steroids – Preventable: Protecting Our Largest Organ

IID Conference 2018, PART 1

This past week, Kelly Barta and I attended the International Investigative Dermatology Conference in Orlando, Florida. Kelly is the new President of ITSAN, the International Topical Steroid Addiction Network. We had met on two other separate occasions, so I trusted the week would be filled with both fun and advocacy.

On Wednesday night, we entered the Rosen Creek Hotel dressed in our best and hoping to mingle. To say the conference was packed is an understatement. Doctors and researchers from around the world were stuffed into the open buffet and bartended area, chatting and greeting old friends. We figured out there must be around 3,000 people present. Our mingling strategy was a no-go since there was not much opportunity to interject into already matured conversations between colleagues. We however caught up amongst ourselves and shared our thoughts of what we expected, what he hoped would come to pass, and how to best utilize our time at the conference. Kelly had already set up a fabulous booth in the poster presentation room and all we had to do now was make an impression.

Thursday was our first long day of the ‘marathon’. With Kelly being such a warm and intelligent conversationalist, I would leave her to man the booth while I attended some of the smaller poster sessions and mini symposiums. I was interested to see what else was happening in the field of dermatology surrounding the skin (that perhaps could intersect with our advocacy). There were LITERALLY over 1500 posters being showcased, all with different research topics. Quite overwhelming for an onlooker who didn’t understand every facet of research or jargon being used. The only place I felt confident was at the Atopic Dermatitis presentations.

That night, before the IID shuttled us off to The Wizarding World of Harry Potter, we had a large lecture on Pathoimmunology and Management of Atopic Dermatitis. There were 4 different speakers: Emma Guuttman-Yassky, Jonathan Silverberg, Eric Simpson, and Amy Paller. They are some bigger names in the AD community. Many topics were discussed during this blocked period, most of which were echoed and further looked at in other sessions. One is the two main categorized causes of AD: The INSIDE-OUT, and the OUTSIDE-IN. The former comes from a Type 2 response in the body (like allegories) and all the different IL pathways. IL stands for interleukin, which are certain glycoproteins responsible for immune response. There are many ILs that seem to play a role in AD and other autoimmune issues, such as psoriasis. The latter cause stems from our epithelial barrier and innate immunity– things like filaggrin, which are what help seal out allergens and irritants from entering our bodies.

One huge element I took away from the lecture was “AD (atopic dermatitis) IS REVERSIBLE AND IMMUNE DRIVEN”. That word, reversible, is a word filled with hope. So many patients have heard doctors tell them that they will be on steroids for the rest of their life because eczema is incurable. But, if we can find a way to reverse the damage, it will be a day of joy. I truly hope in the next decade we find out how little we will ever need to prescribe steroids since we will have found safer and more effective drugs that target the causes of our symptoms, not just the symptoms themselves.

At one point, when they were discussing statistics (adults with A.D.: 7%/Children: 15-20%), they were not sure why A.D. was becoming more persistent into adulthood. All I could think in my head was: steroids. If patients are being treated constantly with steroids, some are sadly going to be in the steroid-induced eczema column. They also gave statistics on our lack of sleep and teetering concentration throughout our work days. 90% of sufferers said they experience sleep loss 1 night a week. 50% said they experience sleep loss 5 nights a week! What a large number!

The hottest topic however was new treatments being studied or already in trial for helping relieve patients with atopic dermatitis. The one we already have available in the United States is Dupixent (Dupilumab), which is an injectable treatment that targets IL 4 and IL 13, two culprits in AD inflammation. They are seeing it help around 50% of patients (noticeable to massive improvement), and studies that even show improvement in filaggrin production.

The drugs that are in phase trials going on are the following
(name of drug: the IL it targets):
Tralokinumab: IL 13
Lebrikinumab: IL 13
Mepolizumab: IL 5
Nemolizumab: IL 31RA receptor
ANBO2O: IL 33
Tezepelumab: TSLP
GBR830: OX40.

So many!! And these are just the monoclonals (or also known as biologics). You may be wondering why we have so many IL targets that differ, and it’s because not only can many play a role, but different ethnicities have issues with different ILs. One drug may work wonders for one person, but it may not help another very much. Doctors and researchers are doing their best to tackle this puzzle.

Something I did not enjoy hearing about with these trials however is that many allowed steroid use. So, when you see the number 68% in the placebo group, it’s not because it was just a psychological improvement, but because they were using steroids when needed. How are we supposed to know the efficacy of a drug by itself if steroids are also being used in tandem? Not all trials but too many to count are allowing this. Nevertheless, it still seems to be helping some individuals who are now off of steroids because of it. That is a plus.

Another stellar branch they are trying to utilize is bacteria. It has become apparent that Staph aureus (Staph au.) plays a part in irritating atopic patients. Many doctors present spoke about the need to keep antibiotic-resistence at bay, so this new study (hopefully going to be conducted within this year) is going to be using good bacteria to try and combat the bad bacteria. Different strains of bacteria are able to fight against Staph au. and a couple in particular will be in the trial (I am not sure exactly the one that will be in the trial, but I believe it will be Staph hominis or Staph epidermidis). Exciting times!

At the end of the lecture, Eric Simpson allowed us to partake in an electric quiz. He gave us a scenario and then asked us (mind you us meaning a room mostly consisting of AD dermatologists or researchers) to answer a few questions surrounding what treatment route we would take for the patient. So, this patient in particular had used plenty of steroids, the scenario even including that he had taken oral rounds of steroids. Now, this patient is coming to see you — Your first step at the new office would be?

a. Repeat course of oral steroids
b.Consider patch testing
c. Start ustekinum
d. Biopsy

The majority of us (including myself) put B — patch testing. However, 16% answered they would do ANOTHER round of orals. Right there, in that room of maybe 100 people, that many jumped straight to the easy go-to that was obviously NOT working. It blew my mind since the % for answer “a” should have been 0%.

