Adrenal Fatigue

Topical Steroid Side Effects

  1. Question 1: I’ve never heard of Adrenal Fatigue Syndrome – but I must have it because I’m always tired.  How will I know if I have it?
  2. Answer 1: If you’ve taken steroids for an extended period of time, which the manufacturers claim to be 2 weeks at a time, then you probably have adrenals that are a bit confused. They are asking you if you still want them to do their thing and produce their own cortisol. When you keep applying topical steroids, you are SHOUTING AT THEM IN ALL CAPS, and they are easily offended and take it personally. They shrivel away and actually do get a bit smaller! How crazy is that?
  1. Question 2: How can I jumpstart my adrenals naturally and on my own?
  2. Answer 2:  If only it were that easy to get jumper cables and zap those adrenal glands back to life!  It will take time. It requires a strategic plan of educating yourself first. This is where you’ve got to take control of your health.
  3. If only there was a way to hold you hostage and make you read the book, SKIN CONFESSIONS. Before you go to an endocrinologist that may prescribe an indefinite thyroid medication and says, “you’ll have to take this the rest of your life…”  Will you know why?  Will you even consider asking why? What about alternatives? Will you consider other options?
  1. Question 3: What are some of the symptoms?
  2. Answer 3: Symptoms could include, but are not limited to, the constant feeling of low energy to full-blown exhaustion, insomnia and erratic sleeping patterns, joint and muscle pain, low blood pressure and temperature, insatiable salt cravings, hypoglycemia and a higher level of pre-menstrual syndrome symptoms. Sometimes food sensitivities and allergies develop as a result of a low immune system threshold and higher level of triggers that stress the body even further.

Question 4: Where do I begin to find out if I’m at risk adrenal fatigue or adrenal insufficiency?

Answer 4: A great endocrinologist is a must and the starting point for testing. Please remember endocrinology is one of the most complicated specialties of medicine and your search to find a talented endocrinologist should be a top priority. Look for one that specifically subscribes to the theory that AFS/AFI actually exists.

From there, begin the more comprehensive tests that reflect more of what’s going on beyond the initial blood test. It requires a saliva test in the morning for an extended period of time to help create a pattern of data to identify peaks and valleys of cortisol production and/or lack thereof. There is also a hormone balance issue that needs to be interplayed with that data. Temperature readings also help play a role in understanding hormone fluctuations with a woman’s menstrual and ovulation cycle.

The next step is to arm yourself with the test results and work out a strategic plan to not cause further fatigue or insufficiency. Find the root cause of the adrenals going into snooze control. Was it stress from school, job or relationships? Was it a traumatic incident? Could it have been a negative reaction to a medication like steroids? These are all part of the investigative journey that a diary would help you with to backtrack and plan forward.

Another great resource for Adrenal fatigue is www.DrLam.com. He has an extensive library of publications, books, and videos. On this website, you can deep dive and start your education and weigh your options and go in prepared!

  1. Question 4: What are adaptogenic treatments?
  2. Question 4: In the natural herb world there are certain types of compounds  like adapt-o-genic herbs can adjust and “adapt” to the amount of the herb it releases to accommodate your needs. Ashwagandha, mushrooms, and Ginseng are among those miracle adaptogenic species of plants/herbs and medicines that do wonders to help rebalance hormones.
  3. It may seem intimidating to venture into this vast unknown world, but the first step is knowing the basics about your body and your immune system. The rest is easy if you know where to look. Please be advised that even these need to be well-researched beforehand to fully understand their potential. The point is that there are vast options to explore. Do not limit yourself to the first opinion. Second and third opinions are absolutely a must when it comes to endocrine recovery.

Contact dermatitis

Topical Steroid Side Effects

Question 1: My baby had a rash and now it’s getting worse when I apply the medication…Why?

Answer 1: Many parents witness this, and it can be attributed to the actual preservatives in the medicine itself. As with all medicines that appear to worsen, discontinue and refer back to your medical practitioner.

Question 2: What options do I have for my baby’s worsening rashes?

Answer 2: This is the most frustrating time for new parents. A wild scavenger hunt to discover what could be causing inexplainable rashes is so difficult. From laundry detergents and soap to changing from a trusted brand name to another feels like a drop in the ocean of things that could be the cause. But you must persist.

