Resources

Topical Steroid Side Effects

Question 1:  I’m really interested in hearing more about actual people who have gone through Topical Steroid Addiction/Withdrawal. Where can I go?

Answer 1: Check out the website at www.ITSAN.org which stands for International Topical Steroid Awareness Network. It’s a non-profit organization dedicated to raising awareness about the potential side effects of corticosteroids. Just a bunch of folks from around the world who have been to hell and back because of the lack of disclosure on what steroids can do over a period of time. They can offer a list of doctors who are already aware of the condition and can help patients through the withdrawal process. By the way, ITSAN created this simple cartoon video that explains it all right here.

Question 2: Has anyone documented the actual Topical Steroid Withdrawal process in details?

Answer 2: Yes!  One of the best personal accounts is written by Cara Ward. She has an inspiring writing style about making it through the wicked forest of Topical Steroid Withdrawal in her book, Curing my Incurable Eczema.

Here’s my review of her book:

Question 3: Has anyone made a documentary or videos on YouTube, so I can see similar cases like mine and compare if I may be in Topical Steroid Addiction/Withdrawal?

Answer 3: Yes! Another great resource is the YouTube channel of Brianna Banos, where you can find her documentary, PREVENTABLE: Protecting Our Largest Organ. She has continuously posted videos throughout her journey and while she was making her documentary.

These ladies are just a few of the TSW Warriors that have been courageously trailblazing this awareness movement. They continue to offer their support through their own stories publicly to those in need of more answers.

In her documentary, Briana quotes the National Eczema Association (NEA) stating, “86% of patients were unsatisfied with their eczema treatment and 92% felt their doctor didn’t even know how to treat them.” Briana then dramatically makes an obvious point. “If that’s not an outcry for reform, better education, and awareness, then I don’t know what is…”

Question 4: Are there any support groups on Facebook or Instagram I can join?

Answer 4: Here’s a list…you’ll inevitably find most to be very caring individuals and groups. The administrators try to keep unwanted solicitations and people selling out of the support group forums.

  1. ◆ ITSAN Topical Steroid Withdrawal RSS Support
  2. ◆ Topical Steroid Education (this one is research heavy with medical info)
  3. ◆ Eczema & Topical Steroid Withdrawal for WOMEN – Healing Through Positivity
  4. ◆ Topical Steroid Addiction
  5. ◆ Red Skin Syndrome/Topical Steroid Addiction Awareness (TSA) Group
  1. Question 5: Are there doctors that have published information on this condition?
  2. Answer 5: YES! Some of the trailblazers in treating and spreading awareness are:

Dr. Koushik Lahiri website with over 85 publications

Dr. Fukaya’s blog

Dr. Rapaport’s website and Red-Skin-Syndrome.com

Dr. Peter A. Lio’s publications

Dr. Olivia Hsu Friedman

Dr. Xiu-Min Li

Dr. Albert Kligman & Dr. Peter J. Frosch

Dr. Sanjay K Rathi & Dr. Leishiwon Kumrah

Rosacea.org  & The Great Imposter: Steroid-Induced Rosacea

Question 6: Okay, you’ve got my attention and I want to learn more about the deeper cause, like whatever that original problem was to begin with before this nightmare! Where can I find more information?

Answer 6: Remember in Chapter 1, when I said you get a text message in the form of a rash, irritation or swelling on your skin? It’s THAT message from inside that matters.  You’ll find so many answers of those messages translated in my book, SKIN CONFESSIONS. You will hear straight from the source in her own voice, DERMA! She explains everything.  She single-handedly wants to save the world by saving your skin. So this is your chance to hear it directly from her. You can totally disregard her sassy attitude and potty mouth. But she’s loaded with medical research that backs her wacky claims and weird ideas like how the skin can hear, smell, see, and tell time and create its own sunscreen. Once you hear her voice, she gets under your skin and will nag you until you change those little bad habits that have been handicapping her all along!  

Derma will talk to you about her best friends forever (BFFs) inside your body. She will gossip about all their drama. Once you get to know all their personalities, and who the real bullies are inside of you, it will be easier to understand how your body and immune systems really work.

Then Derma dives deep, in so many baby steps, about what you can do to make your skin cooperate a lot more. Simple daily tricks that will make a world of difference and lighten her load of all the toxins and problematic products you’ve been using on her. She will open new ideas on re-setting your immune system that are cutting edge and some that have been around for ages and just now getting legitimate medical respect.

Look…skin conditions are reaching epidemic levels in most industrialized countries. Eczema has now reached 1 in 10 adults and almost 2 out of every 10 children.  You can’t blame that on genetics! The book SKIN CONFESSIONS dives deep into the causes and alternative cures outside the realm of yes, you guessed it, topical steroids!  FYI – the book is not all about skin – it’s about the immune system and how to recalibrate it with the most innovative and exciting adventurous and fun ways!

Derma also has a wild imagination and reveals what it is/was like to be the skin of famous personas like Jack LaLane, Princess Diana, Tiger Woods, Alicia Keys, and Arianna Huffington. Derma brings a light-hearted voice to help you understand her many personalities through her fictional portrayal of herself with these incredible people.

Get to know Derma in

Wet-wrapping

Topical Steroid Side Effects

Question 1: My doctor told me to apply steroids and then wet wrap with plastic and then bandages to make the medicine go deeper while I sleep so that it works better. Is that okay?

Answer 1: NO!

Question 2: Why?

Answer 2:  In the United States there are 7 Classifications of Topical Steroids. Class 1 is the highest and most potent. Class 7 is the lightest like the hydrocortisone you can find over the counter in any drugstore.  Once your eczema falls into the vicious cycle of steroid rebound phenomenon and the adrenals get more and more angry, the eczema appears to be getting worse every time you try and stop. Doctors will continue to prescribe higher dosages. 

