Update: Month 8

Hi Boys and Girls!

Another month down. Just to clarify, I am done with month 8 and into my ninth month of withdrawal. I went off Clobestol Propionate completely sometime mid-December 2012… not sure what day exactly. So I’ve said January 1st to simplify things. Technically I could be at 9.5 months!

August has been an interesting month. There has been major markers of improvement and feel lucky to have gone through only moderate withdrawal symptoms. I continue to visit the sunbed every 2-10 days for 2 minutes at a time. Yes, I’ve been inconsistent and have seen a positive relationship between improved skin condition and sun therapy. The 10 days I went without it, my perioral area worsened — more sensitivity to allergens, sweat, kisses, etc. Every 5 days seemed to be a happy compromise between my self that wants to avoid tanning at all costs, and my other self that wants to keep my mouth area looking normal.  Otherwise, if things were rashy, I would go more often though for a shorter time.

Anyway, I’ll start with the cons…

Downs:

The biggest downer was my perioral area regressed in the last couple of days of August. It acted up after giving Dexter (my Beagle) a bath. Raised bumpy red rashes and little oozing and crusting. Taking salty baths and getting “sun” has helped only some, though I’m thinking that it will be better in a 1-2 months time.

Scratching. Healing is progressing slowly, but surely. Not many open wounds this last month. I’ve avoided using my hands to scratch, which seems to be less damaging. Instead I use flat surface objects which seems to be moderately better because using my nails seems to break skin open quickly. This advice may seem… irresponsible. I should be telling you to not scratch at all throughout withdrawal, but I have accepted that scratching is inevitable. It gets me through the morning, afternoon, night.

The deep wrinkles and linchification from scratching in the early stages of topical steroid withdrawal are still very visible. And upset me time to time, but it is was it is.  Itching has evolved into a burning and shock-y sensation. Fellow TSW-ers have talked about a burning sensation that was alien to me until now. The only way I can describe it is… it feels like a large area of nerves are excited and feels like a fiery sensation. It hasn’t been very intense at all, but worries me because I’m only experiencing it later into my withdrawal (while others have it much earlier on). It makes me think that the infamous 2nd flare is around the corner.

Hair loss isn’t as bad anymore. I lose hair at a normal rate and my bald spots continue to fill in and grow with baby hairs. It’s crazy to think back to 3 years ago when I was losing hair in bunches when I was unknowingly going through withdrawal (and consequently, going back to steroids).

Ups:

No more antihistamines! Though I continue to struggle with scratching, the itching has decreased by a significant factor. On a scale from 1-10, itching was about 6/10 in August. (Month 2 and 3 was at 10/10 intensity, Month 4 – 8/10, Month 6 – 7/10) I was able to taper off antihistamines until stopping them completely. So I am no longer dependent on Benedryl to fall asleep at night. That’s right!!!! This is the biggest feat this month – hands down.

Taking antihistamines every night was troubling me as I read an article about antihistamines (and similar other drugs) having a negative affect on cognitive functioning over long periods of use.  I was using up to 3 Benedryls and reduced to down to 2.5, then 2.0, then 1.5, then 0.5 from the beginning of my withdrawal. Though in Feb and March, no number of Benedryls helped me fall asleep or lessened the intensity of itching, so I wasn’t bothering with Benedryl back then. I continue to take Licorice Root pills to alleviate the itching at night, which generally reduces my itching noticeably.

Healing on the outside. Despite the sluggish pace of progress that is accompanied by topical steroid withdrawal, I have noticed improvement in my worst problem areas (eg. neck, wrists, stomach, arms). Things are smoothing out some and are looking better than a couple months ago. Comparing my skin to how it was 2-3 months ago makes my outlook on withdrawal seem hopeful.

I avoid potentially unsafe situations like laying on the sand or swimming at the beach where my broken skin would parent an unwanted skin infection. Also, I only use stand-up sunbeds since there is no direct skin contact with the bed. This may seem overly vigilant for a heedless spirit, but it’s not worth the risk. A friend of mine – happy & healthy, no steroid addiction – contracted a skin infection whilst in a horizontal, laydown sunbed. Being more vulnerable to infection, I don’t get into trouble.

