28 Months TSW

Twenty-eight months after stopping topical steroids (TS), how can you tell the difference between topical steroid withdrawal (TSW) and “just eczema”? We in the TSW community ask this all the time, as do some dermatologists and other doctors who can’t believe that TSW could last so long. I agree: How in the world could TSW possibly last this long!?!?

That’s why we’re asking dermatologists and researchers to study TSW in children and adults who are going through this lengthy withdrawal-healing process. They could gather lots of valuable information from the TSW support pages, pictures, and blogs and interview the affected adults and caregivers of children who are going through TSW. From this they could create a picture of this iatrogenic condition and formulate hypotheses on which to conduct more formal research.

I’m not complaining, mind you, or saying, “Woe is me (Brian),” because Brian pretty much has his life back, and skin care and itch management is part of our routine. I just want answers.

My questions to doctors and researchers who believe TSW is just eczema are these:

  1. Does eczema cause full-body, visible, measurable flaking and shedding of skin? TSW does. The pictures below show just the skin that shed overnight.
  2. Does eczema cause full-body erythema/flushing at one moment then return to normal-colored skin the next, then back to flushing again? It still happens now–28 months after stopping TS.
  3. Does eczema result in plasticky “elephant skin”? It happened early in TSW and it’s happening now, more than 2 years after stopping TS.

    4. Does eczema result in “red sleeves” in  arms/wrists and/or feet/ankles? TSW does.

    5. Does eczema result in heat radiating from the body at night like and TSW-ooze-smell sweating? Still going on most nights.

    So, if these signs and symptoms are not TSW and not eczema, what is causing this continued manifestation of signs/symptoms that were present in the early months after stopping TS? Is it just the long-lasting adverse effect of TS use?

    AND if doctors and eczema researchers have seen eczema that presents like signs/symptoms 1-5 above in their patients, are those patients using topical steroids? If so, then how can one definitively say that these signs/symptoms in the patients were NOT caused by TS?

    Food for thought and questions to ask your healthcare provider next time. . . .

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Life after eczema herpeticum. . .Getting through the challenges of Winter weather… Spring is right around the corner…Current regimen/treatment follows the pictures below…Don’t let TSW keep you down!  Look Beyond the Itch!

“I have set the LORD always before me. Because he is at my right hand, I will not be shaken. Therefore my heart is glad and my tongue rejoices; my body also will rest secure.”                        Psalm 16:8-9

2/1/16

2/1/16  Morning

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1/30/16

1/30/16  Night time

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1/30/16 night time

1/30/16

1/30/16

Goals: To keep the skin clean, hydrated, and infection-free; itch/scratch management

Treatment: Twice a day shower/bath followed immediately by application of either coconut oil, sunflower oil, or lemongrass balm/Zinc balm combo or a combination, depending on the condition of the skin. Wet wrapping (WW) both ankles and tops of feet at night with filtered water and dry sterile dressing; WW wrist and hands as needed if they are excessively dry or have open areas.

Vitamins: B complex, 4000 iu D3, Zinc, 2 Nordic Naturals fish oil capsules

Itch/Scratching: varies between 0/5 to 2+/5 scratch scale (see Log), stress scratching; benadryl PRN, ice packs, moisturizers (sunflower oil, coconut oil, aquaphor, and/or The Home Apothecary’s lemongrass balm), itch-B-gone spray; deep breathing and relaxation techniques, CBT, acupressure points

Function: Excellent! All A’s in honors classes, playing basketball, practicing and conditioning for baseball, x-box, RC cars, able to get up and ride bus to school with friends.

Look Beyond the Itch!

 

Plugging along at 20 months TSW

A few minutes ago, Brian called me from a friend’s house asking if he could stay for a sleepover. I said, “How do you feel?” He said, “I feel great!” I said, “OK, what do you need?”

Ahhh. Finally! a short, sweet conversation without TSW being the focal point of decision making. A few weeks ago, that would have been a “Not yet” because he was still snowing like a blizzard (shedding skin) and scratching hard enough to disrupt sleep. We’d discuss the shedding, sheet changing, clothing, skin care, bathing, scratch management, moisturizers, etc. My understanding but disappointed son would walk away praying for better days.

Maybe they’re here. Since school ended 2 weeks ago, his feet have been improving and the scratching has overall decreased. We’re hoping he’ll have a nice “skin and itch break” like he did last summer.

6/16/15

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more feet pics

May 17, 2015

May 17, 2015

June 17, 2015

June 16, 2015  compared to–>

Brian missed most of 5th grade due to TSW. This year, he completed 6th grade with perfect attendance and all A’s for the year. Itch or no itch, he’s going to have an A+ summer as well!

Don’t let TSW keep you down!

6/12/15 last day of 6th grade

6/12/15 last day of 6th grade

“Blessed is the man who perseveres under trial, because he has stood the test, he will receive the crown of life that God has promised to those who love him.” James 1:12

A little break from shedding, but those feet are a real ITCH….

One would think that after 19.5 months of TSW the full-body shedding would have stopped. Completely. NOT! Well, it did from TSW months 6-9, but it came back, steadily increasing to a flurry over the winter months and, finally, this past week we’ve seen a measurable decrease.

It has decreased from about a teaspoon of nightly shedding a few months ago to  1 teaspoon 1 month ago and to about 1/8 teaspoon today. 19.5 months TSW. This is very encouraging, but I won’t put my teaspoons away just yet. 🙂

Measureable shedding started 2 months TSW 12/7/13

Measurable full-body shedding started 1.5 to 2 months TSW 12/7/13  (This is just what was on the sheet in the morning.) 

 

More skin!

More skin January 2014!

 

7/29/14--Chicken Champs!

7/29/14–Summer break from shedding

After no shedding months 8-12,  RETURN of the dreaded measurable shedding at 14 months TSW! 12/2/14

Steadily increasing in quantity to ….

Almost 1 teaspoon at 15 months TSW   1/10/15

Almost 1 teaspoon overnight shedding at 15 months TSW 1/10/15

1/2 teaspoon overnite shedding 18 months TSW 4/15/15

1/2 teaspoon overnite shedding 18 months TSW 4/15/15   (Spoon sizes: 1 tsp, 1/2 tsp)

1/8 teaspoon shedding overnight at 19.5 months TSW

1/8 teaspoon shedding overnight at 19.5 months TSW (Spoon sizes: 1 tsp, 1/2 tsp, 1/4 tsp)

 

And those FEET…well, they continue to be a real ITCH! Dr. Rapaport says itching means healing….

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19 months TSW    5/17/15     Erythema decreased slightly. Multiple excoriations due to scratching.    

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5/17/2015

5/17/2015

Must be a whole lot of healing going on!  Thank you, God, for fingers to scratch the itch.

“Blessed is the man who trusts in the LORD, whose confidence is in him.” Jeremiah 17:7