Topical Steroid Withdrawal
Easing the pain of Topical Steroid Withdrawal (TSW)
‘Cold Turkey’ Is Not The Way
Dr. Chris Reynolds. M.B.,B.S.
“Every time I see a doctor or dermatologist they don’t
know what I am talking about - they say steroids just thin
the skin. The most recent derm who I was told was one of the
best in Sydney started off by saying that TSW is a "load
of s**t" and doesn't really exist. I was so upset when
she told me to just go back on steroids.”
Sound familiar? Many doctors, even dermatologists, simply
don’t believe topical steroid withdrawal causes rebound flares.
The overarching belief is that symptoms are due to eczema.
If there’s a flare, keep applying steroids and if it doesn’t
get any better, use a stronger one to keep it under control!
One reason doctors deny the existence of TSW is because they
have no drugs available to counteract withdrawal symptoms.
They have no choice therefore but to recommend ‘cold turkey’.
I have one word of advice if you are anticipating or already
using this method. “DON’T”. There’s a better way.
It may be the most popular method advocated by doctors, but
unfortunately it invariably results in severe suffering for
the patient. It can be extremely difficult to tolerate withdrawal
symptoms that can take more than 4 years to overcome – and
even then one can be left with permanent skin damage.
WHAT IS TSW?
Topical steroids (TS), were first used for treating eczema
in 1951 apparently “revolutionising” its treatment. Unfortunately,
like many new ‘miracle’ drug treatments, it was soon realised
that prolonged use atrophied the skin and caused various other
adverse side effects. Today there are an estimated 250 million
TSW sufferers worldwide.
Even after a few days of TS use, microscopic damage to the
skin can be detected. After prolonged use though, macroscopic
damage occurs and is often irreversible. There are many other
potential adverse effects from long-term use. Also, the immune
competence of the skin, which protects our bodies from external
invaders, becomes compromised.
"Flares" or "rebound" effects, well
known to TSW sufferers, can occur just hours after ceasing
the drugs. The reaction can be severe, extremely distressful
and difficult to control. Burning pain, weeping, fragile,
easily damaged skin, constant itching, scratching, dryness,
recurrent bacterial infections, patchy discoloration, disfigurement,
depigmentation, cracking and tightening of the skin, and even
urgent hospitalisation for treatment of blood-poisoning may
occur. The unsightliness of one's skin can lead to adverse
Eventually rebound symptoms come to control the patient’s
life while skin damage relentlessly continues. Increasingly
stronger steroids and even anti-cancer and immune-suppressant
drugs such as Protopic (tacrolimus) and clobetasone (some
600 times “stronger” than hydrocortisone) are used.
These unfortunate individuals are often referred to as “steroid-addicted”,
but their rebound symptoms are no fault of their own. After
all, doctors prescribed the drugs that created the situation.
To be fair though, given the limited tools at their disposal
i.e. modern pharmaceuticals, they had no other choice.
In many cases the original problem, atopic eczema, spontaneously
recovers, but the patient is left with TSW. Terms such as
“topical steroid addiction”, “red skin syndrome” etc. are
often used to describe this condition but are not believed
by many doctors. Also, these terms describe symptoms,
not the actual status of the skin.
(I prefer to use a more descriptive term: ‘Topical steroid-caused,
thinned and inflamed skin’ or, in medical terminology,
Iatrogenic atrophic dermatitis. (IAD))
Iatrogenic - a Greek term, meaning "brought forth
by the healer”
Atrophic - the partial or complete wasting away of a part
of the body
Dermatitis - inflammation of the skin
HOW DO TOPICAL STEROIDS DAMAGE MY SKIN?
The skin is a highly complex organ; the body’s largest in
fact. TS damage involves structural as well as functional
deterioration. Even after a week or two of TS “treatment”,
there is a reduction in the size of skin cells and the number
of cell layers forming the skin. Reduction in cell division
and growth leads to damage to the ‘microcirculation’ i.e.
tiny blood vessels and nerves that control blood flow.
