Uncategorized – TSW Assist | Topical Steroid Withdrawal Insights

Tapering Off Topical Steroids

Jason Vergara — Fri, 21 Mar 2025 02:23:50 +0000

Hello everyone,

It’s been a great journey, but TSW Assist has come to an end. I will no longer be updating this website.

Before I go, I would like to share my book. ‘Taper’ is now available on Amazon.

Taper is a call to action for integrative health—inviting sufferers and health professionals to rethink TSW care.

The physical suffering of TSW can be mitigated.

Taper explores the iatrogenic illness of Topical Steroid Withdrawal (TSW) and the global tidal wave of awareness surrounding it. Jason shares his integrative approach to bypassing topical steroid withdrawal, while healing eczema. The book highlights the work of Dr Richard Aron, Dr Xiu-Min Li, Dr Marvin Rapaport, Dr Chris Reynolds, Dr Shi Zong Zeng, Sue Armstrong-Brown, Peerawat Jay, and other leading health professionals.

Taper delves into topical steroid withdrawal, eczema, community advocacy, the mental health crisis, and integrative treatments. It contrasts the experiences of cold-turkey TSW warriors with the medically guided path of tapering off topical steroids.

“I was bedridden for a long time from cold-turkey TSW. Through integrative health optimisations and slowly tapering off, I was able to bypass TSW. I wrote this book for anyone living in fear of a future with TSW. The physical suffering of TSW can be mitigated.”

Why I’m Stopping TSW Assist…

Before I take a break from TSW Assist, I want to share the biggest challenge I faced with my own Topical Steroid Withdrawal journey, as well as running this website for the past four years.

The Cold Turkey vs. Tapering Dilemma

When people experience steroid-induced skin atrophy and TSW after long-term use, quitting topical steroids becomes a common choice. However, there are two main paths in the TSW community:

1. Tapering

The standard medical advice is to taper off steroids gradually. For many—including myself—this was extremely difficult.

“Gradually tapering off is essential compared with abrupt discontinuation, particularly if the medication has been used for an extended period “- (Safer & Zito, 2022)

2. Cold Turkey

The majority of the global TSW community chooses to quit steroids abruptly. Within days or weeks, their skin and overall health decline rapidly as they endure withdrawal head-on. Their suffering has been widely shared on social media, driving awareness and recognition of TSW worldwide.

TSW is no longer a stigma or hidden condition—it is now a global phenomenon with a community demanding recognition and support. Many who have endured the cold turkey path have healed after months or years of withdrawal. TSW Warriors who have chosen this path share their journeys to inspire hope in others.

At the heart of both approaches—whether tapering or cold turkey—is the same goal: healing.

The majority of the TSW community has chosen the cold turkey path.

I personally quit topical steroids cold turkey many times. It was brutal. I was bedridden and isolated myself for a long time.

In the end, I actually went back on topical steroids aggressively, then tapered off slowly.

That might be triggering for a community that is largely anti-steroid, but it was my personal choice. By integrating various health approaches, I was able to approach eczema and TSW in a controlled way — mitigating and bypassing the devastating withdrawal effects.

As much as I want to help the cold turkey community, it’s no longer my place. The symptom management insights and data remain on TSW Assist, but cold turkey TSW overlaps with so many other factors:

eczema
HPA-axis dysfunction
adrenal crisis
anti-pharmaceutical perspectives
alternative healing modalities
metabolic health considerations
chronic inflammation management
and the psychological impact of long-term withdrawal.

The cold turkey TSW community has grown into a global network of some of the strongest people I know. Many have become my dear friends over the years.

For almost four years, I worked on TSW Assist at night and on weekends outside of my day job and family time. It was a passion project driven by a deep desire to help others. However, I no longer have the capacity to grow this website and continue finding insights into the complexities of cold turkey TSW. So, I’ve decided to stop running the survey for TSW Assist.

It was an ambitious project that successfully solved the challenge of crowdsourcing symptom management insights for Topical Steroid Withdrawal. Beyond the survey, conversations in TSW groups continue, with hot topic discussions on Cold Atmospheric Plasma (CAP), Cyclosporine, and Dupixent being the most common topics.

Thank you to everyone who has been part of this journey. The TSW community is one of the most resilient I have ever seen. I wish you all strength, healing, and peace on your paths forward.

I’m taking a break for now, but this not a goodbye!

Sincerely,
Jason Vergara

View tapering insights from the survey
Both Methods Explained: Cold Turkey Vs Tapering

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Cotton Sleeves for topical steroid withdrawal

TSW Assist — Fri, 01 Sep 2023 07:23:07 +0000

This post is under review and in the process of being rewritten.

Benefits of Cotton/Bamboo Sleeves for Topical Steroid Withdrawal

Although topical steroid withdrawal can affect the whole body, flares commonly appear on the face, scalp and limbs. The limbs are perhaps the most functional parts of our body and are in constant motion and contact with objects and spaces. This makes them susceptible to rash and irritations.
Cotton or bamboo sleeves can help manage the discomfort and protection of the skin during topical steroid withdrawal. Cotton and bamboo sleeves are comfortable, snug-fit but not compressed materials that wrap around the inflamed area, protecting it from direct contact with allergens and keeping treatment in. Typically, a gauze roll can be wrapped around the forearm, however it is not very durable and may quickly come loose. A cotton or bamboo sleeve is snug and firm and can help maintain the functionality of your limbs while protecting your skin from external allergens.

How can cotton or bamboo sleeves help manage topical steroid withdrawal?

1. Improves quality of sleep

Sleeves are more commonly used at night, even though they can be used during the day. Cotton is a highly absorbent material, and bamboo is four times more absorbent than cotton (1). This makes cotton and bamboo sleeves a favourable option for an overnight therapy for those who wet wrap overnight.
During the night, when cortisol levels are lower, flare ups can often happen which can trigger unconscious scratching during sleep. Sleeves can help physically obstruct your nails scratching the surface of your skin – protecting the healing progress of your skin.