Once you reach Classification 1 and there is no sign of it getting better…Surprise! By that time, it’s been a few years that you’ve been on these meds and you’ve probably gone through a lot of tubes. There’s only one other option left for the doctor. 

Maximize the highest, most potent steroid by embalming it onto your skin with a mummy wrap of cellophane plastic wrap that does not breathe and could potentially cause sweating, moisture and therefore fungal breeding ground which is another nightmare.

But wait…there’s more…Your skin needs to breathe! This could cause a plethora of other problems, not to mention death, but on the lighter side, you are virtually dumping the highest potency of steroids in a condensed time period and giving your entire endocrine system a flooding natural disaster kind of Emergency Broadcast Signal that THIS IS IT! All systems Alert! WE ARE ON MASSIVE EMERGENCY STRESS MOTHERLOAD OF ALL DISASTERS!

If you’ve read through this book by now, you’ll know your adrenals are literally deep snoozing on their La-Z-Boy Chairs and they are not going to get back up come hell or high-water. The damage is done; they have officially taken a long leave of absence.  

The stress of wet-wrapping could cause so many other infections as well. Please reconsider your options. There are full body soaks you can do in the tub with mineral salts or apple-cider vinegar to get you through full body eczema flare-ups.  There are more intensive emollients like ELAJ that can all be found at www.ELAJnaturally.com.

Adverse Drug Reactions

Topical Steroid Side Effects

Question 1: Shouldn’t there be a quality control system in place to monitor drugs and if they are safe for everyone?

Answer 1: Guess what? It does exist! The number is 1-800-FDA-1088.  Seriously. That is the number and it is easy. Go ahead and program that into your phone. You can also go to the FDA.gov website and report online as well. Unfortunately, most people do not know how to report a negative reaction to a drug. But now YOU know. How cool is that? And you can help let others know that any drug they take should be monitored and any unusual reactions can easily be reported.

Question 2: What are the Legal and Ethical reporting responsibilities of doctors when they witness or suspect an Adverse Drug Reaction (ADR?)

Answer 2: There is no legal obligation to do this, but we all should argue that there is an ethical obligation to do so. This is where you can learn more about a physician’s important role in recognizing and reporting suspected ADRs – Adverse Drug Reactions.

Question 3: So why is there a gap in reporting, and why don’t the statistics reflect them properly?

Answer 3: The problem is that most people do not report back to their doctor. Patients should ask the doctor to report it – which would have even better results and echo louder in those long corridors of the FDA.  Another very real problem is that so many people are intimidated by their own doctors or fear the doctor will only prescribe stronger prescriptions. After a few cycles of using topical steroids, and the problem exacerbating further, a patient’s intuition kicks in that the problem may just be getting worse, and they feel they are on their own to explore other options. Many people just don’t go back to the doctor when the problem gets worse. They opt out and start exploring on their own.

Meanwhile, doctors do not have an alternative to offer their patients. That is part of the medical world’s unusually dependent attachment to steroids. To doctors, the benefits are still higher than the risks statistically. They have not heard otherwise (yet.)

Question 4: What happens when patients disappear ‘off the grid’ and don’t go back to doctors?

Answer 4: It causes the statistical data to be skewed. The assumption from doctors is that if you don’t come back, then the problem cleared up. If you do not communicate the complete picture of side effects, the doctor is in the dark too.

The entire statistical picture is not being reported. Partially because of patient disillusionment or just giving up in search of other solutions. Topical steroid abuse and lack of efficacy are the missing pieces to the puzzle. Patients and doctors are not partnering up to communicate back to the pharmaceutical companies and the FDA that the drugs were futile or making the problem worse over time.

Question 5: Is there any other centralized reporting system that patients can access to get honest information about drugs or certain therapies that do or don’t work?

Answer 5: YES! We are so excited about this – that we mention it over and over in this book. You can jump to Section III ~ Chapter 1 to read Patients Like Me. Go ahead skip over everything and jump to that and then come back here to dive deep into the serious stuff about topical steroids. Enjoy reading about that incredible forum just for patients!

The Undeniable Magic of Steroids

Topical Steroid Side Effects

Question 1: How is it that steroids are so amazingly effective?

Answer 1: Yes – they are magical. Modern medicine has been able to make medical miracles happen thanks to steroids! They are known as anti-inflammatory drugs or immunosuppressants and can make things disappear. They can instantly give relief. They can stop the body from attacking itself. They can cure a cancer like lymphoblastic leukemia. They can help an asthma sufferer actually breath on-the-spot. They can stop allergic reactions cold-turkey.

Without steroids, organ transplants would have been practically impossible. “Glucocorticoids were one of the first classes of medications used to prevent rejection after solid organ transplantation.” They help by allowing the other organs to slowly get to know the new organ or prosthetic without the immediate attack response system kicking in as if a new foreign alien was among them. Steroids allow an acceptance period for the original organs to accept the new kid on the block (new organ) to learn and tolerate each other’s differences by suppressing the hyper responsive immunologic protection reactions to not occur right away.  For this reason, the medical community weighs the good they have done and respects the need for a system of tapering off steroids in a closely monitored manner.

That’s why you may have noticed drugs like Prednisone are given with strict guidelines to reduce oral intake each day over a period of time. This is key to allow all the organs and endocrine system to re-adjust back to their own normal activities, but nice and slow without causing another shock to any organs.

Recently in the last 10 years, steroids are being re-evaluated in comparison to other newer drugs that may replace or substitute them. According to the American Society of Nephrology they have found stopping immunosuppressive prednisone even sooner after transplants was found to be safe to avoid serious side effects including high blood pressure, high cholesterol, diabetes, cataracts, bone loss, increased bone fractures, mood swings and, in children, growth retardation.