In the book SKIN CONFESSIONS, there are case studies about baby wipes and a commonly used preservative that not only caused a baby’s negative reactions, but the parents developed contact dermatitis from using it with their bare hands. The preservative could be the cause of a baby’s delicate genital area getting inflamed. Then add fuel to the fire and get a prescription for the irritation and voila – the medicine has the same or similar preservative trigger to another flareup! What a nightmare…No one would have thought that to be the case and suspected the medication to further exacerbate the problem. But yes it does happen.

Question 3: Isn’t the area already more vulnerable? Answer 3: Yes and that’s why treating with alternatives are an important consideration. A Vitamin E & D emollient with Zinc oxide can help. ELAJ Emollient happens to be loaded with those ingredients and because it is an oil-based emollient, it is water and urine proof as well. Basic corn starch also is an alternative to the powdered and fragrant baby powders.  Air, oxygen and a bit of sunshine help too! www.ELAJnaturally.com

Growth Retardation

Topical Steroid Side Effects

Standard disclosure on package insert of prescription topical steroids:

“Like all steroids, fluocinonide may slow down the growth rate of children and teenagers. Contact your child’s healthcare provider if you are concerned about a slow growth rate in your child. In general, children may be more susceptible to side effects of steroids. Close monitoring is necessary for any child receiving long-term steroids in any form.

For the higher strength of fluocinonide (Vanos), it is not recommended to use the product for more than two weeks at a time. Although the drug is highly effective, it should not be used on a long-term basis.

Question 1: How do steroids affect my child’s growth potential?

Answer 1: They slow down the endocrine system which is responsible for creating its own growth hormones. There is also more mineral depletion and that directly affects bone density and growth. In adults and elderly that is considered osteoporosis, but for children, it is a serious consideration and should always be monitored closely by your doctor and yourself.

Question 2: How can I offset the effect of topical steroids on my child who needs this medication?

Answer 2: Follow the manufacturer’s recommendation of STOPPING every 2 weeks. The body needs rest periods to allow the skin, adrenals, and the rest of the endocrine system to jumpstart itself back up to continue doing its work.  You have to shock and pause every few weeks. Please get a second and third opinion if a doctor tells you to keep using topical steroids “continuously as needed” or to use more without a full strategy in place.

KEEP A DIARY of when and how often you are applying the steroids.  Note how extensively you are applying based on time of day or night and on how much body surface and the quantity used. That will really make a difference.  If you use more than 2 gms. at 2% strength of topical steroids on 20% of the body (arms) for 2 weeks, you are already risking adrenal suppression. That’s all it takes.

In some cases, where the skin is already thin (face, trunk, genitals) it may take less to absorb more. If the skin is open, sores and with lesions, then most likely, your child will be absorbing far greater than the doctor’s recommended dosage based on standard situations.

Question 3: If my child has asthma and takes a steroid inhaler, does that double up his intake, and should I be worried?

Answer 3: Being able to breathe normally is non-negotiable and top priority. However, there are now new inhalers that have very minimal or no steroids becoming more available. Express your concerns with your child’s pediatrician. Ask for more information on how to balance the cumulative effects of both. Again that diary will become immeasurably valuable when you discuss a precise health strategy with a caring team of medical practitioners. 

Fetal Risks

Topical Steroid Side Effects

Question 1: Why did I get a prescription for topical steroids for my eczema when my doctor knows I’m pregnant – is it safe for my baby?

Answer 1: Maybe your doctor thought they could nip it in the bud with a short, quick dosage to give you relief. The severity of the case must be weighed in relation to the risk. The risks have still been under scrutiny for over 30 years.

Question 2: What do the medical studies show about risks to the baby?

Answer 2: There are conflicting reports on this depending upon the studies. The results could have different conclusions based on different ascertainment of exposure. Variations of application, quantity and potency can make significant differences of fetal reception of the dermal absorption.

Another study in Norway reports, “In sum, the association of maternal corticosteroid exposure with oral clefts has been addressed in a range of large and relatively well-designed epidemiologic studies. The fact that a preponderance of reported associations have been positive may reflect publication bias. Still, it is not possible to exclude the possibility that corticosteroids present some underlying risk to the developing fetus. Our own attempt to clarify this question in two large studies has only added to the conflicting information. At this point, we can conclude only that a causal effect cannot be dismissed completely, and that if causal, corticosteroids could explain only a very small portion of oral clefts.”

In contrast, another case-control survey of 48 children with non-syndromic orofacial clefts, claiming a significant increase in the prevalence of maternal use of topical corticosteroids in the first trimester of pregnancy compared with 58 controls born in the same hospital.

“…maternal exposure to potent or very potent forms shortly before and during pregnancy was significantly associated with fetal growth restriction and was confirmed by a significant dose-response relationship.”