Then, he gave us a new scenario (I can’t remember all the criteria), but his first question was “You think the patient has AD. Your first line treatment for this condition would be”: and 58% stated topical steroids. It is still very much the go to, first line treatment. I was sad to see this, but this is what is taught. And it doesn’t make me sad because I think steroids are evil — that’s not my thought process. It makes me sad because when they are given steroids, it is most likely going to be for a much longer prescription than advised by the FDA guidelines (which is around 2-4 weeks of use). However, I was pleasantly surprised/perturbed by the next question: “He fails aggressive topical therapy, what is your next form of treatment?” Great, right! He is saying if the patient fails the first prescription, you move onto the second and not keep the patient on steroids forever! But, vaguely, what does “aggressive” therapy imply? Quick but super potent dose? Excessive use of steroids at different potencies? That part did catch me off guard. And his answer for the question was Phototherapy. I wish that would be considered as first line treatment and not steroids — but it can be impossible for a patient to do since it requires coming in 2-3 times a week for a short burst of UV treatment. Inconvenience, cost, and slower progression in skin repair is NOT what we want (or can sometimes even have as an option). We want the RIGHT NOW, which is steroids. They are quite the temptation. But that was the ending of the conference day, educational wise.

During the day on Thursday, while I was out scouring the posters and soaking up as much lecture information as possible, Kelly did a stellar job networking! I am in awe of her skills. She has a knack for starting conversation and speaking fluently with any stranger. She was able to talk with a few different doctors who were aware that steroids were not the chronic bandaid patients should be dawning, and thankfully she had a wonderful talk with two women from the Psoriasis group! Plus, a plethora of individuals came by the table checking out ITSAN case studies printed out in a binder, ITSAN brochures, and even USB drives with the case studies loaded on them. I’d say it was a pretty successful Thursday! Plus… Universal Studios!

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(stay tuned for Friday and Saturday)

Also, I am not on ITSAN’s board and do not speak on their behalf. We are both advocating for the same cause and I am honored to be working beside them in raising awareness.

Feature #33: Mel & Heather

Mel Lynch

Age: 37

Career: Teacher

When did you cease using topical steroids: October 2013

What type did you use: I used pretty much every sort for over 30 years. Including eumovate, betnovate, fucibet, dermavate, betnovate scalp treatment and lots of courses of oral steroids too.

What was your favorite product for comfort? When my skin was at its worst, I would spend most of my life in the bath. I used Dead Sea salts in my bath and always moisturized. I also used zinc cream to ease redness and swelling. I also found comfort using bandages especially if my skin was oozing.

What was the hardest thing to deal with during this condition? At times the pain was unbearable and I hated being unable to move and being stuck in my bed or the bath all day. But the very worst thing was not being able to hold or cuddle my daughters. My youngest was a month old when I started tsw so I spent the first 2 years of her life being ill on and off. Very depressing but she doesn’t remember! My eldest was very good when I was ill. She is 8 now and doesn’t like to talk about it or see pics of me when I was poorly. It definitely had an impact on her.

What is the first thing you will do when healed? I consider myself close to being healed, the thing we did first was go on a family holiday. I do enjoy being able to take my girls swimming … that was something I couldn’t even do before tsw as my skin would never be clear. Now it’s great to be able to show off my legs!

Heather Lee

Age: 26

Career: Currently in my last year of nursing school

When did you cease using topical steroids: October 2015

What type did you use: Desonide, hydrocortisone, triamcinolone, as well as dexamethasone injections and tons of oral prednisone .

What is your favorite product for comfort? Aquaphor and Zinc Paste

What is the hardest thing to deal with during this condition? I started nursing school at the same time I started TSW, it’s hard trying to take care of patients and having them ask what’s wrong with you. At times I was in the hospital taking care of others when I felt I should be in there myself.

What is the first thing you will do when healed? Travel! I already travel a lot but it’s hard to fully enjoy it with TSW. My dream is to go to Iceland and not be worried about my skin cracking open

NYC Mount Sinai Integrative Medicine Conference

New York City is one of my favorite places, so when I was informed by Henry Erlich that this conference was being held in the Big Apple, there was no hesitation in buying a plane ticket.

The conference was this past weekend, May 13th-14th. I was only able to attend the primary day. However there was plenty of information to be absorbed. My main reason for going was to hear the prestigious and awe-inspiring Dr. Xiu-Min Li spill her knowledge on allergic disease, ASHMI, and her take on Red Skin Syndrome. She will be one of the doctors I humbly get to interview for the documentary this summer, and I am stoked! Such an amazing woman whose research I know will change the way we treat eczema in the next decade. I see a Nobel Prize in her future.

Dr. Li has a phenomenal opportunity while working at Mount Sinai, bringing together both Western and Eastern medicine in a clinical setting. No Western doctor will be able to deny her results and her rigorous efforts to show how wonderful Traditional Chinese Medicine can be (and is!) for our growing allergy and eczema problems.

Besides Dr. Li, there were a plethora of doctors participating, some even flying all the way from China. We had headphones and a translator present in order to understand everyone speaking.

At the bottom, I will be posting a video of Dr. Li’s talk and all that I was able to film. Sadly, I was told we couldn’t video anything so I wasn’t prepared. It was only very late the night before that I was told I was misinformed. I did my best filming with my heavy camera and old phone while trying to listen. It’s a bit shaky, so I apologize. It had been down pouring that day, which soaked my shoes, so most of the conference I was bare foot, attempting to sit on my feet in hopes of warming them up in that already frigid auditorium room.

But here are a few highlights from the conference:

1st Speaker: Susan Weissman

Her son, Eden, had horrific allergies, asthma, and skin problems. She found Western medicine was not helping their son improve. She is an avid promoter of Dr. Li’s work and is happy to say her son is finally able to enjoy life because of her protocol. She is the author of Feeding Eden, a memoir about raising Eden with all of his serious health problems. I think the most profound thing she mentioned was her question to Western medicine doctors: “How do we treat the entity of allergic disease?” Medicine seems to be extremely narrow-minded instead of looking at the body (or a condition) as a whole.

2nd Speaker: Dr. Xiu-Min Li

She gave a brief oration before her longer one at the end of the conference. The merit of her work is astounding and she emphasized how necessary it was to be able to show how TCM brings results that Western doctors can believe in and not have them be able to dispute them as “false” or “not supported.” All of her work has to be proven through science.