As an aside, scratching has become a guilty pleasure. I physically feel better after a good scratch. Somehow more relaxed. Speaking of which… For the last month now, I’ve been able to to have a glass of wine without going into a flare-up. I last tested this in May with no success. I poured a glass — perhaps with foolish bravado — and regretted it deeply. But August has been good to me, so I’ve been enjoying a little bit of wine throughout the month.

Overall:

Slight regression in perioral area after handling Dexter in the bathtub. Itching  is reducing, though experiencing increasing burning and shock-y itch sensations. No longer using antihistamines is a wicked milestone to reach. I was thinking about it for a long time and finally felt ready to do it despite the incessant nightly itching. This new level of healing really tells me that my body is moving forward and repairing itself. I definitely still have many months of healing ahead of me, but hopefully have already seen the worst of it behind me. I’m not sure if I’m prepared to deal with the infamous 2nd flare if it is to happen. But if it would follow a lifetime of health, I’m ok with that.

Lotions and Potions

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.

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.

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.

 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.

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.

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.

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.

Pre-TSW + Month 2 Symptoms

 

Oozing – Many TSW patients have areas around their body that ooze fluids, often appearing yellow and hardening to a yellow crust. Dr. Rapaport describes this as the excess plasma expelling from the body, formed during the accumulation of steroid build-up and is a part of detoxifying process from steroids. I have oozing above and below my mouth area, around my ears, in my ears and parts of my neck. Oozing occurs where my skin is raw and thickened. The area around my mouth where the oozing occurs was diagnosed with a non-resistant staph aureus infection and was prescribed numerous antibiotics over 8 months, including Bactroban which is a very potent antibiotic. This lack of success with antibiotics for a non-resistant staph tells me that what I’m dealing with is not staph. I treat this by using my home-made astringent made of witch hazel, apple cider vinegar and tea tree oil – 7 parts witch hazel, 2.9 parts ACV, 0.1 parts tea tree oil. If I don’t use the astringent regularly, the ooze returns.

I’ve come to the conclusion that the oozing is plasma rather than staph for a few reasons:

1 – The oozing is very localized and has not infected other parts of my face when I accidentally touched the ooze and other parts of my open-sore body consequently without sanitizing my hands in between.

2 -I saw no sustained improvement with the use of antibiotics meant to eradicate staph infection. If there’s one thing I learned from House, the health issue can be determined with the correct or incorrect medication.

3 – Dr. Rapaport’s professional opinion that plasma will appear and be diagnosed as staph by a doctor as the diagnostic method cannot distinguish between plasma and staph. This is probably because staph is a naturally occurring bacteria that lives on the skin.

4 – I don’t experience itching from the ooze, which is common with a staph infection.

Although I officially begun TSW this January 2013, I’ve been oozing off and on for the last year. I believe that this is the case because I’ve been intermittently withdrawing during my non-use of steroids. It always got a bit better during use, but went downhill soon after.

I experience oozing very mildly relative to other TSW’ers. Some have to wrap a cloth around their neck overnight to soak up the ooze. I’ve read that some ooze so uncontrollably that you can smell it and must keep towels/cloths around them at all times to keep clean. This is the case for very long-term TS users.

Irregular Body Temperature – I experience this sometimes. It’s difficult to predict when it will happen. If it’s on the warm side, I will heat up very rapidly. The reverse is true aswell; if it’s a touch too cool, I feel too cold. I’ve read about more extreme experiences from others, like they get so cold that they have to layer multiple blankets to warm up. Irregular body temperature is most noticeable at bedtime. A blanket warms me up too much and makes me sweat; no blanket leaves me uncomfortably chilly. This can keep me up all night.

