In today’s podcast, we are bringing back a very special guest for today’s topic on topical steroid withdrawal (TSW).
I can’t begin to explain to you how many people I know that are going through this right now. I would say that the majority of people in my 8 week group coaching program are going through this, and in our last round we saw that everyone who was dedicated to showing up on our weekly calls saw great healing progress.
Nonetheless, in today’s podcast, you will get to hear dr. Jason share more about TSW and how to heal from it. Dr. Jason is one of the rare practitioners and naturopaths who actually suffered from this as well (as he used steroids for 12 years!), so he has first-hand experience of it (he’s also one of the experts and speakers in my 8 week group coaching program with the Conqueror Eczema Academy and also for my Baby & Children Eczema Workshop).
Now, I just want to give you a heads-up that we didn’t originally plan to film this podcast, so it is a lot shorter than my usual podcasts, but it is still full of useful information that you can learn from.
IN TODAY’S PODCAST, YOU WILL LEARN:
- What factors determine how long you’ll go through TSW for
- How long it usually takes to heal from topical steroid withdrawal (TSW)
- If you should reduce your steroid use slowly or cut out steroids cold turkey
- Healing tips for your TSW journey
- A case study of healing a patient from TSW
You’ll learn why healing usually depends on a case by case basis, and why everyone’s healing path is different (and why different solutions work for each person).
If we have the chance, we may also do a follow-up podcast with him or another practitioner regarding topical steroid withdrawal, because it is such a popular topic these days. I hope you enjoy today’s episode.
WATCH OR LISTEN TO THE PODCAST BELOW:
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If you’d like to listen to the audio only version, click below to listen.
You can also read the transcript below:
Abby: Welcome back to the show, Dr. Jason!
Dr. Jason: It’s a very big question because it all depends on the case. The thing is the intensity of topical steroid withdrawal depends on how long the patients get on steroids, the strength of the steroids, and how compromised their system is.
What topical steroid withdrawal basically is, is the patient has been suppressing with some kind of topical medication to deal with the inflammation on their skin. When they suppress it long enough it can actually aggravate things and make things worse later on because you’re covering the issue.
It’s almost like if you drop a glass on the ground and it breaks and you throw a rug on top of it that doesn’t make the glass go away. You covered the glass. You don’t see it. But the glass is still there. As you walk on the rug it’s crushing the glass into the ground even more. Then one day when you get rid of the rug all the glass is still there and now it’s scratched into the floor and stuff like that.
It’s kind of like what topical steroid withdrawal is. And I went through a bit of it myself when I was on steroids. I was on steroids for about 12 years from the age of one until about 12 until I saw a naturopath.
She took me off the steroids. And there was no term for topical steroid withdrawal. I just had a massive aggravation. And she said, “You probably will aggravate. And I said, “Why?” And she said, “Because you’ve been covering your skin with this steroid cream.” And I said, “I needed to.” And she said, “I understand that. But now that we’re treating what’s causing the issue you won’t need that anymore. But you will aggravate.”
And I did it. I aggravated for probably about a good month and a half. My skin flared up and got even worse actually. And then it went down and things resolved with treatments. That’s what topical steroid withdrawal is.
Remember, eczema is not a skin condition, it never is. There’s that saying where if you treat something externally like the skin you treat it internally forever because it’s not really a skin condition. Eczema is something inside the body where the body either is intolerant to something you’re eating, it can metabolize certain things, there’s certain stresses on the body that’s causing the gut to leak. And when they got leak the material leaks out through the body causing a skin reaction creating eczema which is an inflammatory issue on the skin.
When you take a steroid, steroids are fantastic in that they are great at reducing inflammation. And what’s really interesting about steroids is that the actual compound that it is, a corticosteroid, it’s a cortisone, is actually a derivative of a stress hormone made in our own body called cortisol. So I find that unique in that they’re actually giving you a derivative of a stress hormone to deal with your inflammation that tells me that you’re not producing enough cortisol on your own to deal with the issue that you have, which maybe a stress sign or a stress result, because it is a stress hormone.
But anyway, you’re suppressing the skin so you’re keeping it at bay. You put the steroid on and maybe the skin might clear up. It may move to a certain area which we’ll probably suppress with some more steroids. And you keep doing this for years, and years, and years, or months, and months, and months, and the skin seems to be better. But the moment you stop it, of course the issue has never been dealt with. Steroids don’t fix the issues, it just covers it. So the problem is still there and it sort of comes back.
The problem is that the body is pushing toxicity to the surface of the skin for a reason. So if you block that process it pushes it deeper into the body. And that’s why you’ll see patients who’ve been on steroids for a long time develop more systemic issues such as allergies or asthma. And that’s why they have that allergic triad which I think I’ve talked about in some previous videos of allergies, asthma, and eczema.