In summary, researchers are still conducting more studies. Until then, caution is the best option.

Question 3: I heard emollients help eczema around 67% more than topical steroids – is that true?

Answer 3: There’s been a lot of recent research that does suggest that emollients are better at retaining skin’s moisture barrier than normal moisturizers that are diluted with water and contain alcohol, preservatives, fragrance, and other toxins. So, yes – research has shown emollients do better, and the added benefit is they are typically safer without the side effects! The National Eczema Association also states, “Correct use of emollients can reduce the need for topical corticosteroids.”

Question 4: Why don’t more people know about emollient use and why didn’t my doctor tell me that first?

Answer 4: Recently studies have introduced the use of emollient therapy as a viable alternative to topical steroid therapy and now education of how to use emollients is getting pushed to the stage.

Their conclusions were:

A community-based multifaceted educational support programme greatly increased emollient use, reducing symptoms of atopic eczema and general practitioner contacts, without increasing cost. Significant benefits may accrue to the families and carers of children with atopic eczema due to improved sleep patterns and greater feeling of control.

Education of parents and children with atopic eczema is now recognised as one of the most important interventions in the management of atopic eczema.

“Parents and carers of children with eczema often underuse emollient therapy, essential to repairing and protecting the defective skin barrier in atopic eczema. Educational interventions delivered by specialist dermatology nurses in hospital settings have been shown to improve emollient use and reduce symptoms of atopic eczema, but benefits of community-based interventions are uncertain. Support and information about appropriate care may often be inadequate for patients and carers in the community.”

Question 5: Is there actual evidence that educating patients on emollient use has direct benefit and actually helps reduce symptoms?

Answer 5: As part of a trial about atopic eczema education to parents of children and adolescents with atopic eczema, the results were significantly positive. Through a nurse-led educational intervention, the increase of emollient usage was 800% and resulted in 89% reduction the severity of the atopic eczema.

Question 6: What is an example of an emollient that has shown good results?

Answer 6: ELAJ Emollient has been in use for over 70 years around the world. It was introduced in the United States in 2008 and has become a popular resource to help alleviate the intense dry, itching flareups of eczema and psoriasis. More information can be found at www.ELAJnaturally.com. The founder of this company, Suhein Beck is the granddaughter of Dr. M. A. Bchihalouk, a Circassian doctor that formulated this and other medications originally for wound care. It was completely accidental that Suhein discovered ELAJ helped with eczema and other serious skin conditions. 

Weaker Immune System

Topical Steroid Side Effects

Question 1: Why am I constantly getting sick now?

Answer 1: Because your immune system took a hit. Corticosteroids substituted your natural body’s immune system with a synthetic-grade and now your body feels weaker because it can’t produce its own cortisol.

Question 2: How do I regain my strength and rebuild my precious immune system?

Answer 2: That’s a loaded question. The book, SKIN CONFESSIONS dives deep into that journey of discovery and self-care.  That book is 10 years worth of jam-packed research  to help you take control of your immune system and never let anyone rock your boat again.

Until then, the TOP 5 Immune-Boosting Tips are:

1. Give up sugar and alcohol. (Non-negotiable)

2. Sleep!

3. Early morning walk, mild exercise, preferably in nature.

4. Re-strategize diet and quality of food.

5. Surround yourself with loving relationships.

Psycho-Dermatology

Topical Steroid Side Effects

Question 1: I’ve heard of “road rage” but what is “‘roid rage?”

Answer 1:  The word “roid” comes from “steroid rage.”  Although the term was originally specific to anabolic steroid abuse, the concept has more recently begun to be used with general corticosteroid usage, including topical steroids.

Question 2: I feel like I’m another person, and I get out of control so easily…is that normal?

Answer 2: As part of steroid adjustments in the body, yes, that can be a side effect. However the extent of the rage needs to be checked. In the cases of body-builders and weight-lifters who abused anabolic steroids, there are documented cases of extreme “‘roid-rage.” In topical steroids it has not been documented as well due to overall lack of reporting. However there are various forms of emotional distress, anxiety, sleep deprivation, and temperament control. 

Question 3: What other emotional/mental symptoms are there?

Answer 3:  Anxiety, aggressive behavior, sleep disorders, depression and even suicidal tendencies can develop as a result of the imbalance of hormones from steroid misuse.

Question 4: How can I control my emotional health when I’m dealing with so much physical anguish and embarrassment of my skin being so bad?

