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Can I use topical steroids while on The Eczema Diet?

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Topical steroids can give temporary relief from eczema but symptoms can return soon after you stop applying the creams. Topical steroid manufacturers have warnings on the labels - do not use for more than 7 days and do not use on broken skin - so it's easy to get nervous about using them on your skin, or your child's skin.

"Can I still use topical steroids when beginning The Eczema Diet?" 

If you are currently using topical steroids to control your eczema (or your child's eczema), it's important to not suddenly discontinue use as this can induce topical steroid withdrawal symptoms. So yes, if you are currently using topical steroids you can use them and then we suggest cutting down on use, as described below. However, if you are NOT currently using topical steroids then do not start as you won't need them.

  

"I'm not sure if my prescribed skin creams are topical steroids... What are the brand names?"

There are literally hundreds of types of topical steroids. To check if your medications are topical steroids you can check the packaging/box or search this website for the brand name here >>

 

How to avoid topical steroid withdrawal (TSW)

If you are using topical steroids and would like to stop, then read this valuable advice about topical steroid withdrawal. It's probably quite different to the advice you have read online. As mentioned, if you are currently using topical steroids keep using your current medications - don't suddenly stop.

Why? Because stopping suddenly can induce painful symptoms of topical steroid withdrawal and it can take up to two years to recover. This will also slow down your results when you follow The Eczema Diet. Often people suddenly stop using steroid creams at the same time as beginning the diet and this can trigger a worsening of your symptoms - note this is due to topical steroid withdrawal, not the diet. However, this can be avoided and I'll show you how shortly.

What happens in your body when you stop using topical steroids?

A tsunami of chemicals (nitric oxide) floods your system and affects your blood vessels - this creates painful symptoms that can be avoided or reduced.

But first let's find out what happens when you use topical steroids:

  1. When you use topical steroids the medicated creams constrict blood vessels and this usually prevents skin reddening
  2. You use the steroid creams on and off for years
  3. The creams eventually stop working or you need higher doses, applied more frequently
  4. You get to a point when you think this is not good for me (or my child, if the eczema sufferer is a child)
  5. You decide to go cold turkey and stop applying topical steroids
  6. A crazy chemical imbalance occurs
  7. Your blood vessels excessively dilate due to high nitric oxide levels
  8. Severe symptoms occur (see next)
  9. Your skin eventually gets better (6 months to 2 years later)

When you suddenly stop using topical steroids your nitric oxide (NO) levels elevate and this causes an unnatural and excessive widening of your blood vessels (see diagram). If you have healthy skin this can have a positive effect as NO improves exercise stamina, however when you have skin inflammation it worsens your symptoms. 

Nitric oxide dilates blood vessels

Blood can now rush to your skin's surface so your skin may appear red. And unfortunately your blood vessels stay dilated which causes a reddening of the skin similar to rosacea. It's painful, hot, flakey and can cause the itch to worsen for months and months (sometimes years). Nothing seems to help your skin inflammation now and this can be incredibly depressing. 

There is a better way to stop using topical steroids.

Topical steroid manufacturers have known about topical steroid withdrawal for years, which is why doctors usually advise you to "gradually cut down on use rather than stopping suddenly". Suddenly stopping use of topical steroids (after years of applying them), is sort of like running a marathon and avoiding training advice such as "drink water/stay hydrated". It can result in serious side-effects. 

For example, you decide to run a marathon. You have never done one before and you suddenly realise it would be a great way to get healthy (and everyone else is doing it online so you have lots of people saying "go for it"). But the marathon is tomorrow so you put on your sweat pants, grab an electrolyte drink and away you go. The lack of training causes injury, you are in constant pain and you are unable to work for six months (this sounds a lot like topical steroid withdrawal - I will explain further). 

Training for the marathon 
I'm guessing you would not run a marathon the very next day. You would probably train for it: i.e. run a little further each day; each month you push your boundaries, strengthen your muscles, plus improve your diet and nutritional status. Then after about three months of training you run the marathon. You complete it successfully and without injury. This is the ideal scenario right?

