Topical steroid withdrawal (TSW) is not something that many of us have heard of, but for the unlucky sufferers of this skin condition, TSW means constant pain and irritation and a complete disruption of daily life.
Here at Cryozone Health, we have been treating several TSW sufferers with our Cryochamber and in this blog, we will talk about the skin condition and how cryotherapy has changed the lives of our TSW clients.
Topical Steroid Withdrawal
TSW is a skin condition that can develop from the frequent use of potent steroids. The condition usually develops within days to weeks after stopping the use of topical steroids, or it can manifest as a worsening rash which then requires stronger and more frequent application of topical steroids to control it.
There are two main types of rash that can develop:
Erythematoedematous rash
This type of rash is more common in the people who used the topical steroid for an underlying skin condition such as atopic dermatitis (eczema) or seborrheic dermatitis, and has the following characteristics:
- Redness and swelling of the skin at the site of the topical steroid application.
- Skin that is scaly or peeling.
- Red bumps.
- A defined rash border: In some people who develop this type of rash on the face, there may be a sharp cut-off between the red and normal-appearing parts of the skin.
Papulopustular rash
This type of rash is seen more commonly in people who use the topical steroids for acne or cosmetic use, and has the following characteristics:
- Redness with prominent red bumps and pus-filled bumps in the area of the topical steroid application.
- Less prominent swelling.
- No skin peeling.
The sufferers of TSW can also experience the following symptoms:
- Burning, stinging skin which can be exacerbated with exposure to heat or the sun.
- Itchy skin following a period of burning, stinging skin. The itching is often severe enough to interfere with sleep.
- Facial hot flashes.
Most cases of TSW have been seen in people who use mid to high potency topical steroids, for example triamcinolone 0.1 to 0.5% cream or ointment and mometasone 0.1% cream or ointment, among others. The skin condition can also be caused when topical steroids are used more frequently or for a longer duration than recommended, and most people who develop TSW use the steroids daily for more than 12 months. Using topical steroids on the face or groin regions also increases the risk of developing TSW, as the skin in these areas is thinner and absorbs more of the steroid, predisposing the individual to develop TSW in those areas.
Toxicity from topical steroids appears to bury itself deep in the fatty tissues of our bodies and it is thought that the residue left by the drug is extremely difficult to eliminate. This means that the detoxification process can be lengthy and extremely painful, and it is often that TSW victims believe they are well into the healing process only to find that they have another wave of detoxification to go through before they can start to develop normal skin again.
Treatment
Typical treatment options for this skin condition include the discontinuation of the use of the steroid, antihistamines, antibiotics, a short course of oral steroids, psychological support for the symptoms sufferers experience, and the application of ice or cool compresses for relief.
Cryotherapy and Topical Steroid Withdrawal
Hannah Thomas has suffered with severe Topical Steroid Withdrawal for 7 months and found Cryozone Health just before Christmas last year. Realising that it would be life changing to other TSW sufferers too, she has been spreading the word and bringing more TSW clients to us for their treatment.
Here, Hannah explains her symptoms and how a combination of whole-body cryotherapy, our infrared sauna, and LED treatments have changed her life.
How did your TSW come about?
My eczema had been getting more and more difficult to control and I was having to use more and stronger steroids to keep the flares at bay. But even then, it was starting to become unmanageable. When I went away on holiday or away for the weekend and I didn’t take my creams, my eczema would flare up everywhere and start to become very red and inflamed and I would be desperate to get home to my steroid creams. My boyfriend started to become concerned about the amount of steroid cream I was using and wanted me to stop. I started to google natural cures for eczema and how to keep it under control without steroids and during my many hours searching, the term TSW (topical steroid withdrawal) came up. As I read about the condition it was like a lightbulb moment. All of the symptoms fit, and the explanations people were giving fit exactly with what I had been experiencing. Having googled it, I was petrified about what was to come but also excited that I might be able to have a life that wasn’t plagued by what I now know was topical steroid addiction/ steroid induced eczema and not just something I would have to deal with for the rest of my life!
What TSW symptoms do you have?