Many doctors accept that steroids were a necessary tool with maximum effectiveness for chronic  conditions like arthritis, psoriasis and eczema for immunosuppression previously, but many now suggest that they are no longer the best option. Especially with low-risk populations that can do well just as well without the side effects.  New drug therapies have been showing better results.   This marks an exciting new pivot point in steroid therapies. Could the future of medicine start crossing a new bridge towards alternatives? How does that translate to the topical steroid therapies for skin immunology? These are all questions we are starting to witness exciting answers to in our lifetime!

Question 2:  Exactly what are steroids?

Answer 2: Steroids are synthetic versions of our own natural hormones. Surprise! Now here’s a little fact. Most drugs are just the synthetic versions of what your body already makes. Because sometimes our body just needs an extra push or wake-up call to readjust itself.  Steroids are synthetically-derived hormones from plants like the Mexican yam that mimic estrogen, progesterone and yes, even the manly machismo hormone of testosterone. Birth control pills started out as simple variations of those basic molecules from a yam from a farm out in Mexico! The pharmaceutical manufacturers add a couple of basic variations to take something natural to be able to molecularly patent it, to make it proprietary so they can profit.

Similarly, antibiotics are just a trigger of a small fraction of an actual illness or bacteria for your own natural antibodies to kick in. They learn how to fight it. Your body is loaded up with soldiers on-call. This boot camp of yours even has its own elite soldiers that create memory immune cells to fight that pathogen invader anytime in the future to always fight that bugger, but in more heavy-duty dosages. You are a walking, flying, swimming military compound of the highest tech equipment and fighter systems!  We think there is nothing sexier than a strong, handsome immune system like yours all powered up and ready to defend…Go, YOU!

Question 3: Are these the same steroids that body-builders and athletes take to buff their muscles up?

Answer 3: There are two main categories of steroids. One is corticosteroids which is what we will be referring to here in this book. Topical steroids falls into this category. They are the cortisone substitute for your natural cortisol hormone produced by your adrenal glands. Your hormone cortisol slows down inflammation. That’s exactly what the steroid medications intend to do when applied, ingested, injected or inhaled are designed to do. 

The other is anabolic-androgenic steroids. They are man-made versions of the male sex hormone, testosterone. When a male does not produce enough testosterone, a doctor may prescribe to help adjust production. In certain cases where a person has lost considerable muscle mass due to certain cancers, AIDS, atrophy and other debilitating diseases, a dosage of testosterone may be necessary to quickly rebuild tissue. However, the illegal and controversial use of anabolic steroids is a constant menace among the sports industry today.

Question 4:  Exactly how do they work?

Answer 4: Our discussions here are primarily about the corticosteroids, so let’s imagine your body sends a text message to let you know something is wrong in the form of an alarm bell or an obnoxious car theft signal. Sometimes this message appears as a rash, itching, and/or swelling on your skin. That basically means something is wrong on a deeper level. It could be a food or medicine allergy reaction. It could be something simple like the anti-bacterial soap you are using. It could be the liver working overtime. Another common culprit could be stress! It could be a combination of any of these and other variables.

That does not mean you need to put a band-aid on it. It does not mean for you to silence it and tell it to just calm down. No one ever calmed down when you told them to calm down, right? Same thing here. That original irritation or text message means your body is asking you to go to a really good mechanic (doctor) and get some deep diagnostics to figure out what your body is rejecting. Something’s up. It does not send you a random false alarm.

Question 5: So, when I get an itchy rash, that actually means my body is trying to communicate something more serious to me?

Answer 5: Yes. Your body is being kind and merciful by letting you know something more serious is going on. The problem is as soon as you get this alarm, we have been conditioned to a knee-jerk reaction to prescribe hydrocortisone or a stronger topical steroid without asking the more important, WHY? What caused the irritation, rash, inflammation, itching, redness in the first place? The really important questions are not being asked!

And yes, the magic cremes are pretty darn impressive. I get it. But no. You and your doctor did NOT even read the text message. You jumped without questioning or trusting that something is going on inside. There could be a foreign invasion of an allergen, bacteria, pathogen or some toxic fragrance from a cheap air freshener or laundry detergent that is messing around with your immune system.

Meanwhile, if there are any excess levels of sugar, gluten, and/or alcohol that your poor liver is already struggling with, that creates a system overload. You know when you are stressed out, you have a tendency to turn to chocolate or a couple more glasses of wine? A stress reliever for you, is a stress burden on your poor liver! That’s when your liver has no choice but to push it back out into the bloodstream. Don’t blame your liver for this.  That rash is the big boss, your liver and your immune system begging for mercy.

Instead of focusing on listening to your own immune system communicate with you, you call these superhero forces (topical corticosteroids) to clean up the problem and get rid of the evidence and suppress those important text messages instead! So then it’s nearly impossible to detect future occurrences without reaching for more of the topical steroids instead of wondering deeper that a more systemic problem is developing.

But every crime leaves a clue, and that’s why you are reading this book.  We salute you for reading up on this mystery. You’ll learn more about how steroids work throughout this book.

Question 6: So, what am I supposed to do when my skin goes crazy?

Answer 6: You need to step up and be the captain of your own ship. You need to check your location, check your supply tanks and prepare for a journey of discovery. 

Take a breath and start asking the real questions. How? When? Where? What? Why? Start a health diary to help you jot down any and every possible trigger. Take pictures and mark the date and times of when they were taken. Connect the dots with any other hormonal cycles. Where you studying for an exam and stressed? Did you eat junk food? Did you lose sleep? Did you celebrate with sweets or alcohol? Did you change your environment? Bed sheets? Laundry detergents? Be an obsessive detective and work backwards towards the scene of the crime.