2. They enhance pharmacological outcomes of eczema therapy.

Atopic dermatitis is a chronic condition often managed with topical and systemic therapy. The use of cotton or bamboo sleeves for eczema falls under non-pharmacological treatment. Still, it has been proven to improve the effectiveness of topical treatment for eczema. In one study, paediatric patients treated with wet therapy did not require any systemic immunosuppressants to manage eczema flares. (2)
Experts recommend using wet therapy with cotton and bamboo sleeves as a component of multidisciplinary treatment for Atopic dermatitis.

3. They can prevent acute scratching

Cotton and bamboo sleeves are lightweight and made from breathable material. Wearing a sleeve during the day stops you from scratching triggering a flare up. Some cotton and bamboo sleeves also come imbibed with antimicrobial agents like zinc oxide, known for their soothing activity. (3)

References

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Cotton and bamboo gloves for topical steroid withdrawal

TSW Assist — Fri, 01 Sep 2023 07:22:01 +0000

This post is under review and in the process of being rewritten.

Benefits of Cotton/Bamboo Gloves for Eczema and Topical Steroid Withdrawal

Unfortunately, the hands are the most common part of the body that develops atopic dermatitis and topical steroid withdrawal. This can be incredibly debilitating to do simple, everyday tasks, and especially difficult for those who work specifically with their hands all day.
In most cases, the itching and discomfort are aggravated by contact and use (1).
Maintaining the skin health of your hand during topical steroid withdrawal is often the most difficult task to maintain, especially in a post-pandemic world with the constant use of hand sanitizer. Gloves can help prevent secure healing progress, and minimise the skin drying and reduce contact with irritants.
To prevent skin flares on your hands, gloves made from safe, inert, organic materials like cotton and bamboo, are usually recommended.

How can cotton or bamboo gloves help?

Topical steroid withdrawal wounds on your hands can often reduce the quality of life and social outcomes. Here are a few reasons how cotton or bamboo gloves can help.

1. Reduce itching and discomfort

The prevalence of hand eczema amongst medical workers confirms it as an occupational disease (2). Even if patients are naturally predisposed to skin diseases, hand eczema is often worsened by contact and use. Since we cannot entirely cease using our hands and fingers, the most apparent and rational thought is to use protection.
Cotton and bamboo are soft, breathable and hypoallergenic materials. They do not store heat compared to materials such as polyester and rubber.
Although gloves can prevent their user’s hands from harmful substances, it also protects the user from satisfying their itch – reducing inflammation and making the healing process more linear.

2. Improves sleep

During the day, the adrenal glands produce large amounts of the hormone, Cortisol. Cortisol is a steroidal hormone that prevents inflammatory flare-ups (3). Although its presence during the day can help with managing flare ups, its absence at night is often noticed – this is a common reason why most people with topical steroid withdrawal experience flare ups at night time.
When cortisol levels are lower at night, it is wise to wear cotton or bamboo gloves. As the gloves physically prevent you from unintentionally giving in to your itch while you sleep, it gives you an overall improved sleep time. Over time, gloves may also be used to train children with eczema not to scratch their face or skin while they sleep.

3. They improve the efficacy of medications.

For those who use creams and emollients on their hands for topical steroid withdrawal, it can often be difficult to keep the topical products on your hands. Everyday tasks like eating, reading, using the laptop, and washing the dishes can often interrupt or remove the topical products from your hands.
Using cotton and bamboo gloves over freshly applied treatment or moisturiser will keep it dry and locked in.

Using cotton or bamboo gloves for eczema and topical steroid withdrawal can be incredibly useful for hand eczema. Cotton and bamboo gloves are ultra-soft, breathable, comfortable and easy to manage. Many people with topical steroid withdrawal also suggest to use cotton sheets for bedding and wear cotton clothes.

References

The post Cotton and bamboo gloves for topical steroid withdrawal appeared first on TSW Assist | Topical Steroid Withdrawal Insights.

Cotton Clothes for topical steroid withdrawal

TSW Assist — Fri, 01 Sep 2023 07:20:57 +0000

This post is under review and in the process of being rewritten.

Benefits of Cotton Clothes in Eczema and Topical Steroid Withdrawal

People living with eczema and topical steroid withdrawal have reported that certain fabrics are associated with allergic flares and severe itching when wearing thick clothes and synthetic materials. Clothes made from 100% organically sourced cotton can help mitigate these implications.
Cotton is the fabric most recommended by dermatologists for people with sensitive skin and allergies. (1) This is due to its soft feel and inert nature.

Here are a few reasons why cotton assists in managing the discomfort and flare ups of eczema and TSW:

How can cotton clothes help manage Topical Steroid Withdrawal?

1. No latex proteins

Unlike polyester and other synthetic fibre, cotton does not contain latex in its process (be sure to check the manufacturer materials). Exposure to significant amounts of latex proteins daily may lead to latex allergies, characterised by itching and redness (2). Some cotton blends, however, contain minute amounts of latex proteins that may or may not cause an irritation, depending on the presence or absence of other allergy triggers. In any case, 100% cotton remains the safest option.

2. Free from formaldehyde

Special eczema-care clothing is made of cotton produced without the use of formaldehyde. Formaldehyde is a potent skin irritant which is employed in the textile industry to reduce wrinkling (3). Specially formulated cotton clothes for eczema patients are free from the irritant, formaldehyde.

