In the Battle Ring with Topical Steroid Withdrawal (TSW)

Of the many hardships that I have been through as a Mom, one i will never forget is being in the battle ring with my daughter's topical steroid withdrawal (TSW). I had childhood asthma and my husband's parents and siblings had asthma as well. So genetically, there is a higher probability for our kids to have asthma or eczema.

My eldest had eczema from the first few days of his life. It was easy to find the trigger as it was one of the most common ones newborns have - cow milk allergy. "Eliminate all dairy, wipe the affected area with boiled clean water, put on some moisturiser and he will be alright" was the comforting advice from our trusted Paediatrician. I learnt a valuable lesson then. Cow milk allergy allergens are not just limited to milk and butter, eggs (yup, eggs too!) and other by products such as Milo and cakes should also be on the watch list! Soon, I realised that the list is quite extensive. Fortunately, with good diet, proper hygiene and good moisturisers, he outgrew his allergies at 8 months.

I take pride in the fact that my eldest daughter was eczema free for the first year of her life! I even thought that maybe because I was still breastfeeding my eldest when I was pregnant with her, I was taking very good care of my diet, and that contributed to her silky smooth skin. However, when we relocated to Miri, somehow, something triggered her skin. It started with what we thought were sand fly bites from a trip to the beach during our first week in Miri. She started having patches of itch. The itching was uncontrollable and she couldn't sleep at night.

We visited the Paeditrician and he gave us some medication. "Just spread a thin layer on the affected area and moisturise her". I took comfort in his advice, it seemed simple and effective. We saw amazing results in just a few hours.

Much later, after being in the battle ring with topical steroid withdrawal, we realised that the medication prescribed were steroids. Addiction to these steroids can be a big issue.

Why do I call it a battle ring?

Well, after the roller-coaster rides, going round and round in circles, this episode taught me a few things:

1. Steroids work wonders on the skin, but (there's always but!!) the moment you stop using them, the inflammation sets in again. Plus, the more you spread on your baby's already very thin skin, the thinner the skin gets. After another eczema attack episode of lots of crying and scratching and reassurance from the doctor that steroids are safe and problem free, all you need to do is progressively reduce the steroid dosage, I learnt from many other experienced mums that it doesn't really work and their children still go through TSW every time.
2. After you progressively take Steroid out of their daily routine, red patches start to appear, scratching becomes a routine yet again. If you don't know, scratching is one of the major triggers of a worsening eczema condition, read this post here.
3. As a mom, when your daughter is scratching the whole day long and waking up to a bloody bedsheet becomes a routine, you have the tendency to give in to steroids again. Some knowledgeable individuals may say, "There's no other way, she needs it, don't shortchange her". You give in and apply the steroids thinking lets do this right, it will be used sparingly and pray hard there won't be addiction.
4. The skin starts to look alive again. You can see new skin has formed and what used to be dry, patchy bleeding skin has formed a new layer. You can even see your daughter's veins (I learnt later that it's because the skin is soooooo thin after steroids!). It's been sometime since you've seen healthy skin with no dry patches. You try reducing steroids and every time you reduce, even just a dose less a day, she starts itching. You see scratch marks when you don't lock your eyes on her.

This went on for a few cycles until we went through a very bloody Topical Steroid Withdrawal episode.

From this episode, I learnt a lot and also found a very good moisturiser made with probiotics. I now understand how ensuring a balanced skin microbiome helps her skin. Unlike with steroids, the results were not immediate, but after a good week of strict routine, she was attack free for quite a while. Recently, she suffered another episode. Read my post about that encounter here.