Diet and Nutrition for Topical Steroid Withdrawal

Topical Steroid Withdrawal is a severe health condition caused by an adverse reaction to corticosteroids creams and ointments prescribed by doctors worldwide. Common side effects from stopping the usage of topical steroids include red ripped skin, oozing skin, skin infections, flakey skin, hair loss, fluctuations in body temperature and inability to thermo-regulate, vision impairment and light sensitivity, anxiety, depression, deep itching,  and ongoing chronic pain. Unfortunately, TSW is not recognised as a medical condition, there is no cure, and there is no exact time frame of how long it takes to recover from topical steroid addiction. Anecdotally, food and nutrient dense food can assist in the healing process and reduce inflammation.

With eczema being a medical condition that initially led to the use of topical steroids, once a person chooses to quit using topical steroids, it is common that both eczema and topical steroid withdrawal can be present.
Skin quality and overall homeostasis of the body can be further improved by diet and the type of food you consume.

Detoxing

Withdrawing from topical steroids causes the skin to become highly reactive. To avoid worsening its symptoms, healthy food consumption is a common priority. As your body is in period of healing and detoxifying from prolonged steroid use, it is recommended to nourish your system with nutrient-dense foods.

For detoxing, many consider decreasing the consumption of salicylates and amines found in foods. Decreasing intake of these natural chemicals gives your liver a break and can help in correcting hormone irregularities.

Inflammatory Foods - Food You May Want to Consider Avoiding

The following list of foods is sourced from Karen Fischer’s book called the Eczema Diet. She lists her top 12 foods to avoid for people suffering with eczema – also known as her ‘Itchy Dozen’.

1. Fermented foods

There are two reasons why fermented foods like sauerkraut can intensify TSW and eczema even though they treat some health problems.

1. They contain yeast that’s used in the fermentation process and also have molds.
2. They are high in histamines or amines, vasodilators causing skin rashes and blood vessel dilation in sensitive individuals.

Examples of fermented foods are:

• Chutneys
• Yogurt
• Kimchi
• Fermented fish
• Kefir, pickles
• Pickled cabbage
• Mayonnaise
• Sour cream
• Even healthy apple cider vinegar is not encouraged because it is fermented and has sulphites that worsen eczema.

2. Dairy products

Dairy products are not recommended for three reasons:

1. People with skin inflammation can be sensitive to lactose, a kind of milk sugar. This is according to Australian research from the RPA Hospital Allergy Unit.
2. Flushing, itching, and rash symptoms can be stimulated by rich sources of histamines contained in sour cream, cheese, yogurt, and mayonnaise.
3. Dairy products can potentially harm the gastrointestinal tract lining of those people who are more sensitive. When the gut lining is damaged by dairy consumption, microscopic holes allow larger food particles to enter the body, resulting in allergic reactions and sensitivities. This is known as 'leaky gut syndrome' by naturopaths, and doctors refer to it as 'increased intestinal permeability.’

3. Dark green vegetables

Dark leafy greens like broccoli, spinach, silverbeet, and kale are good for overall health. However, these vegetables are rich sources of salicylates, amines, or monosodium glutamate (MSG), which can worsen symptoms of eczema and topical steroid withdrawal if you are sensitive to salicylates.

4. Highly acidic and dried fruits

Fruits like Mandarins, Kiwis, Pineapple, Oranges, and Plums are highly acidifying and high in salicylates and amines, which can worsen itchy skin.

Lemons and Limes are slightly healthier since, once digested, are highly alkalizing fruits, but they still contain salicylates and amines. Limes are occasionally listed incorrectly on low salicylate foods lists, but these lists are inaccurate. For 12 weeks, avoid citrus and high-acid fruits to observe if the skin improves.

Dried fruits like sultanas, apricots, and dates are high in monosodium glutamate and have sulfites considered preservatives that could worsen TSW symptoms.

5. Grapes, Avocados, and Tomatoes

Grapes and other grape products like raisins, juices, wines, sultanas may be worth removing from your diet. Grapes contain salicylates, amines, and glutamates (monosodium glutamate or MSG) that is known to intensify skin inflammation symptoms.

Avocado is a nutritious addition to your diet, however is a known source of amines or histamines and has itch-promoting salicylates that might aggravate your symptoms.

Tomatoes and tomato-based goods, such as tomato ketchup and spaghetti Bolognese, are not recommended since they are high in salicylates and amines (histamines) that are considered natural MSG.

8. Tamari or Soy sauce

Amines and MSG are abundant in soy sauce and other sauces such as tamari and marinades- both natural or artificial. From a Japanese study published in the Journal of Dermatology, consumption of soy sauce, fermented soybeans, chocolate, cheese, coffee, and yogurt can worsen eczema symptoms. However, after three months of avoiding these foods, all of the participants' eczema symptoms were significantly decreased.

9. Deli Meats

Deli meats, such as sausages, ham, bacon, and flavoured meats, are heavy in nitrates, flavour enhancers, and saturated fats, all of which are known triggers to cause a flare up in eczema and may slow the healing of topical steroid withdrawal. Devon, meat pies, and salami contain salicylates, amines, and MSG/glutamates.