3. Generally allergen free

Pure, organic cotton is hypoallergenic. While this does not mean that it is impossible to develop allergies to cotton clothes, it assures you that the risk of such occurrence is extremely low. Organic cotton is not manufactured with any strong chemicals and does not contain any metallic ions known to trigger allergic reactions and episodes of extremely sensitive skin during topical steroid withdrawal. Some cotton may contain dyes used to imbibe a colour to the material. That said, white cotton is preferred for the most sensitive areas of the skin; the groin, armpits and face. For instance, using a soft, white handkerchief to mop up sweat is safer than using a coloured one, albeit a little harder to maintain

4. Breathable and washable

Cotton contains short fibres that are loosely woven together, and can contract and expand with change in temperature. This feature makes cotton fibres comfortable to wear, even in humid conditions. This is important to eczema and topical steroid withdrawal sufferers because a common trigger for flare up and discomfort is heat. Cotton is also easily washable and does not require any strong detergents that may cause hypersensitivity reactions. This supports the claim that cotton fibres are the first choice in the prevention and management of acute eczema attacks. More so, they are a durable option.

Organic Cotton

For those that choose to use organic cotton, be sure that it is GOTS certified. For a textile company to be GOTS certified, it must produce fabrics that are at least 95% organically sourced. This includes cotton, silk and wool. GOTS certifications confirm that a fabric has no pesticide residue, was not treated with any harsh or carcinogenic chemicals like formaldehyde, and contains as little dye as possible. The harsh chemicals monitored by GOTS include bleach.
Cotton clothes are preferred for sensitive skin because it is hypoallergenic, breathable and comfortable. Organic cotton is just an extra reassurance in mitigating any chemical allergens are in the production process.

References

The post Cotton Clothes for topical steroid withdrawal appeared first on TSW Assist | Topical Steroid Withdrawal Insights.

Cotton sheets for topical steroid withdrawal

TSW Assist — Fri, 01 Sep 2023 07:19:31 +0000

This post is under review and in the process of being rewritten.

Benefits of Cotton Bed Sheets for Topical Steroid Withdrawal

Night time itching is a common problem during topical steroid withdrawal. At night, the earth’s temperature drops, and the blood seeks to balance it by rushing to the surface to warm you up. At night he body releases more inflammatory cytokines and less cortisol(1), resulting in the body overheating and inflammation. These chemical messengers make it easier for people with topical steroid withdrawal to fall into the brutal scratch-itch cycle.

Cotton bed sheets are considered a non-pharmacological therapy for skin irritations during topical steroid withdrawal.

Cotton Bed Sheets for Eczema and Sensitive Skin

Cotton is the most recommended fabric for topical steroid withdrawal because it is non-irritant, hypoallergenic and comfortable to use.

1. Comfort

If you seek to improve the quality of your sleep time, consider switching to a cotton bed sheet. Cotton is made of short fibres that easily contract and expand. This great feature enables cotton to be flexible and pliable. The kind of cotton fabrics recommended for use in eczema and topical steroid withdrawal is 100% organic cotton made with no harsh chemicals like formaldehyde, commonly used as an anti-wrinkling agent in textile industries (2). Consider seeking GOTS certified cotton, which guarantees cotton production with no pesticide residue. This reduces the possibility of discomfort caused by chemical treatment.

2. Reduces heat-build up

The short fibres which make up cotton are good at maintaining a heat balance (3). Unlike polyester and other synthetic materials, and even some natural fabrics like silk, cotton does not retain heat. Heat is one of the prevalent triggers for inflammatory reactions, discomfort and itching.
During cold seasons, you may be tempted to wrap yourself up in a heavy duvet, despite your skin. When warmth is sought, cotton blankets and duvets are the better options. The multiple layers of cotton conserve heat but retain ventilation. This set-up promotes a more comfortable, breathable sleep.

3. Non-abrasive

When shopping for cotton bedspreads and pillowcases, be on the lookout for the 100% cotton label. Pure cotton is made entirely of cellulose and is soft to the touch. Pure cotton should not give an abrasive feel when rubbed against the face. Friction against the skin mimics the same effects as scratching. Abrasive bed sheets encourage heat build-up and rash formation. Since moving against your sheets is inevitable, cotton sheets will help ‘lubricate’ each movement and reduce friction.
Other materials also tend to become bumpy and abrasive with use, even if they were once smooth. This is rarely seen with 100% cotton, making it an excellent choice for to use during topical steroid withdrawal.

Cotton bed sheets are hypoallergenic, durable and comfortable and suitable for use in eczema and sensitive skin. Cotton sheets should be maintained by gently swirling in a mild detergent and warm water solution.

Cotton gloves, cotton clothes and cotton sleeves are also recommended to help manage topical steroid withdrawal.

References

The post Cotton sheets for topical steroid withdrawal appeared first on TSW Assist | Topical Steroid Withdrawal Insights.

Dead Sea Salt Baths for Topical Steroid Withdrawal

TSW Assist — Fri, 01 Sep 2023 07:15:14 +0000

This post is under review and in the process of being rewritten.

What is Dead Sea Salt?

Dead Sea Salt is a natural salt derived from the dead sea in Israel. It has been a highly valued mineral for centuries, dating far back to biblical times.
It differs from the normal table salt in its mineral composition. Table salt is composed majorly of sodium chloride. In contrast, dead sea salt has a lower composition of sodium chloride, and a higher composition of other minerals such as magnesium, potassium, calcium, and a host of others.

Dead Sea Salt is often used as a key ingredient in several beauty products such as body scrubs, shampoos, and body washes.

Benefits of Dead Sea Salt for Topical Steroid Withdrawal

In 2005, a 1clinical trial was conducted to find out the benefits of dead sea salt on the skin. One arm was submerged in dead sea salt solution, and another in tap water for 15 minutes. At the end of the study, the arm that was submerged in the dead sea salt solution had smoother, more supple skin with reduced signs of inflammation. Dead Sea salt has several benefits for the skin, as the study has shown. More of these benefits include:

1. Hydration

Dead sea salt contains high amounts of magnesium which helps to strengthen the skin’s barrier. Skin with a strengthened barrier hold locks in moisture more effectively. Hence, dead sea salt helps to improve the hydration of the skin, especially if the skin is dry.