Many TSW sufferers experience phases of coldness and sweating. This has to do with the adrenal glands recalibrating itself, or re-learning how to produce cortisol. Remember that applying topical steroids leads to a dependency of the high levels of cortisol seeping into your bloodstream. Because the body is receiving cortisol without the effort of its own self-sufficient production, it becomes lazy and forgets how to produce its own cortisol. Kind of like when you mom do the laundry for you; you don’t bother checking if there’s any dirty laundry or not because you assume she’ll do it for you. When you’ve withdrawn from topical steroids, your adrenals go into shock because it has forgotten how to produce its own cortisol. Because the adrenals are so closely linked to body temperature, our bodies are also re-learning how to regulate body temperature.

Flaking – I experience flaking all over my body – face, arms, back, scalp… It occurs when I’ve scratched, except on my scalp where it flakes on its own. I need to exfoliate these flakes in the bath/shower regularly. Otherwise I get itchy as it feels like my skin can’t breathe well. Many complain about flakes “flying around” them on a regular basis, which isn’t the case for me. The flakes come off either in the bath with a terry cloth or when I’m scratching. They’re not flat but more round and gritty. Seeing and feeling these buggers on the bed or elsewhere is distressing and makes me feel icky about my skin.

After exfoliating, the skin underneath is pretty soft and ready to absorb moisturizer. My issue is that moisturizer takes FOREVER to sink into my skin. I stand around in front of a fan for as long as it takes (30-40 min) to soothe my skin after moisturizing and assist the skin in absorbing, while messaging it all in. Flaking is a result of the extreme dryness that we TSW’ers experience. I like to think of it as a facial peel. Every time we peel, there’s new skin awaiting underneath. See “Dryness” below.

Swelling – Current swelling is minimal, mostly in and around knees. My face (i.e. cheeks) were swelled up the latter part of 2012 and long before. One side of my face was more swollen than the other, which has swelled down since then. Remember I’ve been using potent TS for the last few years intermittently, which means I would’ve undergone withdrawal symptoms during times of non-use. I think that this is the most interesting point about steroid-induced eczema: we are constantly but intermittently going through withdrawal in between the times we were/are using steroids. Just because we didn’t have a clue or aren’t in a total conscientious withdrawal, doesn’t mean we don’t withdraw during these short periods of time. I perceived these times as just plain ol’ eczema. There’s no reason that we wouldn’t be withdrawing during these times. If we’re following the prescribed 1-2 weeks of steroids per month, then we’re most definitely withdrawing the other 3-4 weeks we’re not using it. The swelling is from the inflammation, as well as the build up of plasma.

Intense Itching – Month 1 of withdrawal, I experienced to-the-bone itching. I couldn’t help myself but scratch to the point of bruising my body and seeing blood.  I’m nearing the end of month 2 and the itching has since improved. It’s more superficial, on the surface and happens at any time. It’s itchy when I’m moisturized, when I’m in the bath, when I’m drier. I experience what TSW’ers call “Pins ‘n Needles” itching where the itches are a sharp and short sensation. I sometimes jump when these shocking sensations happen. The itching is said to be the blood vessels healing and expelling the TS. This is my worst symptom because itching drives me absolutely bonkers. I easily lose focus and frankly I itch almost all the time, so you can imagine having a conversation with someone who’s only half listening… or a quarter listening.

Linchification – Meaning “thickening of the skin.” This seems to occur where the skin has experienced the most rubbing and scratching. For me, I have it on several areas. I have it on my abdomen right above my groin where my jeans rub against the skin. I also have it on my inner biceps right by my armpits; on my jawline; and on my wrists. The thickened skin on my jawline also oozes. Last month, all these areas had a hard, shiny and smooth appearance, like plastic. Pretty off-putting but hey. Linchification also means deep fissures in the skin, which looks like deep valleys in the natural landscape of the skin. The fissures occur where there the skin naturally folds, such as behind the elbows or folds where you have rolls on the stomach – sexy! I also get them in places where there aren’t any natural folds, like above the groin and below the abs.