The symptoms changed month by month. In the first two weeks my skin turned bright red and I felt like a burn victim. The heat inside my body was unbearable. But on the outside, I was freezing and had the shakes even though my temperature was hitting 39 degrees most evenings. The itch was unbearable and the nerve pain (zingers) felt like ants were crawling underneath my skin. I was averaging an hour’s sleep a night. From 6pm onwards, when your natural cortisol has dropped, you experience proper drug withdrawal symptoms. Shaking, nerve pain, distress. Think train-spotting but for coming off eczema creams!
The symptoms then progressed to include night sweats, raw skin that stuck to everything, shedding of so much skin (we were having to vacuum the bed each day), open cuts everywhere, crippling insomnia and debilitating anxiety about what was to come. The bright red skin was turning to extremely dry, flaky skin but the most classic symptom, the red sleeve, remained.
Month three came and bought with it extreme weight loss (I dropped to six and a half stone), hair loss and ooze (this was the protein from the blood because I had no skin cell barrier). By this point I couldn’t sleep in a bed and had to sleep sat up on a stool so that only my bum was touching something. I was still shedding a ridiculous amount of skin and my body was just open wounds and scabs. I couldn’t wear clothes, only incredibly loose cotton. My nipples cracked, bled and oozed every night and the ooze was so bad from some parts it would just drop off me and soak through clothing. The ooze bought with it a terrible smell too. The emotional and mental toll was beginning to cripple me, and things were steadily getting worse. I had elephant skin everywhere where my skin had no elasticity.
By month four, I was really struggling. I was down and in so much pain I was unsure if I could carry on. Then on December 23rd I found Cryo.
What did the doctor recommend/prescribe?
The doctors recommended I went back on steroids, a course of oral steroids and immunosuppressants. They didn’t believe in TSW. They belittled me and made me feel like an idiot. The dermatologist told me I was a fool and I would crawl back into there, begging her for steroids when I realised how silly my decision was. I finally found a supportive GP who was open to the idea. She promised to support me through the journey, prescribing me antihistamines, pregabalin for the nerve pain and some sleeping meds.
I found out about a Japanese dermatologist who has been treating TSW for 30 years who has quite an extreme method, but it gets you through faster. It involved limited showering and bathing, no moisturisers, limiting fluids to under 1L and moving your body for 30 minutes a day. The aim is to completely dry out your skin so that it forces it to repair quicker.
What had you tried before Cryotherapy?
I followed the Japanese dermatologist’s (Dr Sato) advice from week two. It was tough but complemented Cryotherapy so well. I also bought every supplement going but I don’t know if this worked or not. I cleaned up my diet and cut out things it was hard for my body to digest to give it the best chance it could, and I used UV and red light therapy for six sessions at Cryozone Health!
How has Cryotherapy helped?
Cryo has been my saving grace. It literally saved me. When I got out the car at Cryozone Health that first day, I could barely walk or move. I was below 7 stone, in agony, tired and exhausted and emotionally and mentally drained. My body was ripped to shreds with open wounds and scabs and I was red raw.
I have been going to Cryozone Health 4-5 times a week for 3 months and it has completely changed everything. It has given me the internal energy to fight, my skin has become stronger and thicker and much more stable, it has taken away the inflammation and pain and it has given me strength emotionally, physically and mentally.
What treatments do you have at Cryozone Health?
At first, I used the sauna for a few minutes because I was so weak we needed to get my blood moving. Then I would use the chamber for 3 minutes. It was so hard at first and they had to coach me through it, counting down every 30 seconds. Then I built up my time in the chamber and sauna.
The sauna helped me to relax my muscles and calmed the chills by heating me up from the inside. It was the only place I could relax, and it became my safe place. The chamber was freezing but I could tell it was working and after a few sessions I felt more like myself. I could walk again and move my body better as it was less stiff, and my muscles could move without pain. It took away the itch and calmed the red burning skin.
As my skin started to clear, I stared to use the Celluma which was so amazing for my face where I had a lot of skin damage. I now use this once a fortnight. At first, I bought 10 sessions and then I bought an unlimited pass and have done that for the past 3 months. My skin is so much stronger and stable and is learning to function by itself.
For more information on how any of our treatments can help you, please get in touch.