2. Exfoliation

It is not uncommon to use salts as exfoliating agents, however, dead sea salt is known as a potent exfoliator. Compared to other salts, it has the added advantage of infusing the skin with several helpful minerals as it sloughs off dead skin cells. This can help the skin have a refreshed and have a healthy glow.

3. Relief from various Skin Conditions

Dead sea salt has been used to manage several skin conditions for years. Such skin conditions include psoriasis, eczema, and more recently, topical steroid withdrawal (according to anecdotal evidence from various TSW community groups). It helps these conditions because of its potent combination of minerals helps to improve hydration and reduce inflammation. It can help to reduce itchiness as the skin is more hydrated and less inflamed.

How to use Dead Sea Salt

Dead Sea Salt is used to make and promote the efficacy of several beauty products such as soaps, shampoos, body and face scrubs, masks, and creams. For topical steroid withdrawal, we suggest to refrain from using such products that may contain other harsh chemicals that can often be intolerant and harmful for skin with topical steroid withdrawal.

To use dead sea salt for topical steroid withdrawal, the most common way is to have a bath with pure dead sea salt and water. All that is required is a cup of salt poured into a tub of bathwater.

Conclusion

Dead sea salt is a natural ingredient with a plethora of benefits for the skin. With its effects on hydration and reduction of inflammation, it is often used as a key ingredient in several beauty products. Within the TSW community, many choose to incorporate it into their bathing process.

References

Ehrhardt Proksch et al. Int J Dermatol. 2005 Feb, Bathing in a magnesium-rich Dead Sea salt solution improves skin barrier function, enhances skin hydration, and reduces inflammation in atopic dry skin, National Library of Medicine
https://pubmed.ncbi.nlm.nih.gov/15689218/

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Red light therapy for Topical Steroid Withdrawal

TSW Assist — Fri, 01 Sep 2023 07:11:02 +0000

This post is under review and in the process of being rewritten.

What is Red Light Therapy?

Red light therapy is a relatively new treatment that utilises low wavelength red light for therapeutic and cosmetic effects on the skin. It is considered to be bioactive at this low wavelength, making it potentially capable of improving cellular function.
The use of red light therapy started with the National Aeronautics and Space Administration (NASA) using it for experiments on plant growth in space and 1healing wounds of astronauts. It is now more widely used in the medical industry for therapeutic and cosmetic purposes.
More research still needs to be done to discover what other benefits it may have for the human body.
For the skin, various benefits have been reported.

How Does Red Light Therapy Work?

Light-emitting diodes release light and heat. The red light penetrates the dermis layer of the skin, which is the middle layer. At this level, it can reach organelles within individual cells to exert its effect. Its target organelle is the mitochondria, the powerhouse of the cell. It stimulates the mitochondria to produce more energy. With more energy, the skin cells can produce more collagen and elastin – proteins responsible for maintaining the integrity of the skin. Some cells also absorb the light causing them to work more efficiently.

Benefits of Red Light Therapy

1. It can help improve the appearance of fine lines, wrinkles and age spots

Red light therapy increases the production of collagen, elastin and Hyaluronic acid in the skin. Hyaluronic acid is an endogenous fluid found mostly in the eyes and joints that helps retain moisture in the skin.
By increasing the production of these substances, red light therapy helps to reduce the appearance of fine lines and wrinkles on the skin.

2. It can improves Acne

Red light therapy decreases signs of inflammation such as redness. It can also kill bacteria and minimise oil production on the skin. Acne thrives on all these factors. This makes red light therapy a suitable treatment for it.

3. It can reduce the appearance of scars and stretch-marks

Red light therapy can reduce scar tissue and improve circulation in the area. For stretch marks, it can boost collagen production which helps improve the appearance of the skin.

4. It may assist in managing inflammation in topical steroid withdrawal

Red light therapy can be effective for chronic skin conditions such as eczema, psoriasis and rosacea. It can reduce itchiness, redness, flaking, rashes or bumps, and inflammation in general. It can also strengthen the barrier of the skin.
For topical steroid withdrawal, there are anecdotal reports with online support groups that red light therapy has been effective in managing their withdrawal process. More evidence is required to validate its efficacy and we will update this page as more evidence emerges.

Conclusion

Red light therapy is a new frontier in medicine that requires more research to fully understand the extent of its capabilities. How and why it works need to be fully understood to potentially expand its range of use.
Current studies about red light therapy have shown it has several benefits for the skin. There is also evidence outside 2clinical trials to prove its efficacy.

References

Whelan H. et al., 2002, Effect of NASA Light-Emitting Diode Irradiation on Wound Healing, Journal of Clinical Laser Medicine & Surgery, https://www.researchgate.net/publication/11582463_Effect_of_NASA_Light-Emitting_Diode_Irradiation_on_Wound_Healing
Alexander Wunsch and Karsten Matuschka, 2014, A Controlled Trial to Determine the Efficacy of Red and Near-Infrared Light Treatment in Patient Satisfaction, Reduction of Fine Lines, Wrinkles, Skin Roughness, and Intradermal Collagen Density Increase, Photomedicine and Laser Surgery, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3926176/

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The Use of Air Purifiers for Skin Issues

TSW Assist — Fri, 01 Sep 2023 07:09:16 +0000

This post is under review and in the process of being rewritten.

How Does Air Quality Affect Skin Health?

Atopic dermatitis Eczema is an itchy inflammation of the skin commonly caused by allergies. There are an array of things that could cause an allergic reaction in different people. Since the skin is completely exposed to the environment, it can be easily affected by allergens that can be found in the air. Some of these allergens include pollen, pet dander, dust mites, and even smoke.