Don’t panic by reacting too quickly. By applying a topical creme such as hydrocortisone, those adrenals will wonder why they even laced up their boots to show up for the battle. They love drama! Hence, the name ‘adrenaline.’ They want a piece of the action. They’ve trained in boot camp for this glorious moment to protect you. But you? You didn’t even give them a chance. You may be missing an opportunity to monitor when the flareups take place and what the culprit is.

Meanwhile, the sad truth is the original problem is still there lurking around waiting for another opportunity to poke through another message to you. But it knows to stay on the low-key like a creeper for a while. So it just kind of chills until it thinks the drama is over or it goes to another neighborhood in a different location on your body and marks its territory somewhere else. Another rash again? Another text message, ‘We are here! Hello – can you hear us now?’  This is a cat and mouse chase like no other. Just when you think you nipped it in the bud, it comes back with a vengeance. That’s because you didn’t figure out what the original problem was. Welcome to “Steroid Rebound Phenomenon!”

What is Topical Steroid Addiction TSA?

Topical Steroid Side Effects

Question 1: How would I know if I’m addicted to topical steroids?

Answer 1: It could be as easy as seeing if you can quit. Usually, your body will tell you within a few days or weeks.  If you have a reserve of synthetic steroids built up for a long period of time like a few years’ worth of heavy usage, it may take 1-4 months. At that point, your adrenal glands are forced to wake up and realize that they can’t take it easy anymore and they have to get back to work.

Upon stopping or reducing the use of topical steroids, the flareups begin again. With each cycle of stopping, the body communicates that it wants more. Take a long picture of your body front and back wearing minimal undergarments or nothing, if possible. This will serve a baseline as your starting point. Mark your calendar. Begin a journal of monitoring the time frame of when another flare begins to appear. Is the flare worse?

If a few weeks go by without a flare – great! Keep it up for a few more months just to be sure. If three months go by without any major flare-up and/or large red patches appear, then you may be in the clear.  It does take at least a few months or so because the body has been known to keep a reservoir of topical steroids in the most minute areas of the vascular system due to the vasoconstriction that topical steroids cause.

Remember your normal eczema patches and flare-ups are not what we are referring to, but rather a larger surface area of red skin that feels burning deeper inside and almost like the skin is wearing a red long sleeve shirt. If your skin flares up in a more angry, feverish kind of way then you may begin to see different signs and symptoms progressively.

Question 2: How will I know it’s not just another eczema flare-up?

Answer 2: TSA and RSS are different than eczema in that they encompass larger surface areas than the dry, spotty eczema patches that you may have had earlier on before starting topical steroids. There is a deeper burning sensation that goes beyond a local itching flareup.

Question 3: What kind of reaction can I expect if my body is addicted?

Answer 3: Remember in the first chapters when I mentioned those adrenal glands are like the schoolyard bullies? They get spoiled quickly and feel entitled to the slow, lazy life and they don’t like it when they actually have to do homework and work with the thyroid again rebalancing out your body’s temperature, metabolism and re-strengthening your immune system.

So…they get angry. They will definitely let you and every part of your body know. How? By causing a few reactions such as:

A body flushed with red. It may look like you are wearing a red turtleneck sweater with long sleeves. The red usually appears around the neck, chest and may be stronger in those areas and then also along your forearms right up to your wrist. For some crazy reason, the red flushing usually stops right about there. Sometimes it does cover the hands to the finger tips too.  On the legs, it will usually stop right at the ankles. Don’t be fooled into thinking that only the original areas where you applied topical steroids would be affected. Once they are in the system   the red flushing can appear anywhere, it is not specific anymore to your original eczema dry spots. You’re in the big leagues now of systemic side effects of topical steroids. 

Extreme body temperature fluctuations and hot/cold flashes.

Nausea, vomiting, lack of appetite or a voracious need to eat.

Extreme case of body itching. Some have reported itching so deep that it feels like your bones are itching. It really is that deep and intolerable.

A sudden dryness to your skin that is far worse than the original eczema or psoriasis flare-ups. Some crusting areas around lips and hands and crevices like inner elbows and knees making it virtually impossible to move or talk.

Full body dandruff with constant flaking – that’s from the extreme dry skin.

Some experience a phenomenon of oozing or the sensation of sweating a yellow or clear substance that has a pungent, sulfuric smell.

Severe insomnia and disruption to sleep quality.

Weight loss/gain. More likely it will go the opposite way of what you want.

An immune system that is generally weaker thereby allowing any cold to turn into something more dramatic that lasts longer.

Change in eyesight and/or development of cataracts and changes to the Interocular Pressure (IOP). Please get your eyesight checked 3-4 x per year if you’ve used any topical steroids on your face. 

Decreased sexual libido, fertility, and increased dysfunction.

Bone loss, weakness from mineral depletion. In children or babies, it could translate to stunted growth and lower bone density.

Symptoms of diabetes, Cushing syndrome and other auto-immune conditions.

Highest Areas of Absorption

Topical Steroid Side Effects

Question 1: Does it matter where I apply the topical steroid and how much is absorbed?

Answer 1: Oh yes! Beware of the most delicate areas around the eyelids, face, jawline, neck and thinnest skin on and around your private parts and genitals!

Question 2: Does it matter if my medication is an ointment, creme, foam, gel, shampoo, solution, lotion, compounding powder or spray for absorption?

Answer 2: Yes! They each have varying degrees of absorption and should be noted with your doctor as to when and where to apply. A diligent doctor may prescribe an ointment to skin areas that are thicker like palms of hands or psoriasis plaque areas from excessive itching and cumulative trauma to the skin with layers of dead skin piled up. Perhaps a more or less soluble ointment for other areas based on doctor’s assessment of how compromised the skin is in that specific location. A cream for the acute and subacute dermatoses that are rash prone and areas that can hold moisture. Be prepared to ask specific questions about each medication and where and when to apply.