What often starts off in most patient as eczema when suppressed heavily with steroids becomes asthma, and they’re suppressed with puffer steroids or whatnot, and it becomes seasonal allergies. And this may go on for a span of 5-10 years or a span of a couple of years for a patient. The more suppressed you are basically the worst topical steroid withdrawal you’re going to have.
How do you deal with something like that is an excellent question because it all depends on the patients and what their actual issue is and what’s causing the eczema. But basically we try and reduce the steroids slowly. I don’t suggest just go and write off them altogether because sometimes for some patients the reactions are so severe it can really throw them off and really cause a lot of issues, not only just how they feel but mentally it can really affect people. Because they might have been suppressed for 20 years on steroids and now for the first time they’re experiencing how bad their skin actually is.
So we try and cut it down bit by bit, while at the same time treating the underlying issues as to why the skin flares up in the first place. And as I said those can be varied. It all depends on the patient. We have the tests to find out what actually is causing the issue. And slowly we kind of get this balance where we’re suppressing less and less and less, or treating more and more and more.
And then we come to this balance where things eventually work really well. We can get off the steroid altogether. That’s what steroid withdrawal is basically, you stop the steroid and you’re seeing how bad the skin actually is because the steroids is just covering the issue.
Abby: Do you have an example of how you would treat a certain patient, or maybe like a case study of a topical steroid withdrawal patient that you’ve had?
Dr. Jason: I had a kid the other day that came in. She was probably about 12 years old and was going through a pretty bad rash reaction after stopping steroids. The parents wanted to stop it altogether. And I said I think that could be done because the child had been on the steroids for probably about two years.
And they should’ve what started off as spot treatments. So they have some flare ups, they use it. And then another flare up, they use it. It became eventually a continual treatment where they needed it. The moment they stopped it they’d have a flare up. Through our testing methods we found out that the patient was intolerant to oils and fats, as well as all-grain.
We got them off grains. And we did some sensitivity work with oils and fats, so they can digest fats a lot better. We used a couple of stuff. The big this is a good probiotic. There’s so many kinds of probiotics. Not all of them are fantastic for eczema, but we used one that’s specific for their case. And we did some other work to heal the gut.
And it was actually interesting because [inaudible [00:06:16] had a great vitality. What happened in the end was they were off the steroid. They reacted quite horribly for about a month. I’d seen them after they’ve been off it for a month. So when they came into my office they did not look good particularly good.
And then it got really bad. I think after about one week of treatments they were still having these big flare ups. So I asked the mother to use the steroid topically just spot treatments on the worse spots. So she used a small amount each time. And then I think she did four spot treatments over a span of two weeks. And then things got better after that. We basically didn’t need them anymore. The flares were still coming but not nearly as aggressive. And then the skin was just very, very dry near the end.
And that’s how eczema heals. The number one thing you want to get down is the inflammation. So the redness and all that has to come down. The angry look has to go away.
What ends up being the end product that you treat near the end is the skin is just very dry and flaky. And that’s actually good. When it’s dry and flaky it might still be itchy but it’s not red and angry, that’s the best, or getting that down first and then we deal with it. That’s a more simple case of topical steroid withdrawal. You get some patients that come in and they’ve had it for years and they’re reacting heavily.
The kind of rule guess you could say is, if a patient’s been on the steroids for a year it can take up to a month of treatment. If the patient’s been on steroids for 30 years it could be 30 months. That’s doesn’t mean I’m trying to spend 30 months with a patient but they can really react for a long time. It totally depends on the case. It depends how well they follow the protocol. It depends on stresses in their life.
The more stressed the patient is the worst it is. Because remember, steroid cream is derived from cortisone, which is basically a derivative of cortisol which is a stress hormone. If the patient is highly stressed they’re dumping a lot of cortisol. They’re going to burn through that and they won’t be able to deal with inflammation as well. They need more cream and it’ll take longer.
That’s why stress affects skin so heavily. Even though people think stress is not relating to skin at all, when the body’s forming there’s three major embryological tissues, and I think I’ve touched on this Abby.
The first one is mesoderm that forms muscle and all the joint tissues and things like that. And then there’s endoderm that forms all the organs like the stomach and intestine and whatnot. And then there’s another tissue, the ectoderm that forms the nervous system, the lungs, and the skin, which is why they’re all linked. You have asthma, allergies, and eczema, all from the same tissue. Some can be very, very severe, some can be very, very mild. It all depends.
Thank you for listening to this podcast!
Abby is a Registered Holistic Nutritionist who helps clients achieve optimal health. She is passionate about seeing people use health and nutrition to transform lives. She hopes that her experiences and knowledge can help educate others on natural remedies that will help eczema. Follow her on Twitter, Facebook, Pinterest, Instagram, or YouTube for more updates!
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