The quality of the air can have profound effects on the skin. Dry air, in particular, can have adverse effects on the skin. Dry air causes normal skin to be rough and flaky.
Eczematous skin suffers even more as it has a damaged skin barrier, which means the skin cannot retain water. This often manifests as bumps or rashes on the skin. This leads to severely dry and itchy skin and more frequent flare ups.

Indoors, the air contains several chemicals found in cleaning products, paint, furniture, and even mattresses. These chemicals affect allergies as well.

The humidity and temperature of an environment also affect the health of the skin. Lower humidity leads to dry skin, as there is less moisture in the environment. Lower humidity is often found in cooler seasons or climates.

What Does An Air Purifier Do?

Air Purifiers are machines that remove particles in the air and sanitize it. These particles include allergens, toxins, and pollutants. These machines rid the air in your home of all the impurities that pollute the air we breathe and in turn, have negative effects on our quality of life.
To do this, they typically take in the air through a system of internal fans, filter the air through the machine and then release the clean air through another system of fans
Are air Purifiers good for our skin?
Since most eczema triggers are airborne, it is plausible that the use of an air purifier could benefit people with eczematous skin. In some cases, indoor air pollution being as much as five times worse than outdoor air pollution, it might even be imperative for a person with eczema to get an air purifier.
By cleansing the air of allergens, an air purifier removes the triggers for flare-ups. If it does nothing else, that alone is a great relief to one who has eczematous skin.

Effects of Air Purifier On The skin

1. Air Purifiers may prevent flareups and improve acne

Air purifiers trap particles that can trigger flare ups which are often identified by rashes, itching, and redness.
In the absence of these allergens, the skin is free to thrive without external pollutants in the air. Skincare products may also work better in the absence of these particles leading to healthier skin.

2. Air purifiers improve the skin tone

Some particulates are associated with skin hyperpigmentation. These particulates are known as polycyclic aromatic hydrocarbons. These hydrocarbons break down vitamin E that is present in the skin, making the skin susceptible to free radical damage. Hydration, sunscreen, and the use of antioxidants help in reducing the appearance of hyperpigmentation. However, taking the hydrocarbons out of the air is immensely helpful also. An air purifier with a HEPA filter- short for High Efficient Particulate Air can assist in this.

3. Air purifiers can slow down ageing

Excessive exposure to the sun’s rays carry harmful ultraviolet rays that harm the skin by creating free radicals that damage the skin, causing more wrinkles and hyperpigmentation. Similarly, air pollutants can contain free radicals too.
Polycyclic aromatic hydrocarbons are also implicated here. They break down proteins in the skin responsible for keeping the skin supple and youthful-looking such as collagen and elastin. The destruction of these proteins causes the skin to sag. Constant exposure to hydrocarbons causes the ageing process to accelerate

Can Air Purifiers Help Manage Topical Steroid Withdrawal?

During topical steroid withdrawal, the damaged barrier of the skin is open and vulnerable to air-borne particles. Allergens within the particles can aggravate the skin and may cause flare-ups, itching and other unwanted reactions. Many people within the topical steroid withdrawal community use an air purifier within their homes to assist in removing allergens pollen, pet dander, dust mites, and smoke from the air. As topical steroid withdrawal is a new medical phenomena, we will update this page once research emerges that air purifiers can assist in managing topical steroid withdrawal.

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Gut Health and Probiotics for Topical Steroid Withdrawal

TSW Assist — Fri, 01 Sep 2023 07:07:40 +0000

This post is under review and in the process of being rewritten.

Probiotics for Gut Health and Skin Issues

The link between a healthy diet and clear skin has long been established. In IgE-mediated food allergies, pruritus and urticaria are observed immediately after an allergen (such as peanut) is ingested, among other manifestations of allergy.
Many inflammatory skin conditions such as atopic dermatitis (eczema) are idiopathic. Although they are suspected to be affected by genetic dispositions, it has become clear that the microbiome has a role to play in the immune reaction.
Restoring normalcy to the gut lining may translate to the normality of the skin and epithelium. In this issue of restoration of balance, probiotics find their use.
The role of probiotics in eczema symptoms has undetermined findings, however continues to be researched.

What is Gut Health?

Gut health simply refers to the state of the micro-organisms that line the gastrointestinal tract. These ‘’good bacteria’’ are essential for optimal health and digestion. There are about 300-500 species of bacteria living inside the stomach and adhering to the lining of your mouth, throat, stomach and intestines.
These microbes prevent many diseases by simply occupying the space a pathogen needs to anchor itself and cause an infection. Also, these friendly bacteria release some enzymes that are essential to digestion in humans.

When the line of defence formed by these microbes is compromised, a gut illness can occur. This is seen in approximately 70 million Americans who suffer from gut health issues such as Leaky Gut.
An equilibrium if said to be required between the microbes and their environment to have a healthy gut. Too many or too few of these bacteria will cause digestive diseases.

What is the microbiome?

The microbiome is a community of organisms found in all body parts but most concentrated in the stomach and intestines. The gastrointestinal environment is harsh and highly acidic, which deters the growth of many kinds of bacteria. However, a host of organisms find these conditions suitable. Common microbes that make up the microbiome include Staphylococcus species, Streptococcus species, and Lactobacillus.

What do these organisms want?

The microbes in the gut are mostly symbiotic; their actions benefit them just as much as they help the human body. These organisms want food and shelter in return for the digestive aid and protection they offer most of the time. They feed on the food that enters the stomach and replicate at such high rates that no other microbe (pathogen or not) has any space to anchor itself. As they feed, they produce helpful enzymes that help accelerate digestion.
In a healthy individual, these microbes only take an insignificant amount out of your diet, hardly shortening your ration at all. When the stomach is emptied, replication immediately ceases. This manages the proliferation of the microbiome.
A few opportunistic pathogens are harmless until the immune system becomes compromised by infection or disease.

How do they help us?

