on my face, neck, hands, basically exposed skin areas. I would like to give avocado oil a chance but have not found a bulk size that would make the purchase worth my money. I didn’t care for almond oil; it was sort of like grape seed but a tad bit heavier. Sea buckthorn is often sited for eczematous skin, but did not see a difference. I would argue that any slight benefits that it offers would be difficult to discern as skin going through TSW is too damaged to notice its benefits. I will probably go back to it if I need to in the future. For now, I’m happy using grape seed oil as my main emollient.

Gluten

I eliminated gluten, a common food allergy, from my diet. 

I removed gluten from my diet for 90 days (3 months) without success. When I re-introduced it into my diet again in December, I did not see a noticeable difference in my itching responses. The only things that made me itchier was some nightshade vegetables like eggplant and squash, as well as shellfish. I avoided these, but still continued to experience itching in and around my body. Despite my newfound allergens, there was a strong residual itch that could not addressed by eliminating those foods stated above. It was expensive but very healthy. When my income allows it, I would go back to this diet. I was desperate at the time and sacrificed some money in going gluten-free thinking it would help me. Eliminating gluten also allowed me to follow the anti-candida diet, which is often sited as a solution to eczema.

GI Tract

I followed the Leaky Gut and anti-Candidiasis protocol.

I also reduced sugars from my diet to eradicate Candida from my GI tract, which is believed to affect the skin because the GI tract houses 90% of the immune system. The thinking behind the eczema-candida connection is that the skin is the last organ to expel toxins from the body since it’s the outermost surface of the body. Candida overgrowth meant that there was excess faecal matter in my intestines, resulting in intoxication in the thick of my immune system.

Because sugars feed the bacteria which supports Candidiasis, I stopped eating fruits, glutonous breads, pasta, candy, all things sugar for 3 months without any apparent improvement or success. In following the anti-Candidiasis diet, I would also be addressing my leaky gut problem too. Leaky gut is a condition in the GI tract where the overgrowth of candida damages the intestines, making the gut hyper-permeable, thus allowing the toxins created by the candida to seep through the walls of the GI tract and contaminate the bloodstream. Because the body works to remove toxins from the host, toxins in the GI tract and bloodstream means that they will show up in the skin, or so the thinking goes.

Dander

 I reduced environmental allergens from my surroundings.

My real problems started when I started sleeping over my boyfriend’s place where cat dander also resided. My face developed these strange, itchy blisters where my face touched his pillow cases, but no asthma. After a few months, I finally clued in (doh!) I started using an anti-dander laundry detergent on everything I laid my skin on (bedsheets, curtains) as I was convinced that the cats living in my boyfriend’s building was effecting my skin reactions.

As a child, my asthma and skin flared around cats and dogs, so I deduced that it was the cats although they did not enter his room. We used an anti-dander solution in our shower soap, an allergy reducer spray by Febreeze. I saw improvement as I wasn’t getting blisters on my face anymore, but still felt unsatisfied, so I completely removed myself from that environment to see if it would make a difference. After weeks and weeks of not visiting his place, I saw no improvement and continued to experience itchy, hot, irritable skin.

Homeopathy

I went to a Naturopath who offered natural solutions. 

I am a strong believer in Naturopathy or at least its principle. Afterall, Western medicine a la steroids is the reason I’m where I am health-wise. I was given Unda 12, 17, 22 & 30, all to assist with my skin’s functioning. I took these for 2-3 months without seeing any marked improvement, while on steroids. I also saw another naturopath who gave me a number of supplements (probiotics, vitamin D, vitamin B, fish oils…). I saw some improvement here in my skin, but still continued to experience intense itching. I continue to use supplements such as fish oils, zinc, silicea, vitamin D, which are all good for the skin, which I can always use some help with.

Mild products

I used mild skin products meant for sensitive skin and avoided fragrance like the Plague. 

I’ve tried CeraVe, Cetaphil, Avene, Aveeno, and so many other brands, though my skin continued to  experience irritation. At times, I would feel stinging/burning sensations when I applied these things. This was especially apparent when I used Protopic (aka Elidel). I eventually stopped Protopic as I saw little to no improvement, and with the price tag on that stuff, it just wasn’t worth it ($93/ 50ml). I’m sure avoiding common irritants like fragrance and using mild product did good for me, but did not completely eliminate my issues. I continue to use mild products to avoid reactions, though I no longer experience sensitivity to them as I did when I was using Protopic. A few weeks ago, I had gotten a little too bold for my own good and went to Lush to grab an old favourite, the Angels on Bare Skin, which I used before my Clobestol days. Serves me right for overreaching. It stung like crazy.

Love life

Thoughts/Conclusion

As a moderately long-time steroid user, eliminating steroids/corticosteroids was the only thing I hadn’t tried. In 2012, I used Clobestol Propionate approximately 30-40 days cumulatively of 365. The diagnosis and pathology of Topical Steroid Addiction suits my experiences with my skin, and is very compelling. Every time I used a round of steroids, I saw an apparent improvement, but saw continued itching, hotness, irritability. I saw a noticeable overall decline in the health/condition of my skin (increased dryness, irritability, redness) soon after I started using Clobestol. Although it gave me anti-flammatory relief, it was temporary and often resulted in “angrier” skin after each use.