10. Wheat

People with TSW can be susceptible to wheat, and in particular, gluten.  Wheat and wheat-based products can aggravate itch and topical steroid withdrawal skin since they can be highly irritant to the body. Wheat-free options include gluten-free oats, rye, and barley for individuals who do not mind gluten. Rice, quinoa, and buckwheat are all gluten-free alternatives.

11. Junk Food

Junk food, particularly coloured lollies (sweets) and chips (crisps), often contain artificial colours and flavours and MSG and other artificial flavour enhancers. In addition, it is largely acidifying due to its high sugar and fat content.

12. Alcohol

Alcohol can be a huge trigger to inflammation

• has a dehydrating effect on the body generally, but also on the skin, which is already an issue in eczema sufferers
• dilates blood vessels making the skin itchier, drier, more inflamed and more uncomfortable
• depletes stores of nutrients, such as B-complex vitamins, and blocks the action of vital vitamin C.
• introduces substances that can trigger inflammation such as sugar and wheat and which worsens eczema
• can damage the liver which makes it harder for the body with an impaired immune system to process allergens, leading to more frequent flare-ups
• makes it harder for the skin to regenerate and repair itself, accelerating ‘ageing’ and skin damage and making eczema flares more frequent and harder to heal from
• can led to poor decision-making over health (ie what you eat, how you manage your emollients etc)

Eczema Diet

When it comes to eczema diet, it is always trial and error. The challenge is identifying and determining which food is good for you and will not trigger any symptoms. Every individual has a level of tolerance and allergies that changes as time goes by.

Here are recommended anti-inflammatory food which could be suitable for people with TSW:

Anti-inflammatory foods

The key is to fight the inflammation in your body and skin.

• The Mediterranean Diet is a popular diet that is rich in vegetables, fruits, whole grains, and healthy fats like olive oil
• Fish is a natural source of omega-3 fatty acids. It fights inflammation in the body. Examples are mackerel, sardines, salmon, albacore tuna, and herring.
• Broccoli - if you are not sensitive to salicylates
• Spinach- if you are not sensitive to salicylates
• Kale- if you are not sensitive to salicylates
• Reddish-coloured fruits like:
  • Blackberries
  • Cherries
• Unrefined whole grains like:
  • Unrefined wheat
  • Oatmeal
  • Brown rice
  • Beans

Vitamin C is a natural combatant of eczema, as it helps to prevent metal absorption. Foods high in vitamin C include:

• papaya
• carrots
• sweet potatoes
• strawberries
• kale
• cauliflower

Elimination Diet

An elimination diet refers to removing particular food in your diet that can cause allergic and sensitivity reactions. For example, removing dairy, eggs, gluten, processed foods, and refined sugar could help. There is a variety of how you can do this diet. For example, you can eliminate one food at a time or remove all potential food that causes reactions in your body.

When someone removes all these foods at once from their diet, they are usually reintroduced into the diet one by one over a timeframe of weeks. The most extreme version of this diet is a complete elimination diet.

It can take multiple weeks to identify the effect of removing a specific food because the process involves elimination and reintroduction. However, it is always appropriate to consult with your doctor first since this diet can remove vitamin-rich foods that are vital for your health.

As you eliminate certain foods from your diet and then reintroduce them slowly, you will be able to identify which foods are causing unpleasant reactions in your body. The option is either removing them entirely for long-lasting relief.

Extreme food elimination diets received mixed reviews - where wide-scale, long-term food elimination diets have been known to lead to vital nutrients removed from a persons diet. Excessive elimination diets can lead to calcium deficiency, vitamin deficiency, severe weight loss, and protein malnutrition. Due to these negative effects, the American Academy of Dermatology (AAD) recommends keeping a food journal to identify patterns in symptom flares in relation to certain foods, and then eliminating only one or two suspected foods at a time for a period of 4-6 weeks as opposed to a broad elimination diet.

More research is needed to determine the benefit of elimination diets, and at what level of elimination they could be the most helpful. As mentioned earlier, it is important to talk with your doctor or healthcare provider before starting any elimination diet on your own.

Food Anxiety and Phobia

By all means, the above information is NOT prescriptive and each person's nutrition requirements are unique.  Anxiety and food phobia are commonly experienced by people with topical steroid withdrawal and eczema. Stress is a known factor to cause inflammation in your body so please treat the above information as an example of what others have anecdotally experienced with food and eczema.  It is important to remember that every person is the unique, with their own individual intolerances and allergies.
Time heals all.  Although TSW is different from eczema, the main goal is the same – to speed up the healing process and reduce inflammation in the body.

Progress Over Perfection

Sticking to any diet or meal plan is not easy. It is okay if your day didn’t go as planned. It is an ongoing process – progress over perfection. The key is to build positive habits to make food choices that you know work best for your own unique personal healing. Nutrient-dense natural food instead of processed junk food will help reduce inflammation in your body. It is advised to consult with a medical professional before attempting to remove any major food groups which can result in nutrition deficiencies.