Question 3: Are topical steroids tested on people with eczema or on people with normal skin?

Question 3: There are two types of tests. Absorption tests are conducted on healthy volunteers without atopic dermatitis.

For clinical purposes, topical steroids that go into the market are tested on diseased skin where the epidermal barrier is defective, and in those, the penetration of topical steroids is 2 to 10 times greater than that of healthy skin according to this study.

Question 4: Will only that area experience side effects or my whole body?

Answer 4: Possibly none, maybe one or all of the above. Some will only experience the most common skin atrophy and thinning locally in that localized area. Some will experience the full-body systemic effect of side effects. There’s just no way of knowing who, what, when will be the most affected and how.

In the example of the eye area, the steroids have been known to penetrate deep enough to affect interocular eye pressure and therefore, accelerate cataracts and glaucoma potential just by applying on the face and not necessarily around the eyes. So it can vary based on quantity, length of usage and the individual’s susceptibility to immune suppression therapies.

Another factor is if the person is already on another form of steroids such as inhalers for asthma and oral steroids such as prednisone for allergic reactions.  Those patients are especially reactive to eye problems.

It’s sad, but here at ELAJ, we talk to young people in their 20’s that are already suffering from eye problems such as cataracts and yet, had no idea the steroids they used on their face were the cause. They simply were not informed properly by their doctor. 

Skin Confessions ~ Derma Finally Speaks

Derma explaining why she’s been so mad at you.

Sample INTRO

Excerpts from SKIN Confessions Book:

CHAPTER 1: Derma Speaks As Your Skin

It’s about time you came around. I’ve been trying to talk to you since you were born, and every time you shut me out. So this time I hired (more like black-mailed) this so-called author, Suhein Beck, to get through to you with this little SKIN Confessions Book.  She can’t refuse me or edit me out or make nice with my words this time. Trust me on this…she can’t clean up what I have to say because I’ve got the dirt on her too, and I’ll just throw her under the bus if I have to, and I probably will at some point in a few chapters, because I’ve caught her being a hypocrite with some of her own bad habits, like very warm showers.  So this is the way it’s gonna go down. It’s gonna get real. 

Hi. I’m your skin. I’ve been dying to talk to you like this, just us, one on one.  Literally dying.  It’s not just you – seriously the whole world is flippin’ on me, yet I’ve got some serious answers, but everyone just brushes me aside like some middle child with freckles. Personally, I think freckles are adorable, and if you only knew the story behind them, you’d appreciate them and me so much more. But whatever! 

I’ve had your back, and I’ve been protecting you from before you were born, so it’s not like I’m trying to sell you something or get you on some new kick. I’ve seen you butt naked and I’ve seen you try and fake everyone out, it’s like you’re ashamed of me. When you’re angry you take it out on me, you scratch the h*ll out of me or you cover me up with some cheap products that just make me angrier. Look…you’re not going to win against me. I know you better than you know yourself, so can I just put this out there once and for all? 

One –  I don’t hate you. 

Two – you don’t love me enough. 

Three – if you really knew me, you’d respect me more and that’s what I really crave more than anything. 

That’s it. If we can fix this relationship maybe we can, oh…I don’t know, maybe not tear each other apart? I get it – you feel trapped inside of me. Well, that’s exactly how I feel with you too, except I’m bursting at the seams.  Look, I’ll call a truce here…Since you’re not a snake, and I can’t just shed myself away from you like I wanted to so many times before, I guess I’m here to stay. No – I meant to say I. Am. Here. For. You. I’m sorry I didn’t mean to sound so angry. Thank you for sitting down and listening to me now, finally…it means a lot. 

Let’s start by not blaming each other anymore, okay? The more I think about it, I have to admit, you didn’t even know half the time that what you were doing was wrong. The other half of time, the schmazzled-up world was messing with you and didn’t give you a chance. So I’m gonna start with them. 

When you were born, you had the sweetest new-baby smell. It was so delicious, it made everyone want to eat you up and kiss and snuggle and munch on your toes. But then the wonderfully smart people at Johnson & Johnson showed up in 1894 and convinced everyone that your smell wasn’t good enough and that they had a better new-baby smell than your natural one. They loaded up their famous J & J Baby Powder with fragrance and forever changed what we knew as the official new-baby smell! Now there are even actual car and home fragrances with “baby smell.” How cute is that?!? 

The base of that powder was talcum powder, which when used carefully, is an excellent magnesium-type of mineral in very small levels for certain medicinal usages. But when sprinkled on a baby’s genitals daily, or in your case, what seemed like a thousand times a day with every diaper change, that talcum powder can easily absorb back into the interior reproductive system of girls. So do the math. One no-no is synthetic fragrance uploading into the baby girl’s reproductive plumbing lines. Second no-no is talc which is like…hmmm let me simplify this…like asbestos to the lungs or like cotton candy to the nose. Do you get the picture yet? It’s like freeze drying internal organs with a powder designed to dehydrate an area. Hello, Disaster – I’ve been waiting for you! 

So that’s kind of where I’m going with this. You were an innocent victim too. I swear I was fighting for you, even back then! You’ve got to believe me…like I totally remember I rebelled like a boss against them. Your pH in that delicate area is so amazingly complex that I’m constantly working to rebalance. But when you were a baby, they wouldn’t stop sprinkling those lovely new-baby white powdered snowflakes from hell all over your bottom. 