The microbiome digests complex polysaccharides which are otherwise indigestible by humans. They are a metabolic aid, converting sugars into Vitamin K, B12, propionate and butyrate. These metabolites are essential in maintaining a healthy epithelium. (1)

The Link Between Gut Health, Skin issues (Eczema) and Immune system

The Gut-Skin axis fosters the relationship between the gut and skin. The exact mechanism of eczema is not known, but a combination of genetics, environment and gut health play a role in its pathophysiology. The stomach, duodenum and oesophagus act as reservoirs for IgE+B lineage cells. This is why food allergies translate to psoriasis and atopic dermatitis in predisposed individuals.
A derailment from the normal microbiome condition of the gut is called dysbiosis, and dysbiosis is a common cause of inflammatory skin diseases mediated by the immune system. About 7-11% of people with Irritable Bowel Disease (IBS) also suffer from a chronic case of psoriasis. (2)

The metabolites of the microbiome serve anti-inflammatory purposes. According to one study, butyrate, a short-chain fatty acid, suppresses the immune system by inhibiting inflammatory cells’ proliferation, migration, and adhesion. The study also claims that this metabolite can halt cytokine production. (3)

When the integrity of the gastrointestinal lining is compromised, the gut microbiome and its metabolites are spilt into circulation, which upsets the homeostatic balance. Gut microbiota tends to accumulate in the skin. Furthermore, another study states that the DNA of gut microbiota have been found in the plasma of patients with chronic psoriasis. (4) This proves the systemic involvement of gut microbiota in skin-related diseases.

More detailed studies are required to ascertain how the gut microbiome influences skin diseases.

What are probiotics?

Probiotics are dietary supplements that may repair the microbiome. A probiotic contains live organisms that, when ingested, occupy the gastrointestinal tract. The organisms commonly found in a probiotic are Saccharomyces boulardii, Lactobacillus and Bifidobacterium.

Probiotics may come as natural foods or as a supplement. Common foods that contain helpful intestinal microbes include yoghurt, buttermilk, miso, tempeh, kimchi and other fermented foods and spices.

Benefits of Probiotics

Oral health

The mechanism through which probiotics influence oral health is similar to that of gut health. Probiotics, especially those containing Lactobacillus, have shown a significant effect on the development of periodontal diseases such as gingivitis, periodontitis and pregnancy periodontitis. (5) in this case, the microbes suppress the inflammatory action of normal saliva microbiota.
Probiotics may also prevent dental plaques and caries, a leading cause of halitosis and poor dental health. Research has revealed that probiotics can reduce the occurrence of plaques by inducing environmental pressure and competition. Unfortunately, benefits have only been seen in a small population. Studies are still being carried out on what probiotic organisms would have the most impact on plaques(5).

Vaginal health

Lactic acid-forming probiotics such as Lactobacillus can assist in maintaining vaginal health. Lactobacillus makes up a more significant percentage of the vaginal microbiome, and its metabolites sustain the pH of the vaginal environment.
The competitive adherence of Lactobacillus to the epithelium of the vagina prevents infections that lead to bacterial vaginosis, vulvovaginal candidiasis and yeast vaginosis. (6)
The use of probiotics in preventing bacterial vaginosis is becoming increasingly popular, and investigations are being made into its effect on preterm deliveries. Many pre-term deliveries and neonatal mortality are caused by Chorioamnionitis, a complication of bacterial vaginosis. As such, the prevention of bacterial vaginosis through probiotics has been included in several antenatal care programs. (7)

Infections, allergies and cold

Probiotics certainly play a role in suppressing food allergies, although the extent of their effect is not certain. Probiotics made from Lactobacillus have shown significant improvements in cow milk allergies among specific populations(8).
Probiotics have also been proven to reduce the incidence and severity of colds among schoolchildren. According to one study, children who take probiotics are less susceptible to rhinoviruses, cough and fever (9). However, probiotics have no effects on nausea, vomiting and diarrhoea caused by allergies and colds.
The use of probiotics in children needs to be closely monitored due to the possibility of a rebound infection. Probiotics should be employed only when the benefits outweigh the risks.

Reduce side effects due to antibiotics

Probiotics can be used to augment and, in some cases, replace the use of antibiotics. The high incidence of side effects with antibiotics and the prevailing antimicrobial resistance has encouraged the search for alternatives to antibiotics.
The use of probiotics may reduce the need for antibiotics by supplementing epithelial lining integrity and immunity. Thus, antibiotics are reserved for when they are most needed. This may curb the steep resistance curve.
Further, many antibiotics are known to cause side effects such as diarrhoea and GI disturbances. Prebiotics may again play a role in mitigating these side effects, making antibiotics more bearable. (10)

Probiotics for the Immune System, Digestion, Eczema, Gut Health

Irritable Bowel syndrome

Probiotics can improve the symptoms of irritable bowel syndrome (IBS) by offsetting the balance between the pathogens and microbiota present in the stomach. The actions of probiotics in the management of IBS may be classified into physical barrier effect, competition and metabolic effects. Recent studies have revealed that probiotics may relieve pain associated with digestive abnormalities by inhibiting opioid and cannabinoid pain receptors in the gastrointestinal epithelium. (11)
Probiotics also regulate intestinal inflammatory responses by inhibiting cytokines. They act on Interleukins and dendritic cells, the antigen-presenting cells for T lymphocytes. These cells are related to the activation of B lymphocytes.

Reduced risk of colorectal cancer

Probiotics may be used in the prevention and management of colorectal cancers. Although the exact mechanism through which probiotics affect colorectal cancer remain unknown, many possibilities have been identified. A few of the postulated methods through which probiotics prevent colorectal cancer are the inactivation of carcinogenic compounds, competition with putrefactive pathogens, inhibition of tyrosine kinase pathways, regulation of apoptosis and cell differentiation. These discourage the proliferation of cancer cells in the colon and rectum. (12)
The intestinal microbiota binds to possible carcinogens found in food, especially those that occur due to digestion. The complexes formed between metabolites of microbiota and those of red meat reduce the exposure of the colon and rectum to mutagens.

