Topical Steroid Withdrawal: What Parents Need to Know.
Eczema can feel like an incredible uphill battle. The itchiness, discomfort and relentless pursuit of relief can test the limits of everyone involved but what happens when the solution becomes a bigger issue than the original challenge?
As more and more individuals bravely share their journeys through Topical Steroid Withdrawal (TSW), this increased awareness shines a light on what parents need to know to make an informed decision.
Understanding TSW.
Picture the following scenario. Your baby develops eczema so you go to your doctor. They proceed to tell you that the only treatment available is topical steroid cream and to use it for as long as you need. You trust them so you diligently begin applying this cream to your young child's skin.
After a few days, things seems to improve. You're relieved and stop applying the steroids, and focus on using the other moisturizing creams you were prescribed, only for your baby's skin to show signs of eczema again very quickly. So you repeat the process but it turns into a cycle. Now you just keep using topical steroid creams as it's the only thing that seems to work. At some point, things change. It could be months, it could be years. Maybe the steroid cream no longer has the same effect it had at first and is failing at suppressing the eczema. They're itching their skin more and more, waking at night to scratch and may have other signs of lowered health resilience including staph infections or allergies. You may even try a stronger steroid cream until suddenly it hits you that this doesn't make sense, and is not sustainable so you decide to stop using the steroid creams altogether. Sound familiar? It's the story of thousands and thousands of families out there who found themselves in amidst the distressing and bewildering journey known as TSW.
Differentiating TSW from Eczema.
At first glance, TSW can masquerade as a series of severe eczema flares however understanding the mechanisms highlights the differences between these two conditions. Navigating these nuances are critical for supporting the children and families involved.
Eczema or atopic dermatitis is an inflammatory condition characterized by red, itch, and inflamed patches on the skin which can vary in severity and may be triggered by a range of factors from food, environment or chemical, stress, genetics, dysbiosis, disruption to the skin barrier or an overly permeable gut wall.
Topical steroids are a class of medications used to manage the symptoms of conditions such as eczema. They come in different strengths and forms, and are applied directly to the skin's surface to improve it's overall appearance. They contain corticosteroids - synthetic versions of hormones we naturally produce in our adrenal glands.
Prolonged and improper use of topical steroids can lead to TSW which occurs when the body has become dependent on the topical steroids and it's own production of anti-inflammatory steroids is supressed and subsequently impaired. When the external source is discontinued, natural production is insufficient to manage the inflammation and the skin is not able to self regulate.
This triggers a rebound effect with severe skin symptoms including redness, burning and flaking which is often more intense and distressing than the original eczema it was designed to alleviate.
An eczema flare may last a few days but TSW can last for weeks, if not months. Sometimes even years.
The reality is that steroids only mask the signs of inflammation. The response to the factors that led to eczema is still occurring on the inside, but the topical steroids 'shut the door' so that things look nice and calm while standing on the porch, but inside the house the party rages on and eventually the house structure begins to crumble.
The Impact on Families and Individuals.
Many of the individuals sharing their TSW stories right now are adults. They likely had childhood eczema with parents did not have the luxury of the internet. Despite the significant rise of information about eczema and how it can be addressed and resolved, the mainstream medical model still heavily relies on prescribing topical steroid creams to suppress. For parents dealing with with TSW, it's more than just the physical affects. The emotional turmoil, physical distress, disrupted routines and sleepless nights are difficult on everyone. Children, often too young to articulate their discomfort, rely on their parents to understand and alleviate their suffering. Parents, often out of their depth, rely on others to help them navigate the complexity of the situation.
A More Empowering Approach.
The best approach is a personalised tookit of support and strategies to acknowledge the individuality of each person's experience to nuture and nourish them on the inside and out. Address rather than suppress is the primary strategy by understanding what eczema is, and empower parents to make informed choices aligned with their goals.
Here are some basic suggestions you could consider in the meantime on how to support TSW if you're currently in the midst.
Emphasize a balanced diet rich in whole, nutrient-dense foods especially bio-available proteins and healthy fats to support overall skin and gut recovery.
Drink spring water water to keep cells and skin hydrated and nourished.
Incorporate anti-inflammatory compounds such as turmeric, ginger and the omega-3 fatty acids found in sardines and hemp seeds.
Nourishing topical compounds like tallow or emu oil may help alongside remedies such as aloe vera and chamomile to provide relief from itching. Do not use creams that contain alcohols, preservatives or other irritating ingredients.
Identify and avoid potential triggers like allergens, fragrances and chemicals.
Keep cool - heat can trigger histamine production which can worsen the itch.
Wear loose-fitting clothing made from natural fabrics like cotton or bamboo.
Healing takes time, so do try to maintain a positive mindset throughout this journey.
Armed with knowledge, parents can engage in purposeful conversations about the benefits and risks of different treatments to empower them to make choices rooted in their child's best interests, both short and long term.
"Wow! I wish I had booked this appointment seven years ago when I was at my worst with TSW. But grateful to have the opportunity now to get me through this flare and hopefully heal. Maryana really knows her stuff! Such a kind, caring and calm natured, and so easy to talk to. Her advice really made sense and the detailed wellness action plan is super helpful. Highly recommend you don't put off booking as long as I did!" KR
Need help?
Navigating eczema, allergies/intolerances, gut healing or TSW? Not sure what supplements to take, what to take out and what to put back in? Want guidance and support to address rather than suppress the root causes of your symptoms?
You can work with me to get information support and a tailored wellness action plan along with follow-ups, no matter where you are located. I offer a comprehensive service with well-rounded solutions that have helped many families around the world. Find out more about working with me remotely here.
You can download my free holistic eczema guide here.
I would also highly recommend joining my Healing Tribe group on Facebook with it's wealth of information and support. If you have any questions, ask in this group or message me on Instagram.
This article is for general information purposes only. All content is designed to be informative and helpful however is not intended to be a used as medical advice nor should it be used to diagnose, treat, cure or prevent any medical condition. Always speak to your preferred medical professional before making any significant changes.