Even counting sheep got tiring for the sheep, lol

Difficulty Sleeping – See all other symptoms. They will keep you up! My sleeping patterns are all over the place. Sometimes I’m able to sleep throughout the night, although most nights I have a hard time trying to get comfortable. I’m either too warm or too cold. My skin is too wet from moisturizing or too dry from not moisturizing enough. I’m too itchy, too fidgety. Too on the edge. As a result, my sleep is very broken, waking up every couple hours. Taking antihistamines seems to be a necessity despite my efforts to avoid them. I seem to sleep better at my boyfriend’s and I think this has to do with my psychological state at home in my own bed where my thoughts are darkest. My room is very cluttered, messy and disorganized. Somehow improving your room with lighting or colour or de-cluttering might help you calm down.

Dry as a desert

Dryness – This might be an obvious one, but it has to be said because it is a huge part of TSW. My skin is extremely dry. It hurts often, especially when turning or moving around. I can really feel the skin struggling to stretch when I move about. It’s a very strange feeling and probably makes me feel the most out-of-touch with my skin because the dryness makes it feel like non-skin, and more like there’s something just sitting on top of my body to protect it. Ew. The worst part is my neck because it feels uncomfortable whenever I turn my head.

According to Dr. Rapaport, the dryness is caused by the dysfunction of the adrenal glands. Apparently, the adrenals are responsible for a whole lot of things! Again, the hypo-cortisol state is responsible for the dysfunction of basic things in our bodies. The adrenals are responsible for manufacturing oil through our sebaceous glands in our pores. Hey Adrenals, get moving already!

Jesse from Full House

Hair Loss – This seems to be a common symptom of TSW. Like some of my other symptoms, I’ve been experiencing this one over the course of  my intensive steroid use these last 3 years. (I have been using Clobestol the last 6, but have been using it heavily only the last 3 years). It has been especially noticeable Summer 2010-Spring 2011 and again all of 2012-2013. I’ve lost a 1/3 of my hair on my head to date, and 2/3 of my hair… ahem well, down there. I’ve had blood tests checking for possible reason for this hair loss without any indicators. My hairline has receded quite a bit, although I see baby hairs growing back already! Dr. Rapaport assures us that the hair will re-grow as we outgrow TSW.  Horrah!

I haven’t read anything specifically on how the adrenals or TSW affect hair, but my best educated guess is that hair needs healthy skin for growth support. And well, us Red-Skinners just don’t have that…  yet!

Edit (April 27): Was looking at photos of myself from a few years back and realized that I’ve lost much more than 1/3 of my hair. I really had a full head of hair! I believe that it’s probably closer to 40-50% of hair that I’ve lost, rather than 30%. Will be taking photos of my hair progress as well now! See this more recent blog post to see how steroid addiction does affect hair growth negatively. Amazing difference.

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Thoughts. My symptoms have been relatively mild this month, though it has kept me at home for the most part. I’ve turned even more into a hermit as I’ve been uncomfortable literally in my own skin. Some of these symptoms were present prior to complete withdrawal and I am not under any delusions my skin will be perfectly functional after TSW. The reality is that I will know what the true nature of my eczema is only after TSW. It seems as though withdrawal takes a very long time so it will be awhile until I will see dramatic improvement.

Some people who are TSW doubt that they have/had STA (topical steroid addiction) because their symptoms are so mild. I feel confident that I am experiencing withdrawal, even in a mild form. TSA/TSW explains the symptoms I’ve been having, which is unique from the “eczema” I was experiencing last year when I still intermittently on TS.

Although the #1 rule is to avoid giving yourself a time frame, I’m giving myself 1.5 year which is generous. Two years until I can be sure.  Many people see sustained improvement for a few months and then go through a flare, which is thought to be one last push by the body to detox. Although my symptoms are currently mild, I am preparing myself for the possibility of a bumpy ride down the road. Which reminds me of this song I was obsessed with in grade school… Bumpy Ride – by Robyn (1996)