4th Speaker: Shi-Ming Jin, MS

*Apologies since I skip over a few speakers* I loved how she spoke about how the integrative world is striving to be more innovative and adaptive to Western world medicine in hopes of showing how TCM is helpful and important in giving patients relief.

8th Speaker: Jing Li, PhD, FDA Botanical Review Team

Basically, there are FDA guidelines/guidance for using botanicals (herbs) in medicine. They are tested in clinical trials just the same as Western medicine, so they are treated equally. It can not be written off. A demonstration of quality control was given, and how they wish to minimize any chemical, biological and pharmacological variations to obtain consistent drug substances.

10th Speaker: Ke Xing Sun

He gave a speech about how using TCM is about keeping harmony in health with our whole body working together as a unit. We are individual people with individual needs, something Western medicine does not always provide. We should be more patient-centered with medicine. He also advocated health in daily life, reiterating how prevention is key.

11th Speaker: Arya Neilson, PhD

*She was a stellar speaker* She deals with acupuncture and the benefits it can give to certain patients, even those with eczema. One of the most interesting things was how this type of treatment post-surgery can help with opiod sparing since we, in the US, take up the vast percentage of opiod use around the globe. Opiod abuse it sky high and having this available is quite a remarkable treatment. Acupuncture is now even included by Western doctors in some therapies! When it comes to allergies and eczema, there was a study done to show how dust mite IgE levels were down regulated after using acupuncture, and how itching was reduced in eczema patients. However, acupuncture is more of a rescue therapy for patients and herbs should come first in eczema treatment. (She is featured on the video)

12th Speaker: Scott Sicherer, MD

He spoke eloquently about his field in allergy/immunology in babies and what could be causing such an exponential climb in allergies these past few decades. No one is for certain, but he feels having exposure to the skin could be a factor. For some reason, there has been found to be peanut dust inside of homes, which is where skin contact could become an issue. If babies have eczema, they are at a higher risk for allergies. He would use oral immunotherapy to try and desensitize the allergy, hoping to eradicate or raise the threshold. Scott touched upon using biologics (omalizumab) for some cases for 20-22 weeks (it’s an anti-IgE), but he says it doesn’t mean it’s going to be any more effective (just perhaps speeds the process).

14th Speaker: Rachel Miller, MD

Rachel continued to speak on allergies and issues in infants and children, focusing a bit on pregnant woman. She showcased how if a pregnant woman is under stress, her child is more likely to have wheezing. She also explained how methylation and DNA does play a role in some of these areas and how Dr. Xui-Min Li’s protocol, ASHMI, has shown good results in pregnant mothers.

16th Speaker: Anna Nowak-Wegryzn, MD

She gave a very in-depth speech about allergies and infant treatment. When she mentioned starting oral tolerance as early as 1 year old, a question popped into my mind. If we can detect and start to treat allergies at that age, why is it that Western doctors are so quick to lather steroids on a baby, but claim they can not test for allergies until about 3 years old? That’s something that I feel should be addressed. When it comes to peanut allergies, she said she personally thinks using boiled peanuts instead of baked are safer to use for desensitization without losing efficacy.

** Funny side note** Dr. Xiu-Min Li came up and asked a question during Q&A. She asked it in Chinese, and the speaker answered back in Chinese. Everyone asked what was said so Dr. Li offered to translate. She started to do the translation, but didn’t realize she was still speaking in Chinese, so someone stopped her. She didn’t realize she wasn’t speaking English. We all had a laugh.

18th Speaker: Julie Wang, MD

She spoke about a drug trial (See pics below)

20th Speaker: Dr. Kamal Srivastava, PhD

One of his best and to the point notes was that IgE is central to the pathology of allergic disease. Another subject he touched on was FAHF-2, which is another herbal formula much like Dr. Li’s ASHMI. Berberine, an herb, is the most potent at reducing IgE levels, and can even help lower glucose. However, it is very badly absorbed taken orally, so they are trying to make it more effective (perhaps, adding to a molecule).

22nd Speaker: Dr. Ying Song, MD

23rd Speaker: Anne Maitland, MD, PhD

She studies Mast Cell Activation Disorders. Anne used the Great Wall of China as an analogy, how it’s not always effective for keeping the bad out. Mast cells can release different things, like histamine or tryptase, and just like a police call, you want to send the correct team out to help for the correct situation. She also touches on how when we figured out how to decrease certain bacterial-based diseases (like Measles), hypersensitivity disorders increased (like allergies). Naps, apparently, are something we need more of to help with stress (which I totally agree!).

24th Speaker: Julia Wisniewski, MD

She spoke about our skin barrier and how we shouldn’t use alkaline soap on baby skin. The best thing she mentioned however was that at the latest AAD meeting, she saw a slide that said steroids do, in fact, have the ability to cause allergic reactions in patients. Near the end, she spoke about Vit D and how it’s definitely important for our bodies.

The last two speakers were Tiffany Camp Watson, the mother who gave her testament about using Dr. Li’s protocol, and then Dr. Xiu-Min Li herself! They are both on the YouTube video speaking. Most of the video is of Dr. Li speaking. After 6:30 mins, it is all Dr. Li and her presentation.

I hope this was informative and I can’t wait to have all my equipment in to shoot these upcoming interviews! 2.5 weeks to go!

Feature #32: Kirk

Kirk Robertson

Age: 19

Career: Self employed Personal Trainer (currently on hiatus)

When did you cease using topical steroids: 29th of December 2016

What type did you use: Eumovate

What is your favorite product for comfort? Dead sea salts

What is the hardest thing to deal with during this condition? Not being able to build my business or build on my plan of becoming a professional natural bodybuilder

What is the first thing you will do when healed? Train with my girlfriend and go out for a meal with my family. Followed by an overdue night out!

Interview #14: Danae Kirtley

Danae Kirtley

Eureka, California

1.When did you start using topical steroids? And why?

I started using topical steroids by recommendation from my family practitioner in an effort to treat my childhood eczema, starting at about age 10.

2. What was the name of the topical steroid?

To begin with, my parents and I were advised to use over the counter Hydrocortisone cream (.5-1%) liberally, to any and all rashy areas of skin. Was also advised to apply like lotion after every bath or shower as a “prevention method” even if my skin was not affected by eczema.