Improved digestion in Lactose Intolerance

The intestinal microbiota consists of many Lactic-acid fermenters. In the lactose-intolerant population, a deficiency of the enzyme lactase prevents the proper digestion of Lactose, the sugar found in milk and milk products. This usually leads to abdominal pain and often diarrhoea.
Probiotics relieve the symptoms of lactose intolerance by hydrolysing lactose and precipitating colonic fermentation. Lactic acid bacteria produce a beta-galactosidase enzyme that performs the role of the human Lactase enzyme. The anti-lactose effects of probiotics begin in the small intestine and continue in the colon.

Treatment of skin conditions, psoriasis, eczema

Probiotics can be used to treat various skin conditions, its primary action being effected through the Gut-Skin Axis. The use of probiotics for the treatment of atopic dermatitis (eczema) has been confirmed safe and effective for children (13). However, more research must be done to ensure its effectiveness against eczema in adults.
In adults, probiotics have been used to treat and manage acne and psoriasis. Some studies say that probiotics reduce the risk of skin cancers to some extent, especially in otherwise predisposed individuals. (14)
Furthermore, probiotics show a promising role in encouraging wound healing (15)

Improves immunity

Probiotics are known to influence the immune system. Recent studies show that probiotics have an effect on both adaptive and innate immunity. Probiotics affect the T and B lymphocytes of the adaptive immune system and the dendritic cells and macrophages of the innate system. (16)
According to the study, a mixture of probiotics induced both T and B lymphocyte hyporesponsiveness. This mixture also downregulated the T-helper cells without inducing apoptosis. These results may be helpful in the regulation of auto-immune diseases and hyperactive immune systems, which are often the cause of allergies and hypersensitivity reactions.
The particular dose at which the beneficial effects can be witnessed is not specific. Some studies vote in support of a lower amount than currently employed. In contrast, others say that a higher amount is necessary due to the anatomical differences between test organisms and humans. (17)

Beneficial and Common Probiotic Strains For Eczema

A proposed common cause of an eczema flare is the dominance of one particular species of bacteria in the gut. The more diverse the microbiome, the less prone an individual is to acne breakouts and flares. No two individuals have the same microbiome composition. However, the following strains and species have been known to have the most protective effects against eczema in humans.

Lactobacillus rhamnosus
Bifidobacterium lactis
Lactobacillus acidophilus
Lactobacillus paracasei, among others

Probiotics and Topical Steroid Withdrawal

With probiotics being used as a supplement to assist in improving the immune system, eczema, psoriasis, and wound healing, many people within TSW online communities and support groups consider improving their gut health with probiotics. As topical steroid withdrawal is a new phenomenon, we will update this page with relevant medical publications and evidence of the efficacy of probiotics and its relationship with topical steroid withdrawal. Anecdotally, we are seeing a strong trend of the usage of probiotics among people experiencing topical steroid withdrawal. It is important to note that there is no current medical cure for topical steroid withdrawal, however managing the underlying symptoms of eczema and inflammation can be mitigated.

Conclusion

The benefits of probiotics are not limited to skin and gut disorders. These living organisms offer a promising role in metabolic abnormalities such as obesity and the symptoms of type 2 diabetes. Further studies and research around probiotics may prove beneficial to the mental health of people living with conditions like depression and anxiety. Usage of probiotics to treat atopic dermatitis, eczema and psoriasis continues to grow and may be beneficial in managing the withdrawal period upon the discontinuation of topical steroids, however further medical research is required regarding this new iatrogenic phenomena.

References

The post Gut Health and Probiotics for Topical Steroid Withdrawal appeared first on TSW Assist | Topical Steroid Withdrawal Insights.

Cold Therapy for Topical Steroid Withdrawal

TSW Assist — Fri, 01 Sep 2023 07:03:27 +0000

What is Cold Therapy?

Cold therapy is the usage of low temperatures to treat a medical condition. It is commonly used to treat abnormal, damaged tissue, lesions, and skin diseases. The temperature recommended for Cold therapy typically starts below 15℃.
Cold therapy has been used by many people with topical steroid withdrawal in attempts to relieve the inflammation and itch associated with Red Skin Syndrome. According to one study, cold therapy has special anti-inflammatory effects experienced by sufferers of skin conditions like atopic dermatitis.
Cold therapy is often referred to as only temporary relief from inflammation, however studies support the ongoing beneficial effects of cold therapy to continue after the cold exposure is gone. (1)

Different Types of Cold Therapy and Their Benefits

The method of application, duration, and site of application are key factors that influence the effectiveness of the treatment method and the comfort of the patient.

1. Ice Packs

These are perhaps the most accessible kind of cold therapy. Different kinds of ice packs include single-use chemical ice packs suitable for outdoor use, the reusable cold compress, and the regular pack of frozen peas that some use at home. Ice packs have been used for inflammation for decades and are often supportive treatments for athletes. People predisposed to atopic dermatitis often utilize ice packs as a method to reduce itching, redness and inflammation of the skin.

2. Ice Baths

This may be a cold shower or a soak in a freezing tub of ice water. An ice bath is said to do wonders for inflamed skin and improve mental health. Ice bath enthusiasts advocate mental clarity and cognitive benefits after each ice bath. After submerging in cold water for minutes, the risk of catching a cold is often said to decrease, due to a boost of the immune system. It is recommended not to soak for more than 10 minutes at a time.

3. Cryocuffs

Cryocuffs target at specific areas such as the knee, upper arm, calf, or ankle. It delivers a cooling effect without the wetness of an ice bath or an ice bag. In a cryo cuff, the cuff arm is attached to a cooling bucket that contains ice. The ice serves to repeatedly cool the content of the cuff, maintaining a steady temperature gradient.