This compromises oxygen and nutrient supply essential for
growth, and skin cells are progressively destroyed. In fact,
the potency or “strength” of TS is measured and categorised
“scientifically” by their relative ability to constrict capillaries.
Damage to the lymphatic system, one of the components
vital for effective immunological protection further
reduces the skin’s ability to protect itself (and subsequently,
the body) from infection.
Eventually, the skin becomes thin or atrophied, and
inflamed. If continued, TS can cause irreversible
damage and permanent atrophy. For example see how
much damage they can do to finger nails after long term use
(and how wheatgrass restored them to normal).
WHY DOES MY SKIN BURN?
Based on numerous observations using wheatgrass for healing
and skin recovery, it appears that the minute capillaries
in the skin and the tiny nerves that control their calibre
have been severely damaged. However, this does not prevent
engorged, larger, deep-tissue blood vessels forcing
blood into the upper layers of this damaged skin. Because
of nerve damage here, the blood flow is unregulated, but some
sensory nerves survive which react to the increased pressure
causing pain, “red skin”, burning and weeping. (See figure)
Dr. Marvin Rapaport, a well known dermatologist in the US
explains "red skin" and "burning" in
this video which I strongly recommend to all sufferers
of TSW and their carers. This is a game-changer in understanding
withdrawal symptoms and is ideal for convincing doubting doctors
WHAT IS WHEATGRASS?
The “wheatgrass” I prescribe for my TSW patients is a potent
extract derived from young wheatgrass sprouts. This is the
stage of growth where maximum bioactivity has been detected
in the plant.
Wheatgrass and other cereal grasses have been the subject
of extensive clinical and laboratory research since the 1930’s
in the US and until the present day. Highly successful for
treatment of burns, injuries, skin pathology including TSW
and many other conditions, it appears wheatgrass is (a)
an efficient anti-inflammatory, (b) a potent immune-modulator
and (c) an activator of growth factors to start repairing
damaged skin. These are all important features necessary for
skin recovery and infection prevention. There is no one
modern pharmaceutical that can achieve all these goals, and
possibly none of them.
View some examples of wheatgrass induced Growth Factor activity:
of diabetic foot ulcers
hair growth in alopecia
skin graft healing
HOW DOES WHEATGRASS HELP TSW?
Being a potent anti-inflammatory and immune-modulator wheatgrass
extract can help control rebound by stimulating new skin growth,
reducing pain, burning and itching. It most likely achieves
this by repairing the function of the tiny nerves that control
the supply of blood to the skin, (see figure above) significantly
aiding the healing process.
Wheatgrass has successfully helped many of my patients over
the TSW hurdle. Damaged skin in time gradually reverts to
normal in the majority of cases if you persevere. However,
this is not a ‘quick fix’. It takes time – around 6 months
– but even so-called “irreversible damage” can be overcome
eventually. By comparison, because the skin structure and
function has not been restored, ‘cold turkey’ patients are
often left with permanent atrophy and associated skin
MANAGING TSW WITH WHEATGRASS (ALL AGES)
To begin with, combine every daily topical steroid application
with wheatgrass Skin Recovery Spray (or wheatgrass juice,
which can still be effective, but is not as potent.) The
aim is to reduce TS by gradually replacing each daily application
with wheatgrass extract only until you are only using wheatgrass.
The combination of TS plus WG helps reduce rebound inflammation
concurrently aiding recovery of steroid-damaged skin. In the
early stages it can be difficult to reduce even one
application of TS, but if you persevere, you will eventually
only need wheatgrass to keep your skin stable and continue
Because itch is usually worst at night, eliminate that TS
dose last. First reduce the morning and afternoon (or morning
dose if you’re only applying TS twice daily). This process
will take time and patience, 4 to 6 months perhaps - but it
is important to persevere and to give the skin a chance to
gradually recover while withdrawing from TS. Click on the
TS Reduction Chart .pdf link below to print out your copy.