3. Were you ever prescribed more potent steroids?

Yes. After a few years of using Hydrocortisone cream and my problem areas had spread and become more vigilant; I was given a trial tube measuring a few ounces of Elidel. After that didn’t work and burned my skin, I was prescribed Triamcinalone ointment, which I rarely used because I hated the texture, greasines, and how much it burned my skin.

4. How did you find out about RSS?

I found out about RSS after researching online desperately for the cause of my worsening symptoms. After using Hydrocortisone cream twice daily to my face, and 3-4 times a week on my entire body like lotion for 10 years- My body had seemingly given up. I couldn’t suffer anymore, and I needed answers. I found ITSAN and there began my diligent research.

5. What made you feel you had RSS?

What had made me feel like I had RSS was that once the information was before me- I just knew. I had never thought that anyone else had suffered the same symptoms and had suffered so uniquely as I had. I read the many testimonials, medical documents, blogs, vlogs and more from people all over the world with the same story I have.

6. Were you diagnosed by a doctor? Did you have a supportive doctor?

I was not diagnosed by a doctor, however- my General Practitioner was very supportive. She was just as baffled as I was at my chronic, increasingly debilitating symptoms. She agreed that the amount of exposure and absorption of steroids I had was alarming. We came up with a plan to taper down my usage and to meet more regularly so that she could monitor my symptoms and keep track of my progress. All the while, she had ordered many different blood tests to rule out any other autoimmune diseases, disorders, deficits in nutrition and more. Nothing of relevance to explain my symptoms came up with as many tests as we did.

7. What were your first symptoms?

My first symptoms of Eczema began as early as preschool years, between ages of 5-6 years old. My inner elbows and back of my knees were always dry, sensitive and itchy. After the first year of using Topical Steroids, my rashes had spread all over my arms, legs, and had begun manifesting on my face, neck and chest. My body would erupt into bright red, inflamed skin, that would burn like I had never experienced before and itch deep within my subdermis within one day of not using Topical Steroids. It had become a begrudging truth that my body NEEDED the application of Steroids daily, and for years, to maintain any semblance of normality. All the while, my health declining. What initially caused me to research the symptoms of long-term use of Steroids, was my rapid decrease in weight, my eyesight, worsening skin condition, and hairloss.

8. Is your family supportive? Friends?

For the most part- Yes. Once I had done about 3 months of personal research, and had already been to a multitude of appointments with my GP, and Ophthalmologist, I created a plan to introduce my and my doctor’s findings with closest family and friends. I asked for their support and provided opportunity to allow them to ask their own questions, express their concern and understanding. Several of them completely agreed that withdrawing from Topical Steroids would be in my best interest long-term. Many of them came to my aide in the best ways they could, be it care-packages of sterile gauze, feeding and helping me with personal care, or stopping by to spend time with me while I lay in bed for those many many months of disability.

9. Have you ever been to a hospital for this? Why?

I had been to the hospital for blood-tests, I had considered going to the ER multiple times when my symptoms were so severe that I was in and out of consciousness because of the extreme amount of pain I was in. Thankfully I was under the care of family and my Fiancee, who all did their best to comfort me and do everything they could to surround me with love and support. The possibility of being administered Steroids in addition to any much needed pain management medication had I gone to the ER- was too much of a gamble against my progress.

10. What has been the hardest part of this condition?

Besides the incomprehensible amount of pain that I endured(and endure still from time to time), is the decline of my mental health. Being suddenly thrust into Disability and not having a definite time-frame for healing and success is taxing to say the least. I was often alone, with my own thoughts, while being unable to move and bedridden. I became unable to look at my own reflection as the person I had always been and seen looking back at me was gone. I didn’t recognize myself, and being unable to function in a physical capacity only fed into a Dissociation type state even further. I was in a very deep Depression along with weeks of insomnia. To this day, my anxiety and difficulty relating to others in social activities still is of great difficulty for me. I continue to challenge myself in positive ways. However it feels as though I am forever changed, mentally, because of this illness.

11. How long have you been in withdrawal?

I started tapering my usage of Steroids under my General Practitioner’s guidance in the very beginning of November 2014. I started my full withdrawal after my birthday in December 2015. On the day that I am writing this, it has been 817 days since my last application or administration of Steroids. I am not yet ‘healed’, however, I have made a tremendous amount of progress. I went from being completely unable to perform the smallest tasks for myself, like sitting up in bed. Brushing my teeth, or walking at times… to now being able to walk, work part-time, I do daily house chores, and even present as a normal person from day to day. I have bad days, but they don’t knock me down nearly as bad as they used to.

12. What do you use as comfort measures during this?

I listen to lots of music, I play music myself, I have been catching up on all the shows, and movies I have missed throughout the years. I drink tea and have many contemplative moments, writing, and lots of snuggles. Sometimes I am inconsolable, but the truth in those moments are that they are always temporary- as my best friend and beloved fiancee has said since day one of TSW, “Maybe Tomorrow…” Which to us, means: Tomorrow may be a better day, it may provide better or different opportunities to be fulfilled, or more able. It is a phrase that instills Hope, even when things feel or seem very dark, it will always get better.

13. Are you employed? Has this affected your job status?

I have now been employed after a 2 year absence in the workforce, for 5 months! This means a lot to me as I have always worked hard and enjoyed being employed. Being affected by TSW still provides interesting challenges at work for me. Thankfully my Manager and coworkers are all very understanding and are more than willing to make exceptions or take on tasks in order to keep me comfortable. I am very thankful and humbled by my ability to work with such supportive people. Sometimes I have to sit, while I am on shift, as I get very dizzy and disoriented after standing for hours. Sometimes I have to take an additional break to relax, or coworkers have had to come in as a replacement for my missed shift because of a ‘Flare-up’ that inhibits my ability to perform my duties. I am pleased to share that my strength and physical duress has improved over the past 5 months and I only hope to continue getting better.