One day – I just blew up in their faces and erupted into a mean diaper rash. I swear it was like yesterday when you’d cry and cry and get fussy and they didn’t know why, and I’d be like, see? See me now? Make them stop with that white powder…eventually, they did, and they calmed me down with some awesome zinc oxide and I’m pretty sure there was some vitamin D and a lot of air, we all just took a break…Some basic pure cornstarch and you were fine after that. I just needed time to get over being suffocated every freakin’ day with all those synthetic ingredients over and over again. Oh and those baby wipes…do not even get me started on those. (I’ll tell you how and why I hate them so much later.)

I mean everyone’s got their limits, right? Well, my limits are clearly defined in this book and it is what I’d like to introduce to the world as the “Skin Burden Threshold” TM.   I keep repeating myself, and I was so tired trying to do my job with your pH.  And you?  You would never go to sleep, and you were peeing all the time, but they kept messing with my mind and my mathematic calculations trying to rebalance everything down there for you. Yes. I do math and I’m a grand freaking genius at it. I’ll prove it later to you. Anyway, I’m really sorry about that and maybe we got off on the wrong foot. Before I go on, please just tell me you do believe that I was fighting for you, not against you, right? I mean you were a really cute baby, why would I intentionally mess with you back then? 

Okay, one more thing I’ve got to get off my chest. Technically it’s your chest, I know I’m just the skin, but before we change the subject, that company? J & J? Yeah, they kind of did something else that was evil if you ask me. In 1953, they marketed the very first baby shampoo. The idea was sure to be a hit. Can you say Ka-ching Baby?!? They had previously tested the chemicals on prisoners right here in the United States. It was cheaper than using chimpanzees! Despite public ethics groups and government regulations, J & J and their subsidiary companies continued that practice. They are still lobbying hard to keep doing that.  

But when they tested it on some prisoners, it made their eyes sting. So they knew it could be a problem for the mothers who noticed that. But since babies can’t speak and explain exactly what was bothering them, the little witness could not be taken seriously. So J & J devised a really cool, pre-emptive counter-punch marketing strategy BEFORE they hit the market. It was called, “No More Tears “ and that would convince the mothers that it could not possibly be the shampoo, after all, this was the specially designed, gentle “No More Tears” shampoo! Television was new and oh-so-powerful back then and it had an air of credibility that no one questioned. 

Fortunately, only 1-2 generations enjoyed the rub-a-dub-dub experiences of J & J. After quite a few hefty lawsuits, J & J have since removed that infamous Quaternium-15 chemical preservative that kills bacteria by releasing formaldehyde, a known carcinogen. You’ll be fine. It’s not like they replaced it with Phenoxyethanol, another suspected doozy. Oh wait…they did. Hey – good luck with that. The FDA hasn’t forbidden it yet, but it’s not like it’s a secret that Phenoxyethanol is a preservative that is primarily used in cosmetics and medications that can depress the central nervous system and may cause vomiting and diarrhea. That should be interesting, right?  

Your immune system has had plenty of time to forget that traumatic childhood experience. Oh wait…I totally forgot – you used to get sick all the time and you were given Children’s Tylenol & Motrin like….all the time which just happens to be manufactured by guess who? Yes J & J! You do know how many recalls they’ve had right? Just in 2010 alone, J & J had four recalls of 136 million bottles of infant and children’s Tylenol, Benadryl and Zyrtec. Even large plastic particles were found in 200,000 bottles of Motrin Infant Drops in 2013. 

Oh, and that one time where they should have done a recall, but instead did this undercover mission by hiring independent contractors to go to all the stores and buy out 88,000 jars off the shelves so they didn’t have another recall on their long history of recalls database! But one of the “undercover buyers” accidentally dropped the piece of paper detailing the secret instructions in one of the stores in Oregon and it was found by the store manager and reported it to the FDA! Dang…that must have hurt! 

Actual instructions on the note left behind by an “undercover shopper”: 

“…you should simply “act” like a regular customer while making these purchases. THERE MUST BE NO MENTION OF THIS BEING A RECALL OF THE PRODUCT! If asked, simply state that your employer is checking the distribution chain of this product and needs to have some of it purchased for the project.” 

That’s a whole other chapter I have to squeeze in this SKIN Confessions book about your how your immune system was messed around with at an early age and that may be why it’s so cray-cray now. Oops my bad…listen I think we need to just take a breath here. There’s so much you need to know, and I just didn’t want to be the tattle-tale for every little thing they were doing to you back then. But it’s time you knew the real story behind the history of your skin and what you are up against now… 

Skin Confessions ~ Baby Wipes, Toilets, and Other Fascinations

How Baby Wipes can cause contact dermatitis

SAMPLE CHAPTER

I tried to tell you. Did you listen? No. I gave you plenty of hints, but I guess the overwhelming convenience of changing a baby’s diaper with a clean, wet disposable wipe was just too good to pass up. I get it. But can we just step back a bit?  Let’s take a look at what that means to me, over here down in the most vulnerable skin of a baby.  The last thing I want is to fight a battle of pH with every peeing and pooping session.

I cringed every time I’d hear that baby bag of weapons open up. Then the diapers opened to reveal each stinky masterpiece, I heard you gasping for air and I knew it would be another round of cold wipes shocking, dragging, wiping me clean. It never got easier for me. Quite the opposite actually, with me breaking down weaker with each battle. 

Do you know how hard I work to keep your outer skin mantle at a comfortable slightly acidic 5.5 pH? Even with the acidic urine that saturates a diaper and rubs against me, I can still combat that, if you change them in reasonably quick turnarounds. But what I can’t deal with is a constant barrage of ingredients like methylisothiazolinone (MI) a common preservative in baby wipes. In fact, thank God for the first case study published in Pediatrics by Mary Wu Chang, MD, from the Department of Dermatology and the Department of Pediatrics, and medical student Radhika Nakrani, BS, from the University of Connecticut School of Medicine, Farmington who were the first to report 6 children with “chronic, recalcitrant perinatal and/or facial dermatitis” after using Cottonelle and Huggie wet wipes. As soon as they stopped using them, the problems completely stopped with no recurrence. Patch testing confirmed the allergic sensitization reactions.