TS Withdrawal dose
reduction table (139 kb)
If you are already established in ‘cold turkey’, you
will still need to use daily wheatgrass to recover your skin's
structure and function. It may therefore be necessary to return
to using topical steroids for a month or so in combination
with wheatgrass to help ease withdrawal symptoms. I suggest
you start from Week 14 on the Reduction Chart, add a little
TS once daily to the worst affected areas then work your way
down the table. This is NOT a backward step. In fact if you
follow the reduction chart and only use TS occasionally combined
with WG, your withdrawal journey will almost certainly be
Remember, the aim may be to rid yourself of TS, but you want
to have normal skin at the end of the ordeal. So try
to see this as a transitional phase. It’s okay to go
backwards from time to time. After all, think how long you’ve
suffered already - and how long you might have to go if you
don't use wheatgrass.
If possible, combine the topical with daily oral antioxidant-rich
wheatgrass extract (e.g. Supershots, or wheatgrass juice).
This helps repair and maintain a damaged immune system caused
by topical and/or oral steroids. Also, there is evidence that
wheatgrass may stimulate growth hormone production from the
pituitary gland. Growth Hormone activates IGF-1 (insulin growth
factor -1) and promotes tissue growth which is what you need
to help your skin overcome TS damage.
video on how to get the best out of taking wheatgrass)
If necessary, grow your own wheatgrass, juice and drink it
and apply it daily – and persevere. Too many people give up
too soon, so allow at least six months to achieve significant
improvement and/or recovery. Given nothing else appears to
assist skin recovery, I can vouch for the fact it will be
worth the effort.
View these successful examples:
#1. 8 y.o. girl - topical steroid-free after 5 months wheatgrass
#2. 10 y.o. girl - topical steroid free after 4 months wheatgrass
#3. Adult - 12 years steroid-dependent recovers in 3 months
with wheatgrass extract
This process takes time. But TSW DOES take time. Mine
is a methodical approach where gradual reduction can
be readily observed and achieved. It is important to photograph
your worst affected areas for comparison purposes before commencing
this programme, bearing in mind, skin eruptions can occur
anywhere and everywhere. Also, these eruptions are TSW symptoms
- an adverse drug reaction, NOT eczema. Any kind of progress
can be uplifting and encourage you to persevere.
Clinical observation shows that the bioactives in wheatgrass
are rapidly absorbed through the skin where they help to contain
rebound. Exactly how this is achieved is not known, but wheatgrass
is SAFE and can be applied as often as you like. However,
I have not found that using it more frequently makes much
difference to the rate of recovery.
Finally, avoid soap. It saps your skin of the natural
sebum that keeps your skin moist. Try to find a colloidal
oatmeal-containing soap-free wash and shampoo. E.g. Aveeno
(US), Dermaveen (Australia).
Also, reduce hot water exposure, it dries your skin
by removing sebum, the oily natural moisturiser essential
for normal skin function. Take 5 minute showers and NO BATHS.
Try to persevere with wheatgrass. See it as a friend helping
you through your TSW ordeal.
Dr. Chris Reynolds. M.B.,B.S.
Email received from NZ customer 2nd February 2015:
I just wanted to let you all know how much your product
helped me get through my struggle through TSW.
First of all, thank you for recognising it as a real condition!
After going through a traumatic two months of going cold turkey
and dealing with doctors who would not take me seriously even
though I looked and felt like a sun burnt zombie it was so
encouraging to finally find a product that is recommended
for treating TSW.
Anyway, after using the wheatgrass cream alongside weaning
off the topical steroids it probably took me a total of 4-5
months to get to a point where my skin was functioning with
nothing at all and the plus side was that during this time
I was able to go about my life as normal compared to an agonising
two or three years I could have faced if I continued cold
turkey, so thank you!!
Also I found it really helpful that you explained the
science behind how TSW works and how wheat grass can help.
Such a good product!
I hope that you can help many more people in desperate
situations and maybe soon TSW will be a recognised condition
and steroids will stop being so easily dished out!
All good things,
Antioxidant Skin Recovery Spray
Price: NZ$39.90 including GST.
Click here for more information
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