14. Have you gone to therapy/wish to go to therapy because of this condition?

Yes, I would very much like to go to Therapy because of TSW. I have all of the classic markers of PTSD from this condition, and because of the extreme amount of mental stress I endured. I have had a resurgence of mental symptoms and new ones (that I do not wish to share), that do get in the way of my daily activities because of TSW. The amount of trauma and pain that we all go through with this condition is absolutely extraordinary and severe.

15. If there is one thing you could say to another sufferer, what would it be?

IT GETS BETTER. It may feel like this pain will last forever, but it does not. I remember that hopeless feeling very very well- but we do get better and I am proof of that.

Thank you for such a terrific interview, Danae!!!!!

Feature #30: Kristen

Kristen B

Age: 21

Career: ECE/ Nanny

When did you cease using topical steroids: Feb 19th, 2017

What type did you use: Hydrocortisone, Ellidel, Protopic

What is your favorite product for comfort? Ice Packs, Aquaphor, burning my arms when itchy

What is the hardest thing to deal with during this condition? Having to re-home some of my pets, the draining of my self-esteem, having to go to bed with multiple ice packs and a fan since I can’t fall asleep otherwise, and the financial hardship having to spend tons on remedies.

What is the first thing you will do when healed? I plan on working out, eating whatever I want and not having to worry about a flare, go out with my friends, play with all my animals again that are making me flare up, and just enjoy life in general again.

Interview #13: Nina Nelson

Nina Nelson
Darien, CT

1. When did you start using topical steroids and why?

I first had eczema as a child but really didn’t use anything for it other than Keri lotion since my parents believed it was just something I had and there was no “cure.” Around 8^th grade it disappeared. It reappeared when I was 30 and pregnant with my first child. The top of my hands became very itchy. The doctor didn’t want to use topical steroids, so he prescribed Protopic. At first Protopic worked beautifully but after a week, it started to burn and make my skin even redder, so I stopped using it. My hands got better on their own.

2. What was the name of the topical steroids?

Protopic.

3. Were you ever prescribed more potent steroids?

After the birth of my daughter, my eyes became very itchy and red. I saw ophthalmologist after ophthalmologist. They diagnosed me with dry eyes and ocular rosacea. The eye drops (Restasis and over the counter wetting drops) they put me on didn’t work. So I saw a specialist from Yale. He tried the same things the other did…in addition to antibiotics ointments in case it was conjunctivitis. Still my eyes didn’t get better. In fact, they got worse. Finally, the doctor put me on a compounded steroid ointment. Didn’t help. We moved on to steroid drops. This whole eye thing went on for about 2 years. After awhile, he said he didn’t know what to do and that he didn’t want me on the steroid drops any more. I didn’t either, so I stopped.

That’s when the skin rashes started. And I saw dermatologist after dermatologist. And allergists. And gastroenterologists. And naturopaths. And acupuncturists. And neurologists (lupus).

Through it all, I was prescribes topical steroids, oral steroids, and steroid shots. From low potency to high potency, for my face, my scalp, my arms, my hands, my legs, I’d walk in and doctors would say, “Whoa, first we need to get rid of this flare with a steroid shot/round of prednisone, then once we get you back to normal, we’ll get you on some creams.” Of course it would work, until the steroid shots/pills wore off and then it would start all over again. And I kept trying different doctors thinking maybe THIS one will have the answer. Nope.

4. How did you find out about RSS?

One day I was googling online and I don’t even remember what I was googling…itchy rash on face/hand/shoulder maybe, and I saw an image of a girl with red circles around her eyes and a “muzzle mouth” just like mine and I thought, “That looks just like me.” When I went to the page, it was the ITSAN site and the more I read, the more I realized that this is exactly what I had…what NO doctor had been able to diagnose me with—even the best-of-the-best-who-other-doctors-referred-me-to-who-didn’t-take-insurance-experts in New York.

5. What made you feel you had RSS?

When I read the symptoms and the history and saw the pictures of all the other people who were going through this, the similarities were too many to ignore. With every new bit of information or every video, and every study that was linked to that site, I kept saying, “This is me. This is me. This is exactly what happened with me. Oh, my God. I know what I have. I’m addicted to steroids.”

I was actually excited. Excited that I finally figured out what it was after all these years of knowing something wasn’t right but not knowing what it was. Excited that there was a cure. And I was ready to stop steroids that minute.

6. Were you diagnosed by a doctor? Did you have a supportive doctor?

I was never diagnosed by a doctor. I had compiled a book of the past 12 years of medical visits, prescriptions, and pictures of me in various stages of flares and when I took them to my GP she looked at them and listened patiently to what I had to say. She said she didn’t think I was over prescribed or that the doctors did anything wrong, but she believed me and was very supportive in my decision to quit steroids and said that she would support me in any way to help me get through this. This included prescribing a low dose hydroxine for the itch and the insomnia and an anti-depressant if I got too low. The hydroxine didn’t really work for me and I never filled the anti-depressant prescription, but I was so grateful for her time, patience, and response. For the first time I felt like I was being heard and taken seriously.

7. What were your first symptoms?
Itchy eyes and then an itchy rash on my face, my scalp, and all over my body.

8. Is your family supportive? Friends?

Yes, although there were some definite rough patches in my marriage

I think the hardest part is that without an “official” doctor’s diagnosis, the withdrawal is not taken as seriously as it would be otherwise.

Obviously, we are sick…we look sick, but I don’t think people realize just how sick we are—on the inside as well as the outside. They don’t realize how exhausted we are from the damage done to our adrenal system and the lack of sleep; how our confidence is gone because we look and feel horrible; how we are in a physical and mental state of torture because of the itch, and the nerve zings, and the sweats, and the cold chills, and the above things I already mentioned. There is no WebMD site to go to that explains that this is absolutely debilitating and patients need time off work and from family responsibilities to heal.

There’s no rehab center for steroid withdrawal like there is for other drug addictions, or pamphlet to hand to family and friends that explains what to expect.

And I felt guilty that I couldn’t be the wife my husband married, or the mother I used to be. But I also put my foot down and stood up for my health and myself. I demanded the time and the rest and the passes from a lot of things and this created friction. I spent huge amounts of money on dead sea salt and water for daily (sometimes twice daily) baths. But I believed so strongly in this diagnosis and my body’s ability to heal and I knew all I needed was time.