When I started rebelling against this cruel and unusual punishment of these wet wipes, you thought it was just diaper rash and took me to the doctor and he misdiagnosed it as impetigo, psoriasis, diaper dermatitis, eczema, infection, and unsuccessfully treated me with various prescription cocktails like steroids, antibiotics, antifungals, and topical tacrolimus (Protopic). Thanks! Just what I needed – more immunosuppressants! 

All that doctor had to do was ask if you had used any commercial wipes that contained (MI) because he should have known that (MI) was named “Contact Allergen of the Year” by the American Contact Dermatitis Society in 2013! Yes, that’s a thing and yes there is a society that awards the number one trigger that sets me off.  Imagine that! An awards ceremony that recognizes the newest chemical for being criminal each year? This gives me such hope. 

Soon after that first study, another group of Australian researchers reported 23 reactions from parents of young children with hand dermatitis as a result of using baby wipes with (MI). So if parents using the same wipes became just as sensitized by the same wipes on their strong, adult hands, then the what the hell am I supposed to say about the most delicate area with the thinnest skin around genitals absorbing this stuff?  Do you feel me now? But wait, there’s more! It doesn’t end with just (MI), there is a whole medley of chemical preservatives out there that I just don’t have the patience to talk about right now. There’s something else pretty serious you need to consider. 

Aside from me being a constant nag in your life, have you asked yourself about the environmental impact these wipes have on the planet? You could easily just go back to using soft disposable napkins that you wet on the spot with some water or reusable cotton, or even better, bamboo towelettes that can be rinsed wet with H2O. How easy is that?  I wouldn’t have to battle the pH tug of war with each diaper change, and you could save so much money. Today we called out this particular preservative (MI), but tomorrow the popular brands will find another scumbag preservative to wreak havoc on other unsuspecting victims and here we go again, another generation of dermatitis, steroids and allergic triggers. Do you just hate me? 

The packaging alone is a burden, the dyes, the labels. The industrial carbon output of their manufacturing added to the costs of transportation, distribution and retail marketing adds to an endless commercialization and environmental footprint that could easily be avoided. 

But no, we’ve taken baby wipes to another level and increased the demand by increasing the age of users. Now men and women each have their own wipes . ’Dude Wipes’ and ’One Wipe Charlies’ and ’Woody Wipes’ are a thing now for a more intimate “executive fresh manly scent.” How cute is that?!?

Female cleansing wipes “removes odor-causing bacteria with a variety of fragrances.” How many times must I repeat myself? Not ALL BACTERIA IS BAD! I need those bacteria to fight off fungal yeast invaders, so if you take those away from me, guess what? I can’t block off those nasty yeast infections that you love so much, damnit. 

So again, you take the most vulnerable skin area and douse it with chemicals, harsh preservatives and my all-time favorite enemy – f*cking fragrances that never have to disclose what’s in them because they are protected legally as f*cking “proprietary fragrance formulations” by one of the strongest fragrance industry lobby groups in the world!  (Whew…I’m so sorry I just needed to vent.) 

By the way, I love how one of the most same famous companies that offers feminine wipes, also offers a medicated creme to stop feminine itching with a HYDROCORTISONE F*CKING STEROID?!?  So in a couple innocent wipes, destroy my magical pH down there, and then punish me with the next ’solution’ of immunosuppressants. Because we all know the law of thermodynamic physics, “for every every action there is a reaction.” We saw that one coming, didn’t we? Congratulations. But hey don’t worry about me, let’s go back and talk about the environment again. 

Remember how these wipes claim to be ’flushable?’ They claim to test and confirm their biodegradability as such. Well, if you ask the sanitation and sewer departments around the world, they kind of have…a different end story to tell.  A revealing article by The Washington Post’s Max Ehrenfreund in September 23, 2013 exposes the “Increasingly clogged sewers attributed to popular ‘flushable’ wipes.”

I don’t always get British humor, and that’s why I don’t see this as, in any way comical, but the most famous incident happened in London when sewer officials reported a 15-ton “bus-sized lump” they comically dubbed as “the fatberg” of wrongly flushed wipes. Meanwhile, right here in our own backyard of Orange County, California, the Sanitation District recorded 971 “de-ragging” maintenance calls on 10 pump stations at a cost of $320,000 in just 2015. 

So the cost of convenient refreshing of your private parts from infancy to adulthood, comes with such a price to both me, your angry skin, and to our precious environment. What if there’s an alternative? You know there are cultures that are just as obsessed with refreshing without destroying and do this in clever little hacks. 

In the Mideast and Japan, most homes have had dual sets of toilets ever since indoor plumbing became a thing. The standard one and a second one named the bidet which was considered a necessity, not a luxury. On the bidet you would sit in a straddle position and enjoy the most thorough vertical or horizontal up-splashing of delightful water hosing the entire genital area. In many Southern European countries like Italy and Portugal, bidets have been required on all new homes since 1975. They are very popular in some South American countries like Argentina and Uruguay, as well as Southeast Asia. 

The one culture that has taken the health science of toilet pleasure to an art form has been Japan. In 1980, a toilet manufacturer named, TOTO designed the deluxe throne toilet/bidet (washlet) combo that offered the first “paperless toilet” to the world! This ingenious creation offers both water and air-drying joy to over 76% of Japanese households as of 2015. Not only do Japanese homes enjoy them, but most public facilities and hotels offer this alternative joy cleansing almost everywhere, including airports. 