It's a similar story when going off topical steroids, especially if you have used them for long periods of time. You absolutely need to train your blood vessels to cope with the crazy chemical changes that are going to occur. You train your blood vessels like you would train your muscles. For example:

Day 1: When you apply the steroid creams your blood vessels constrict

Days 2-3: When you have a steroid free day or two your blood vessels dilate 

Day 4: When you apply the steroid creams your blood vessels constrict

Days 5-6: On your steroid free days your blood vessels dilate

(and so on)

Do you see a pattern forming? Constrict, dilate, constrict, dilate. It's like working a muscle where you flex as you lift a weight and then relax. The muscle get's stronger. This is how you train your blood vessels to constrict again after dilating excessively. It can prevent TSW/red skin syndrome and speed up recovery from topical steroid abuse or overuse.

Note I'm not saying that topical steroids should be used at all and I do not advocate their use. Topical steroid are not good for your skin (especially with long-term use) so it's important to slowly cut down and eventually stop. I have seen many people with TSW and red skin syndrome who are suffering greatly. They stopped using topical steroids suddenly and they did not have the nutritional support or advice they needed at the time.

Why avoid going through topical steroid withdrawal (by training your blood vessels)?

People who are going through topical steroid withdrawal/red skin syndrome can suffer greatly:

  • they often cannot work
  • it affects your social life (i.e. they stay home as public outings cause embarrassment)
  • they stay in the bath for hours (to get relief)
  • they are often in chronic pain
  • their skin flakes uncontrollably
  • their skin feels hot and tight (like it's two sizes too small)
  • and they feel very depressed and anxious about their skin. 

There is a better way. Train your blood vessels, prepare your body. 

Here is another example of how to cut down on the use of topical steroids: 

How to gradually stop using topical steroids

  • Weeks 1-2: Apply your topical steroids every second day (i.e have one TS-free day in between applications).
  • Weeks 4-6: Apply TS every third day and have two days where you completely avoid using topical steroids in between applications. 
  • Weeks 7-12: Buy a lower strength product and apply it every fourth day.
  • Week 13: Stop using topical steroids. 

You can keep using topical steroids as needed with the aim of stopping after 12 weeks, or earlier as your skin gets better.

Nutritional support while you train your blood vessels to normalise:

I see many new patients at the Eczema Life Clinic who are going through topical steroid withdrawal. All of them have several things in common: typical nutritional deficiency signs. These include:

  • hair loss (some also have loss of eyebrows)
  • cracked corners of their mouth
  • cracked lips
  • unusual wrinkling of the skin (thick dry folds, usually around the tops of the knees and on the arms) 
  • insomnia (unable to sleep until early hours of the morning)
  • red skin (not always)
  • very dry skin
  • moisturisers don't work very well anymore
  • some people stop using moisturisers as they react to all products (it's called "moisturiser withdrawal")

Diet and nutritional support

All of these signs are typical B vitamin and mineral deficiency signs. The correct doses of B vitamins plus minerals and other nutrients for collagen production and wound healing are essential for quicker recovery, such as the nutrients provided in Skin Friend. 

B vitamins (use with care)

It's essential to AVOID taking high doses of B vitamins such as niacin (vitamin  B3) which increases nitric oxide levels and causes a histamine reaction that widens your blood vessel (remember topical steroid withdrawal also does this). If you are an adult do not take more than 15mg of vitamin B3 - you need only the RDI amounts to avoid deficiency and heal cracked corners of your mouth etc. Vitamin B3 any higher in dose will worsen your symptoms. 

Folate (avoid this)

If you are going through topical steroid withdrawal or if you have any type of skin inflammation avoid taking folic acid or methyl-folate and other forms of folate. All types of folate dilate blood vessels (like seen in TSW) and can worsen your symptoms. An exception: if you are pregnant or trying to fall pregnant then do take some form of folate as it's important for your baby. 

Delta-6-desaturase nutrients (for the FADS2 gene)

Magnesium, zinc, vitamin B6 and biotin (provided in Skin Friend) are essential for the FADS2 gene which promotes anti-inflammatory prostaglandins.  

While following The Eczema Diet and using the Skin Friend supplements, some people find their skin improves quickly so they can stop using the steroid creams quicker than the above description. Some people can stop using the topical steroids after 2-4 weeks, but only do this if your skin has rapidly improved.

Some people will still want to stop using topical steroids as soon as possible. This is fine, just remember to take Skin Friend a couple of weeks before you stop applying the steroid creams. The extra nourishment and anti-inflammatory antioxidants in Skin Friend will help prepare your your skin and it will boost your energy too. 

 

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