And that’s the second hardest thing about this fight…it takes a long time and that’s hard on spouses who are also losing out on time and life for an illness that is not even recognized by doctors.

But yes, my family was supportive. I hid out mostly from society at the beginning. I was so embarrassed that only my closest friends knew what I was going through. Even after I went public on FB and shared my pictures, my story, and all the links with people so they could share with others, I tended to be less outgoing than I used to be.

But that’s gotten better as my skin has gotten better and more time has passed. Now, I go out all the time even with a flare. Who cares anymore? Judge me, don’t judge me. I’ve been to hell and back; your opinion doesn’t matter to me.

9. Have you ever been to a hospital for this? Why?

No, I was lucky. I never had to be hospitalized. I kept infection at bay by taking Dead Sea salt, apple cider vinegar baths. And I’ve gotten cold sores since I was a kid, so I have a backup stash of Valtrex to turn to so I never got eczema herpeticum.

10. What was the hardest part of this condition?

Phew. I have to pick one thing? I’d say not having the energy that I used to before I got sick. The brain fog was tough too…I wondered why I didn’t have the mental clarity. I guess the hardest part was not being my best person and feeling like I was missing out on life because of it.

11. How long have you been in withdrawal?

I will start my 28^th month on Jan 18^th, 2017, so I have 2 years and 3 months behind me. I began November 19, 2014. Every morning I put a big X through the day before as I marked the days off. It gave me strength to see all those crossed off days.

When I discovered RSS, I was on the first day of a 3-day shoot for a popular sleep aid commercial—I was playing the role of the wife of the man who couldn’t sleep. I tried to stop the topical steroids that day, but my skin immediately rashed up and my husband said, “Nina, you can’t do this to these people. They’re paying you to look good. You have to take it for the next three days.” He was right; I had a professional obligation not to show up looking like I fell into a patch of poison ivy, so I sparingly used the topical steroid until the last day of the shoot and then I stopped cold turkey.

12. What do you use as comfort measures through this?

Dead sea salt baths have been my oasis. I’ve done 20 min DSS baths since day one and am still doing them. I also did moisture withdrawal up until about 3 months ago. Now I feel my skin is healed enough that I use an essential oil mixture on it: jojoba, geranium, lavender, frankincense, myrrh, carrot seed, pomegranate, Vit E.

I also competed in 2 triathlons during this and I know the swims in the ocean and the pool helped to dry out the ooze. I think yoga helped with the detox and the running helped with the lymphatic system…not to mention all these things helped with my mental state. It gave me some power and control over my limited lifestyle. I itched like crazy during the workouts but I felt stronger afterward.

Rest. When I felt exhausted, I knew my body was going through a big healing push, so I slept. I felt so guilty sleeping during the day, but I knew it’s what my body needed, so I dealt with the guilt. I still got up every day with the kids for school, but sometimes I’d fall right back into bed after they left.

13. Are you employed? Has this affected your job status?

I was a commercial print model and actress so yes, I had to book out with my very-understanding agent this entire time. She’s been a big champion of mine and I’ll return to it when I’m sure I’m better. The good thing about commercial modeling/acting vs. fashion is that you never get too old—you can always do denture, arthritis, and grandmother commercials. ;D

I’m also a writer, so I was able to do that from home—although the brain fog was a real butt-kicker.

Because of having to give up the modeling, I ended up picking back up with a past job of mine, which is teaching hydrofit classes. I’m teaching twice a week at my local Y and loving it. It gets me out of the house, pays me, and gets those endorphins going…all things that are vital for my happiness.

14. Have you gone to therapy/wish to go to therapy because of this condition?

No, but only because several times daily, I turned to the ITSAN and Topical Steroid Withdrawal Facebook pages for comfort. Just hearing about other people going through the same thing I was made me feel less alone during this. Posting on my own FB page helped as well. Social media was my therapy.

15. If there is one thing you could say to another sufferer, what would it be?

Stay strong. Head down and do what you need to do to make yourself comfortable. Eat healthy; sleep as much and as often as you can. Listen to your body, it will tell you what you need. Keep living, but above all, be patient and know that even if you can’t see it, your body is healing every single day—on the inside and then on the outside.

Sorry, I know that’s more than one thing.

Thank you so much, Nina! What a wonderful interview!

Feature #27: Donna & Whitnee

Donna Marinkovich

Age: 42

Career: Mum and recently back to my old life (especially since skin is so much better) but part time, art dept for film/tv in NZ

When did you cease using topical steroids: December 15th 2015, as soon as I had read the ITSAN site.

What type did you use: I wish I’d paid more attention but mixed in there was hydrocortisone, elidel, elocon sporadically on and more so off for over 30 odd years.

What is your favorite product for comfort? Ice packs particularly at night for the itch. I didn’t use any products during the early months (1-6) as did moisturizer withdrawal, but since my skin took a turn for the better I have been using Avene products, namely the spring water spray and Xera calm moisturizer.

What is the hardest thing to deal with during this condition? Physically – the insane itch can drive you pretty crazy, the trance of the itch-scratch cycle is all consuming. The skin flaking. Just the general pain, discomfort and constant awareness of how your skin feels so foreign and sore and alien. Mentally – not knowing what’s really going on, the doubt about whether you’ll ever get better (you do though!) As the healing is not linear, eventually one day you may have calm skin, but the next it feels like you have regressed again with no rhyme or reason, so you have to dig deep to accept and just surrender to all this on some level. I am still trying to practice this 15 months in. Trust is a big one, that your body knows what it needs to do to heal. I am humbled by those whose journeys with this are really tough.

What is the first thing you will do when healed? I couldn’t wait to hold my baby against my bare skin and not have it make me uncomfortable or anxious or itchy. The healing was so slow to unfold, but I felt elated when I saw glimmers of my ‘old skin’ again, and so grateful for my body and what its been through. It was awesome to not feel super self conscious of going out in public and showing my face. To feel the anxiety ease off a bit. And every time I settle from a flare, even though it’s only for a day or so, I am still grateful my body can get there and hopefully will one day stay there.