Nowadays there are simple attachments to a standard toilet that can be installed for less than $15.00 with a hose and nozzle head that’s easy to control water pressure. There are some more sophisticated ones that install under the seat as well. On a tighter budget? Ok how about a small, plastic watering container with a long spout? Almost every house in the Mideast and Muslims around the world have those for the ritual cleansing for ’wudu’ before the required 5 Islamic prayers per day. It’s all part of the “Cleanliness is next to Godliness” habitual day-to-day personal care. 

Any questions? Oh of course, what do you do when you are out and about in the real world? Easy – a simple water squirt bottle offers a quick rinse, front and back and you are a new superhero ready to conquer the world with your refreshed and clean and more importantly, naturally well balanced pH’d skin all over! And you get extra credit points for not being a monster to our precious environment…truly superhero status! 

Foreword thoughts

Topical Steroid Side Effects

Dr. Koushik Lahiri

Over the last nearly seven decades topical corticosteroids have meaningfully influenced the dermatologist's proficiency to efficiently treat several demanding dermatoses. The existing choice of preparations and potency gives flexibility to handle all groups of patients, different stages of disease, and diverse anatomic positions and made it almost indivisible from the practice of dermatology anywhere in the globe. But, these are assumed to be used in countless dermatological maladies based on evidence based comprehension and proficiency.

Most of the time, at least primarily, family physicians and general practitioners mostly manage Dermatological disorders. Insufficient awareness about the potency based classification and insufficient understanding about the mechanism of action, indications, contraindications of topical corticosteroids has given rise to the rapid rise in incidence of improper use of these drugs which threatens to bring disrepute to the entire group of these remarkable drugs.

Benefits of rational and ethical use and the harm of overuse and misuse for non-medical, especially for cosmetic purposes, should be clearly conveyed before penning a prescription involving topical corticosteroids. Despite being the most useful drug for such treatment they are known to produce serious local, systemic and psychological side-effects when overused or misused.

This is especially true not only in countries with less than optimum effective rules and regulations but also in the most advanced and developed societies.

This treatise aims to sensitize general public about the potential side effects of this extremely useful group of medicine.

The general practitioners/Family physicians may also be benefitted from this book.

I congratulate the author Suhein Beck for her passion and commitment and sincerely hope that this book would not promote any unwarranted steroid-phobia, rather make everyone aware about the uses and misuses of topical corticosteroids.

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MBBS, DVD(CAL), FIAD, FFAADV, FRCP(Glasgow), FRCP(Edin), FRCP(London)

Vice President, International Society of Dermatology (2017-2021)

President, Association of Cutaneous Surgeons (I) (2013-2015)

Editor, Indian Journal of Dermatology (2012-2017)

Chairperson, ACSI Academy of Dermatosurgery (2017-)

Founding Chairperson of ITATSA (IADVL TASKFORCE AGAINST TOPICAL STEROID ABUSE) 2013-2015

International Fellow, American Academy of Dermatology

Honorary Board Member and Foundation Fellow, Asian Academy of Dermatology and Venereology

Member, European Academy of Dermatology

Fellow, IADVL Academy of Dermatology

Reading “The War of Art”

Author: Suhein Beck
June 11, 2017

Here’s a confession. About two months ago I was doing some mental house cleaning. I came across this dusty blog here at “Skin Confessions” that I started just over a year ago. I was so embarrassed that I was going to just delete it. I was not happy about the quality of my writing nor the consistency. Even the subject matter was not as comprehensive as I intended. I know I can do so much better – so of course, my self critic stepped in uninvited and gave me a whoopin!

My fingers went straight to the SETTINGS options. Just as I was about to erase this from my landscape of TO-DOs and trim down my priorities of just managing my company, ELAJ, I saw that our weekly visit rate was an astounding average of 975 views per week! How? In one year where I’ve barely been active. I admit I was negligent so how did this site miraculously attract over 20,000 visits in one year? I couldn’t believe it so I screenshot it over to my daughters as proof and called them in disbelief. But still, I did nothing. It further paralyzed me even more.

I was actually angry at all at all the visitors that came because they came when my house was not tidy yet…dinner was not ready yet. I needed to take a shower. But actually, I was just angry at myself that I had not given it my all and, more importantly, my true authentic style of writing was not here.

About 4 hours ago at 11:30pm on June 10, 2017, I opened a package from AMAZON. I didn’t remember ordering anything so just as I finished watching the 8th episode of Season 5 House of Cards, I sliced the box open to find this book sent from a dear friend, Lara who had just visited my actual untidy house this last week!

We had a soul-to-soul talk at The Cliff Restaurant in Laguna Beach over some fish tacos where I revealed how much I miss writing. Real writing. Not the stuff that is “marketable” to the general consumers with fluff content. I’m talking the real human stuff. The stuff that grabs you and shakes you to your core. The stories that would make you angry at how doctors and pharmaceutical companies get away with pimping false hope out to psychologically distraught patients with severe eczema and psoriasis. The gut-wrenching stories of a Facebook support group being on suicide watch for some young beautiful girls that can’t live with skin disorders anymore. Desperate mothers sacrificing everything for another magical cream…The story of a young woman filming a documentary to educate the world about the dangerous world of topical steroid addiction and withdrawal. Endless stories.

It’s now 2:15 am and every word of this book, “The War of Art” by Steven Pressfield, just shook me to my core. I’ve tucked away a thousand stories and subjects and article ideas for months, no actually years…But now I am ready to dive back in and enter my cave once more. Naked. What more of a Skin Confession is there when the author feels as if she is naked and exposed? No hidden agendas, no push up bras or Spanx to tuck everything in and smooth bumps away.

Lara – the beast is awoke.
Audience – prepare for takeoff.

​Suhein