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Topical Steroid Withdrawal: The Holistic Approach

Updated: Apr 14

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 about the use of topical steroids on their children especially in the face of many imported creams making claims of being "all natural" or "100% steroid free" only when tests show otherwise.

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 you or your young child's skin.

After a few days, things seems to magically improve. You're relieved and stop applying the steroids, and focus on using the other moisturising creams you were prescribed, only for your baby's skin to show signs of eczema again very quickly - and possibly also slightly worse. 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 which could be months, or 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 more and more, waking at night to scratch and may have other signs of lowered health resilience including staph infections, allergies or constant sniffles. 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 corticosteroids can lead to TSW which occurs when the body has become dependent on the topical steroid and it's own production of anti-inflammatory steroids is suppressed and subsequently impaired. So when the external source of cortisol is discontinued, natural production is now 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 triggers 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 because they have a voice. They likely had childhood eczema and their parents did not have the luxury of the internet, or deeply trusted it when their doctors or dermatologists said steroids are safe and fine. 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, even for infants. 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, 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 complexities.

The Holistic Approach.

The best approach is a personalised toolkit of support and strategies to acknowledge the individuality of each person's experience to nurture and nourish them on the inside and out. Address rather than suppress is the primary strategy to empower individuals and parents to address symptoms long-term on the inside and out.

Healing takes time, so do try to maintain a positive mindset throughout this journey. Armed with knowledge that eczema can actually be addressed at it's root level, you can then engage in purposeful conversations about the benefits and risks of different treatments to empower you going forward.

Buying Creams Online

Some suggestions for when to exercise caution navigating buying natural creams online given the risk that some imported creams run the risk of containing undeclared steroids:

- When buying online from companies who buy in bulk from overseas and then repackage locally under their own labels. They are often manufactured under poor conditions with no quality control, and different batches may contain variable amounts or types of ingredients and/or adulterants no matter what is on the label. Claims of lab testing are often vague and are also from overseas.

- Claims are made regarding FDA approval or other types of test results with no evidence. The FDA in the USA does not ever approve skincare products and should not be confused with the FDA in the Philippines as there's is merely a register of products allowed to be sold there. Be aware of marketing that confuses or or misdirects. The language should be simple and clear.

- When their website spends a lot of space and words trying to convince you that their products are safe, with no evidence of independent lab results and minimising legitimate concerns.

- When their ingredients list only show active ingredients or is in a different language.

- When the skin clears up within hours - this is a tell that the eczema is being suppressed and is discussed as it being a miracle. Sadly there are no miracle products for eczema

- When there is a lot of social media activity, as many of those testimonials may be biased especially from distributors or friends of the manufacturers.

- The marketing uses terms like "guaranteed to heal eczema" "steroid-free" "contains 100% all-natural herbs" "no side effects". I've been working in this space for 12 years and I've never come across any product that can guarantee results.

- When their messaging focuses on how the government is looking to take them 'down' or that people who have concerns are acting in malicious intent because the creams are just too good.

To me, the most effective natural creams are local, single-ingredient products, made by the same people who sell them, or purchased from reputable companies or retailers online. The reality is that if a cream works like a miracle, it is likely too good to be true.

Sadly, many imported natural creams run the risk of containing potent medicinal ingredients such as corticosteroids while actively targeting naturally minded families whose skin can become addicted to the creams, as it suppresses our own natural production leading to serious withdrawal conditions including topical steroid withdrawal and adrenal insufficiency.

"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.

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.


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