Whitnee Springfield

Age: 25

Career: Creative Designer – had to leave work due to TSW

When did you cease using topical steroids: 01.20.2017

What type did you use: Hydrocortisone, escalating to daily use of Betamethasone and Elecon. Also had 3 month course of oral steroids and Tacrolimus

What is your favorite product for comfort? Avene Cicalfate Restorative Skin Cream has significantly improved my face and neck which were super tight, dry and flakey with slight oozing

What is the hardest thing to deal with during this condition? Due to debilitation I have had to move across the country to live with my mum to care for me. This means I don’t see my fiancé often and we have had to postpone our wedding. I miss him terribly.

What is the first thing you will do when healed? Marry the love of my life and return to my passion as a live performer (singer songwriter).

Feature #26: Casey & Tammy

Casey Pratt

Age: 39

Career: Associate Professor of English

When did you cease using topical steroids: I stopped using all steroids on May 10, 2016

What type did you use: I used Desoximetasone .25% ointment, Triamcinolone .1% cream, and Clobetasol .05% solution

What is your favorite product for comfort? Dead Sea Salts and a basic zinc-oxide cream. And Instagram #tsw

What is the hardest thing to deal with during this condition? I’ve seen a lot of people talk about how hard the “not-knowing” is, and how hard it is on families (thanks for helping Mom & Dad) —that’s all true. But for me, the hardest part was the horrendous itching and sleeplessness. It was like being possessed by a demon.

What is the first thing you will do when healed? The first thing I’ll do when I’m healed (this question makes me cry) is play in the ocean with my wife and young daughters. I missed them so much while I was laid-out. Then I’m going to have a word with my dermatologist.

Tammy

Age: 42

Career: Administrative Assistant (but had to take 5 months sick leave from work due to TSW)

When did you cease using topical steroids: September 3, 2016

What type did you use: Clobetasol

What is your favorite product for comfort? Epsom salt baths, glaxal base cream, zinc cream, tea tree spray with peppermint

What is the hardest thing to deal with during this condition? When I was at my worst, I would have to say the pain of my skin was unbearable everyday. The open cuts, swelling and the constant itch was so hard to deal with. Missing out on so many events and limited time with family and friends.

What is the first thing you will do when healed? Spend the day at the beach, and swim in the ocean

Feature #25: Iylah-Rose

Iylah-Rose

Age: 5 and a half years old

Career: Just started school this year (currently manages to attend 50% of the time, and homeschools the other half due to TSW)

When did you cease using topical steroids: March 11, 2016

What type did you use: She started on over the counter low doses in 2014 sparingly (Dermaid, Hydrocortisone Acetate 1%, mild potency), before being put onto moderate potency betnovate 1/5, cortival 0.02%. It would clear for a few days and she’d be pale white, before her skin would erupt in eczema worse than it was previously and she’d be put onto antibiotic cream (bactroban ointment) and a round of internal antibiotics (usually cefalexin) to settle what had turned into a skin infection.

This cycle continued for a few months, while she became more allergic to foods and environmental factors.

We finally got her in to see a reputable dermatologist and she was then put on further antibiotics, potent steroids- Eleuphrat (x2 daily for 4 days with 3 days break, the rebound flares in this 3 day break were horrid for her), Tacrolimus 3% (immunosuppressant protopic – we were told by the derm that this was better for her face because it didn’t have steroids in it, after which I questioned why I couldn’t just use it all over her body instead and his answer was “because it’s too expensive”, it was $50 for a 30g tub, it didn’t last long, we had no idea it was an immunosuppressant!), the next appointment her dosage was upped again, and we were told to keep up with the creams 3x a day for 7 days OR UNTIL IT CLEARED (this was after explaining how horrid the flares were when we stopped for her 3 day break as prescribed in the previous appointments).

She was already showing all the symptoms and signs of RSS, we had NEVER heard of it before, but knew she was getting more and more unwell, this was Dec 2015 and she could no longer eat anything (even her safe food of chicken and rice would cause a facial flare that was similar to that of the beginnings of an anaphylactic reaction) During this time, she had been given oral steroids 3 times in emergency (the latest being january 2016 after she ate half an orange and had painful hives for 48 hours straight).

By February 2016, she was no longer well enough to attend daycare, she was constantly covered in blood and sores, unable to sleep, needed her ventolin puffer twice daily, her IgE levels were 10 thousand times above the normal range and we decided with our GP to trial 6 months removal of steroids as all other triggers had been eliminated. When we contacted our derm and told him our decision, he ceased all contact with us.

What happened next was beyond hell. That’s when we found itsan.org and it all clicked! I remember being so happy we found the solution and thought, a few months is going to be hard but we can do this… after 6 months I remember promising her by summer she would be better, when summer came I promised her by next summer she will be better…

What is your favorite product for comfort? It has changed during the months, to start with she could not stand any water and we sponge bathed her a few times a day, she also spent the first few months in soft pj’s and resting as she had no energy. We did full GAPS with her to heal her gut, this was hard but she was so sick and so reactive she didn’t mind having soup every day (and gummies!). Then, by month 3, the only place she was comfortable was in the tub, the water had to be hot and she would stay in there for hours, sometimes up to 6 hours a day. She would watch movies in the bath, eat her lunch in the bath.. we spent a lot of time in the bathroom! This was her main comfort for months, and the only way to ease the constant crippling itch attacks and keep her body clean as her skin was raw and open with ooze, and again it was pj’s everyday, we even had day pj’s and night pj’s! She was wet wrapped all over to stop her from sticking to her pj’s, and her face was bandaged to keep the open rawness protected (even the wind would sting if she went outside)

By month 8, she was showing signs of healing and was finally seen by the specialists at the Children’s hospital, they applied for IVIG therapy for her (Intravenous Immunoglobulin) and this started in month 9 TSW, she has the infusion monthly via cannulation, and she absolutely hates the needle but when I ask her now what makes her feel better – she says her medicines from her needle. She has improved ten fold in the last 4 months, and although the hospital hasn’t agreed to her being in TSW (she is considered as severe eczema) it has been a godsend in helping her move forward, she was even able to start school this year! There was no way she was able to leave the house for more than 45 minutes a few months ago with out having a complete crippling itch attack, so it’s comforting that her immune system is on the mend.