I am willing to further endure the symptoms of TSW. It will require a long time to see results, but the before and after photos of healed TSW veterans are profoundly promising. If Joey Brown or Kelly Palace (users of steroids for 30-40+ years) can heal, there is something definite to what Dr. Rapaport is reporting in his medical literature and teleconferences. There are a dozen red-winners (red-skinners / red-winners… haha, get it!?) on ITSAN who show a profound improvement in their skin. This evidence is under-publicized and should be further investigated – but not if the pharms can help it. Dr. Rapaport’s 2,000 healed TSW patients and ITSAN success stories, as well as my skin’s matching pathology to Topical Steroid Addiction (TSA) is strong evidence and worth my while. After several months of researching and trials, TSW just makes sense. If 1… 1 1/2… 2 years from now, I am right where I left off, I’ll let you know. Otherwise, I’ll be living life and loving it. Now that’s a thought I can live with! The song below is by Tegan and Sara, whom I’ve been following for a long time now. Their new song, “Drove Me Wild” begins with the lyrics, “When I think of you, I think of your skin golden brown from the sun.” This brings ideas of fun, comfortable days on the beach – something I look forward to.

History + First Month of TSW

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I am so tired today and not sure why ’cause I slept a good 9 hours. I wonder if it’s the stress. I’ve had days where I feel optimistic, then I’ll take a bath and I go scratch-crazy and feel like my world is upside down. My brain feels foggy and I’ve been wanting to write a solid blog post, but I feel like I could fall asleep right this very second if my head just rested more horizontally on this pillow…

So I’ll give you a bit of history of my eczema slash steroid past, in an effort to keep myself awake and do what I made myself to do today. I’ve had eczema for quite some time now – since I age 6. Nothing serious by any means. My mom kept a small tube of hydrocortisone in the cupboard that she’d take out every once in a while. I had and still have environmental allergies at the time (cats, dust, pollen) but was too young to remember if my flareups were connected to those allergens. Either way, my skin really didn’t bother me at all when I was very young. As a teenager, my legs and arms suffered from intense scratching during the humid summers.. My eyelids we red and itchy and used mild TS (topical steroid), but it never really made it better.

By age 17, I was introduced to Clobestol, the most potent TS, by a random Vietnamese lady who ran a salon in her basement when she noticed some rashes on my arm while she was doing a facial on me. She showed it to me like it was the answer to all my itching, rashy issues, and told me that doctors are very hesitant to give it to patients because it is very strong, but it has made her friend’s daughter’s someone’s eczema disappear “forever.” It seemed simple and I took it. No questions asked.

I used the Clobestol sparingly off and on. I used it on my neck, eyelids, arms for weeks at a time. It made it go away, but only temporarily and it would always recur soon again. I figured that this was just the nature of eczema and there was nothing I could do about it.

Fast forward to 3 years ago (age 23) when I started sleeping over my boyfriend’s house where the combination of carpet and 2 cats awaited me. I didn’t clue in at first that I was actually reacting to my new environment when my body was itchy and my face was covered in these strange blistery things. I soon realized that the only thing that had changed was sleeping over his place. My diet was still the same. Stress was non-existant.

So I started using steroids and Protopic on my face to make the yucky rashes disappear. By the summer, the itching was uncontrollable and my body was covered in rashes and bruising. Since then, I’ve been using Clobestol off and on over the last 3 years. I noticed my skin going from very oily to very dry. I hated it at the time, but I truly miss my oily days. It’s comforting to think that I could even produce enough oil that blotting was an absolute necessity every half hour. I was so oily, your mom could fry your breakfast on my face.

Nevermind the zits the would ensue. I would take oily skin over dry any day. By last winter – 2 years into Clobestol use — I had been the driest yet and extremely sensitive, especially on my face and above my lip.

My decision to undergo steroid withdrawal is based on the lack of success with steroids. November 2012 – I YouTube’d “Face Eczema” and watched this video: http://www.youtube.com/watch?v=dfIz8ZBqg5o. I was going through what she was going through. Like her, going to my minimum wage retail job was difficult with an oozing, red face. I read comments about Red Skin Syndrome, although I didn’t take it seriously. I went on another round of Clobestol for 2.5 weeks before rethinking steroids. My skin cleared but was still extremely itchy, so as soon as I got off it, it was worse then ever. It was everywhere, everywhere and spread to new places.

I remembered what I read about Red Skin Syndrome and researched more about it. Everything started making sense to me – what I’ve been going through. The photos of withdrawal from steroid addiction sent tears down my eyes. The more and more I read, I realized that I’ve been going through withdrawal off and on for the last 3 years. The symptoms of withdrawal were very familiar – dry, flakey, deeply itching skin, hair loss, oozing.

My first month (January 2013) of complete withdrawal was hell. The itch in my body was insatiable. I scratched until I bled and it didn’t matter. Going to work was extremely difficult. My neck and face was oozing (and still is) so I kept my distance from co-workers. I could feel my body shivering ever so slightly and was always cold. I made sure I had clean turtlenecks to wear everyday. I used my mini breaks to moisturize my face although I knew my face would shrivel up an hour after. My skin was brittle. Soaking in water was painful. Moving was painful. I saw hair tangled around my fingers every time I’d wash. I wanted to lay in bed under a cover. Every moment hurt and thoughts of suicide were insistent.

Looking back, my skin was in a half decent before my first allergy flare at my boyfriend’s house 3 years ago. In fact, just before I met him, my eczema was a faded memory. No doubt I have skin allergies, but the true nature of my eczema can no longer be accurately measured since the side effects of steroids has tainted its original state. Plus, if this medication is meant to help me, then why have things only gone downhill since I started using it? Over the last year, I’ve tried to stop using TS but I always went back to it because things got worse after getting off it. Sometimes they say, “Things will get worse before they get better.” With steroids, it’s been more like, “Things get better-ish, then get worse.”