4. Cold Sprays

Cold sprays come in pressurized cans that are dry and mobile, ideal for convience of use. Advanced preparation of the cold spray is a device called a Cryo gun. It is used in medical facilities to eliminate tumor cells and potential cancers. It is used to treat benign and pre-malignant tumors. It effectively destroys cancer cells at sub-zero temperatures.

5. Cryotherapy machines

Cryotherapy machines, also known as cryotherapy saunas, are machines intended to deliver a cooling effect to the whole body in one session. They are powered by pressurized or nonpressurized liquid nitrogen at temperatures below the freezing point of water (typically -195.79℃). This low temperature is distributed within an adequately ventilated system. The oxygen content of the environment is of primary importance. Oxygen prevents discomfort and the rare loss of consciousness.
Cryotherapy machines may come built with soft cushioning for extra comfort, safety devices, wireless controls, and even audio-visual content.

6. Wim Hof method

The Wim Hof Method (WHM) is a combination of physical and mental therapy. It stands on three pillars; cryotherapy, mindfulness, and breathing. The WHM involves stages of meditation, deep breathing, and then submerging into an ice bath. The participant is encouraged to start small, with a few minutes each, progressing into more extended periods and lower temperatures as ones advances within the process. (2)
The WMF method yields excellent benefits for the mind and body. Aside from pain relief from soreness and inflammation, it is known to reduce mental stress, encourage weight loss, and improve clarity. The Wim Hof Method has been become a booming trend for people with different types of inflammation and in recent times, commonly used as a method to reduce inflammation during topical steroid withdrawal.

Cold Therapy Benefits for Topical Steroid Withdrawal

Currently, there is no universally accepted treatment for Topical Steroid Withdrawal. Studies suggest pulse therapy, nerve-calming agents such as cold therapy, and moisturizers towards managing the condition and discomfort, however there is no medical solution for Topical Steroid Withdrawal.
The benefits of a cold compress against inflamed skin have long been identified, but only recently has it been included in the management therapy for Topical Steroid Withdrawal. For a condition as unprecedented as this, it is difficult to ascertain the extent of the effectiveness of cold therapy for this new iatrogenic phenomena.

How Cold Therapy May Help Managing The Symptoms of Topical Steroid Withdrawal

Recent studies support cold therapy in the reduction of pain and inflammation. (3) The action of lowered temperature on skin disorders may take any of the following pathways.

1. Inflammation

Cold therapy influences the inflammatory process through direct and indirect means. At first, the low temperature causes the local blood vessels to shrink or constrict instead of dilating. This movement discourages the migration of large-sized leukocytes (4). The inflammation process involves the pooling of heat towards the site of interest. By intercepting this, cold therapy halts the inflammatory process and prevents the transmission of signals. The constriction of local blood vessels canl reduce the redness associated with TSW and prevent the release of inflammatory hormones, bradykinins, and prostaglandins that stimulate pain. (5)
Cold therapy also has a relationship during the thermoregulation back to warmth after the cold exposure. When the cold sensation is withdrawn and blood vessels allowed to dilate, an anti-inflammatory cytokine, Interleukin-10, is released, preventing further pain and soreness. This is seen to a more considerable extent with cryotherapy chambers when compared to ice packs and cold showers.

2. Skin Health

Cold therapy proves effective in the reduction of skin lesions. In one study, a combination of an antibiotic and cryotherapy gave a quicker therapeutic effect than the use of the antibiotic alone (Metronidazole cream). (6)
In this study, cryotherapy was used as an adjunct in the treatment of Demodicosis, a chronic skin disorder often coupled with erythematosquamous inflammation. Cold therapy is also said to yield excellent cosmetic results. Proponents have reported fading of wrinkles with regular use of ice packs.
More evidence proposes that cold therapy may be helpful in treating skin cancers. One study showed a 97% cure rate for non-melanoma skin cancers with cryotherapy. Unfortunately, relapses were noticed 6-24 months after the cryotherapy session (7). However, comparing the pain relief, cosmetic benefits, and low cost of cryotherapy, it was deemed safe and effective in managing skin cancers, if only temporarily.

3. Chronic Pain

Topical Steroid Withdrawal is commonly associated with intense pain and a burning sensation on the skin. Cryotherapy may be an alternative to oral and topical analgesic agents. As cold therapy is commonly related to joint pain and inflammation, studies show that the analgesic benefits of cold therapy can be just as beneficial on sensitive skin than on bones and joints. In a particular study, patients treated with cold therapy following a craniotomy reported that the pain relief was tremendous around the eyelids and midfacial region than the cranial region. (8)
Cryotherapy as a whole was able to relieve post-surgical discomfort edema and lessen the frequency of headaches.

More Relevant Benefits of Cold Therapy

1. Treatment of Atopic Dermatitis (AD)

Whole-body cryotherapy is relatively effective in the management of AD. (9)

2. Immunity

Cryotherapy influences the immune system, promoting the release of anti-inflammatory cytokines.(10)

3. Weight Loss

Cryotherapy may control obesity either by cold-induced thermogenesis or adipose disruption. Cold therapy stimulates the breakdown of stored fat. (11)

Conclusion

There is no current cure for topical steroid withdrawal, but cold therapy is a common method used in managing the inflammation associated with the symptoms of topical steroid withdrawal. Cold therapy can assist in the alleviation of pain, redness, and discomfort associated with Topical Steroid Withdrawal. Ice packs, cold showers and ice baths are the most common forms of cold therapy used. Caution is strongly advised for carers and their children when approaching cold therapy. If you have any concerns, consult with your medical practitioner.

References

The post Cold Therapy for Topical Steroid Withdrawal appeared first on TSW Assist | Topical Steroid Withdrawal Insights.