What is the hardest thing to deal with during this condition? Not being able to play, to run, to jump, to go to school, to dance, to do sport, not being able to be normal like before steroids.

What is the first thing you will do when healed: Go to school full time! – Iylah

When we can afford to, we will be taking our family on a much deserved holiday! To the sunshine, to enjoy the water, the sand and the sun without any pain xx

Interview #12: Torrin Bennett

Torrin Bennett

Denver, CO

1. When did you start using topical steroids and why?

Torrin started at about 4 months for eczema. Small patches first seen on his upper lip and back.

2. What was the name of the topical steroids?

He was first prescribed hydrocortisone.

3. Were you ever prescribed more potent steroids?

Yes, over the next 8 years of his little life he was on and off of these steroids. Also, under occlusive wrappings (Wet Wrap Therapy for his last two years)

Hydrocortisone, Betamethasone Diapropionate .05%, Desonide .05%,Fluticasone Propionate .05% (external cream),Fluticasone Propionate 50mcg (nasal), Qvar 80mcg,Triamcinolone Acteonide .1%,Qvar 40mcg,Elidel 1%, Fluocinonide .05%, Fluticason Propionate .0005%, Mometasone Furoate .1% (cream), Mometasone Furorate .1% (ex ointment), Mometasone Furoate .1% (ex oint), Protopic .03%,Pulmicort 1mg (inhale), Qvar 40mcg.

4. How did you find out about RSS?

On September 11, 2014 I was researching hemp oil (anything to “cure” him) on Amazon. I was told to check out a few sites in that review and ITSAN.ORG was one of them. As soon as I read the signs and symptoms, I knew without a doubt Torrin had RSS.

5. What made you feel you had RSS?

He was full body red, extreme itchy, dry/flaky skin, water burned and stung him.

6. Were you diagnosed by a doctor? Did you have a supportive doctor?

Yes, his pediatrician listened and read the ITSAN material. Then to just educate her on RSS and/or if we needed any medicines, we confirmed the RSS diagnosis with Dr. Rapaport via telemedicine.

7. What were your first symptoms?

Before we knew it was RSS, Torrin already showed signs of TSW ( “bad dandruff”, dry/flaky eyes and skin, redness, sensitivity to heat and water. When we stopped all steroids on 9/12/14 within a few days he became really red, itchy all over. His legs were swollen and could barely walk. The horrible “pins and needles”.

8. Is your family supportive? Friends?

Yes, our family was supportive. Friends were supportive but many just dwindled away and stopped asking to do things (because we couldn’t). We had no life for 2.5 years, basically.

9. Have you ever been to a hospital for this? Why?

Yes,about 28 months in I took him into Urgent Care because his arm looked like eczema herpeticum. Thankfully it was not.

10. What was the hardest part of this condition?

Everything! Watching your child itch himself till he was bleeding, the pain that followed, “pins and needles”, water like acid on his skin, watching his friends go to school, play sports, vacations, swim etc. We went from a very outgoing, athletic family to holed up inside their prison home for months and years.

11. How long have you been in withdrawal?

Since September 12, 2014, 29 months. Torrin is still in withdrawal and has flares on his wrists, knees and feet but nothing like on or after steroids. He was able to bathe and swim after 1.5 years into withdrawal.

12. What do you use as comfort measures through this?

At first baths and Aquaphor for 6 months into TSW. After that he chose moisturizer withdrawal so no bathes and very little Lemongrass Balm from Stephanie Home Apothecary and Honeypacificaco.com. Also, ice packs and fans.

13. Are you employed? Has this affected your job status?

I have always stayed home with my boys. I only worked part time but had to give that up to take care of him 24/7. Our family, unlike many others, were financially stable.

14. Has this affected Torrin’s education?

Yes! He missed all of 4th grade because he was bed ridden. I homeschooled him online last year and some of this year. He went back to school on 2/1/17. He was also held back a grade.

15. Have you gone to therapy/wish to go to therapy because of this condition?

No, we have not gone. Torrin seems to be doing fine and adjusting at the moment. Me, I’d like to go since I have been experiencing depression, anxiety and PTSD.

16. If there is one thing you could say to another sufferer, what would it be?

Sometimes just allow yourself to just lay there and breathe if that’s all you can do at the moment. Sometimes that’s all I could do as I laid on my bathroom floor at 2am crying because I watched him go through so much pain.

FAITH in God, HOPE that he will heal and the LOVE for my child is what got me through each day.

Thank you so very much for sharing your story, Torrin!

Feature #24: Taylor & Blair

Taylor

Age: 26

Career: Homemaker

When did you cease using topical steroids: December 9, 2012

What type did you use: I’m unsure of all the names: topical steroid creams, Ellidel, and a round of herbal pills that contained steroids

What is your favorite product for comfort? Shea Butter

What was the hardest thing to deal with during this condition? Not being able to perform daily tasks because it was too painful to outstretch my arms or turn my head. Feeling self conscious in public or when meeting new people.

What was the first thing you did when healed? Wore short sleeves! Played outside in the heat with my two little boys.

Blair Dunkin-Salley

Age: 21

Career: Unemployed due to TSW soon to be a Licensed Esthetician

When did you cease using topical steroids: September 1, 2016

What type did you use: Locoid Lipo cream on and off since ’15, Fluonicide .01% for body for 8 months, 3 injections, and 1 round of Prednisone

What is your favorite product for comfort? Sticking my head in the freezer and Aloe Vera from a plant

What was the hardest thing to deal with during this condition? When I had a Staph infection on my face and arms for over 3 months and did not know it, and showers. Showers are torture.

What was the first thing you did when healed? Get a job at a Spa, wear short sleeved EVERYTHING, take long warm baths, and wear make up whenever I feel like it! Also I’m going to continue to be very out spoken about TSW in the Esthetics community, and hopefully develop a skin care line that specializes in the treatment of TSW, Eczema, Psoriasis, and Dermatitis related conditions of the skin; or maybe even opening my own spa with a TSW rehab package on the menu. Sky’s the limit!

Danae Kirtley

Nina Nelson Darien, CT

Torrin Bennett

Nina Nelson
Darien, CT