Answer 4: Unfortunately, dealing with the inner non-visible part of your health can get neglected or side-swiped for the more immediate external visible side to your health. However,  they go hand-in-hand. Sometimes the root source of the dermatology problem stems from psychological/psychiatric problems that manifest on skin. So by denying the emotional/mental health variable, you could be missing the key factor that could make the healing journey easier and shorter. The relationship between skin and the brain exists due to more than a fact, that the brain, as the center of psychological functions, and the skin, have the same ectodermal origin and are affected by the same hormones and neurotransmitters

  1. Question 5: Where can I get help?
  2. Answer 5: There is a new field of medical specialty called, “Psychodermatology.” It connects the two disciplines of psychiatry dealing with the internal non-visible struggles with the external visible diseases of dermatology. At these crossroads one can find valuable resources that intersect and can help reduce various symptoms and quite possibly, discover root causes of either problem, or both.
  1. Question 6: Are there steps I can take to administer self-care to myself?
  2. Answer 6:  There are valuable life skills we can all gain by learning. If we could reduce our stress levels by immediately practicing simple breathing techniques, time outs and walking away from temporary surges of stress, the better our body will react. Our immune system would not go into overdrive each and every time.  That, in itself, could make a huge difference. 
  3. What if we don’t turn to sugar and/or alcohol for compensation? What if we didn’t splurge into a pint of ice cream with each heartbreak? What if we alternated our habits into taking a walk in a park with green trees? What if we sat in our car in total silence deep breathing or singing at the top of our lungs? What if we gained a higher spiritual sensitivity?  The key is to identify the baby steps that can lead to better habits that reduce overall psychosomatic symptoms.
  4. Beyond our basic survival instincts to self-medicate, we must always remember we are social beings that need others. Asking for help is not a sign of weakness. It is a sign that it’s time to grow and recover. That takes strength.

The importance of understanding the psychological relationship of skin, mind and emotional health can not be disregarded. Assessing the whole is absolutely integral to maintaining the highest possible level of quality of life under difficult circumstances.

Emotional Instability

Topical Steroid Side Effects

In 1956, the movie, Bigger than Life was made about a man that needed a life-saving surgery and was offered a new experimental drug, cortisone. After a successful operation, and thanks to the steroid drug, he soon became addicted to its miraculous anti-inflammatory and pain-reducing capabilities.

With his remarkable recovery came extreme psycho-somatic side effects to the corticosteroid drugs. The miracle turns into a nightmare for his friends and family threatening their safety and stability. The tagline for the film was, The story of the handful of hope that became a fistful of hell!

Aside from the fact that this film was way ahead of its time and hailed as a masterpiece – and one of the best American films ever made by some critics – and was able to spark legitimate controversy about mental health and addictions, the film bombed both financially and in popularity.  Maybe it was too far ahead of its time? Maybe there was a conspiratorial shuffle to diffuse attention from the drug itself? There are some theories that the pharmaceutical industry pulled some strings to downplay its debut. Interestingly, the film portrays an often familiar practice of doctors reducing their responsibility by blaming the patient’s misuse of the prescription as noted here in the advertisement.

Photo Credit IMDB

Many eczema and psoriasis patients corroborate the same story. The community of patients in private Facebook groups have shared stories over and over of dermatologists and general practitioners prescribing topical steroids in ways that contradict the manufacturer’s warning label. When the patient is told by the doctor to apply “as needed”, “generously”, “apply and wrap with plastic to cover entire areas “, there is far greater potential serious harm. In fact, these instructions accelerate adrenal fatigue and endocrine disruption which can take years to recover.

This form of addiction is far greater than a drug/alcohol addiction that can be biologically detoxed in an average of 20-30 days. The hormone imbalance created by both systemic and topical steroids has far-reaching effects that are not known by the general public. Within the topical steroid addiction/withdrawal community we are still witnessing these warriors struggle past the 5-6 year mark of recurring red skin syndrome flareups.

Skin conditions alone are enough to create an emotional upheaval and break the strongest person down. Add to that the hormonal imbalance that steroids can create and it is a powerful storm brewing. Every action causes an exponential reaction.

They don’t appear at first because they are almost always hidden away from the more obvious adrenaline rush of stress or biological battle up front. The subtle, slower reactions are the ones to watch out for as the dust settles. Aggression and anxiety can appear with no trigger. Be on the lookout and seek help for any tendency of emotional distress.

Please consider the full health consequences of mental and emotional well-being when making decisions about steroidal use. The withdrawals can be severe. The signs can be misconstrued and misunderstood.  Suicidal tendencies are a serious consideration for those that have severe cases of eczema and topical steroid withdrawal.

A support circle of friends and family is integral for the recovery process. However seeking professional help of therapy and is even more important to keep a balance of emotional. Please see the next chapter on psychiatry in dermatology.

Sleep Disruption

Topical Steroid Side Effects

Question 1: Why do steroids disrupt my sleep?

Answer 1: Stress loves to sneak up and destroy your chances of sleep. You know what else loves to ruin a good night? Steroids. Yup. Good luck with that. Here’s the cruel joke though. Steroids have been known to increase fatigue. So they make you more tired, but but then they also read havoc on your natural circadian rhythm.

Oh and that vicious cycle of not sleeping causes more stress, thereby increasing skin flare-ups. Sometimes when flare-ups get out of control, a hospital visit may inspire a higher dosage and possibly the big boy – Prednisone. That one is especially guilty of causing sleep disruption. Some doctors suggest taking it at night because it takes so long to kick in and that helps offset some of its so-called disruption effects. But if you are prescribed a double whammy of two per day, just know that you need to protect your sleep like a bear preparing for hibernation.

Question 2: How do I avoid my sleep from getting messed up?

Answer 2: Focus on your natural circadian rhythm hormone. Try to maintain regularity in sleep preparation time and slow down your evenings at the same time. Relaxation methods do help. You can try taking melatonin.

Read the new book by Arianna Huffington, The Sleep Revolution, to inspire quality pre-sleep habits. The book offers a fresh perspective on the many ways to eliminate sleep disrupters from our lives. It awakens the need to consciously avert the insanity of sleep deprivation.

Sleep is your top priority! It really is one of the Top 5 things you can do to reset your immune system. The second priority is to discover what that original cause was that threw you into a downward spiral to need steroids in the first place. What caused the eczema, psoriasis or any of those original text messages onto your skin?

Question 3: Where can I find the answers to that original message from my skin?

Answer 3: Read SKIN Confessions and listen to the almighty Derma. She really knows her stuff. She will point you in the right direction to further explore.

Hair Loss

Topical Steroid Side Effects

Question 1: Why is my hair thinning and I am losing so much of my hair, but yet my facial hair is out of control?

Answer 1: Cortisone affects collagen production in a round-about-kind of way.  For women, it hijacks the effects of the masculine hormone DHEA and lowers overall estrogen effects.

Question 2: What can I do to offset hair loss?

Answer 2: You can consider taking collagen supplements along with Vitamins A, K and E to help revitalize the hair you’ve got and keep it stronger.  Reduce hair processing treatments that burden the hair with chemicals and bleaches.

Be gentle with your hair and reduce shampooing to 2-3 x per week. Allow for natural hair drying and curling instead of with heated instruments.

Question 3: I’m going through severe Topical Steroid Withdrawal and I’m now balding…

Answer 3: Unfortunately, many have reached a point where the only option was to shave and allow new growth to come in.  Once your endocrine system rebalances itself, the hair will eventually come back. Just know many before you have gone through this and are willing to talk and help you through. Check the resources at the end of this book to meet up and get to know fellow TSWs (Topical Steroid Warriors.)

Ocular Complications

Topical Steroid Side Effects

Question 1:  I thought cataracts only happened to people over 50 years old. How can I be so young and actually have cataracts already?

Answer 1: Steroids immediately impact the interocular pressure of the eyes. Even 25-year-olds have reported eye problems as a result of using topical steroids around the eyes.

Question 2: I also use an asthma inhaler – does that have anything to do with this?

Answer 2: Many inhalers and medical treatments for asthma do have steroidal compounds and therefore are injected in the vicinity of the optical nerves and so can have indirect and secondary effects when used with topical steroids as well. That’s a double whammy to watch out for and should be noted in your medical diary. These are part of the good habits that you should develop to be your best patient advocate.

Question 3: What can I do to avoid eye problems if I have to use steroids?

Answer 3: First and foremost, get your eyes checked more frequently, 3-4 x per year when taking any steroid medication around your face or systemically. If you experience any changes in vision, blurriness, sensitivity to light, reduction of peripheral vision, spots, clouds, please do not hesitate and see your eye care doctor immediately.

Try and use any other alternative than topical steroids on your face. An intense emollient like ELAJ may help offset the eczema problems there. As for the inhalers for asthma, there has been a lot of progress to reduce the usage of steroids. Ask your doctor to offer a different approach and try what works for you.