I have had eczema for almost ten years and all those years I've treated my stubborn itchy rashes with topical steroids. It is, after all, the first line of treatment dermatologists use for most inflammatory skin conditions. It's effective, less time-consuming, and cheap. However, just like any kind of medication, topical steroids have side effects, too. The scariest of which would be the "Red Skin Syndrome" or "Topical Steroid Addiction" or "Topical Steroid Withdrawal".
I have always been cautious in using my cream/ ointment because I am fully aware of the consequences of abusing/ misusing it. However, I still came to that point where in my medication suddenly stopped working and my derma would have no choice but to increase the strength of my topical steroid. This scenario continued on and on until such time that I was already using the superpotent - class 1 steroid cream yet my rashes would still come back (with vengeance) in just 10 days where each flare-up appeared to be worse than the previous one.
I was worried so I started reading articles and journals about eczema and steroid use. And guess what? The information I read from the recent researches published online made me feel even more scared because apparently, topical steroid withdrawal can result from discontinuing topical steroids used for as little as 2 months and that resultant signs/symptoms can last >12 months, even with short duration of use. I've been on topical steroid therapy for almost 10 years, so I was totally in a panic!!!
This was the major turning point of my battle with eczema. I decided I will never use steroids anymore! This medication is so powerful it can relieve itching in almost an instant and clear up rashes in a matter of days. However, with prolonged and frequent use, it can cause dependence, addiction, and even steroid-induced rashes that's way worse than your pre-treatment rash.
[April 2018] The delicious food I feasted on (eggs, shrimps, crabs, fish, nuts, etc.) when we had our vacation in the Philippines took its toll on my left leg. I knew they were known triggers to my eczema but I still ate them anyway. Lesson learned (the really hard way)!
[May 2018] My eczema flare usually starts with small bumpy and extremely itchy rashes that look like pimples. I used to have them only on the inner part of my left leg but this year, they started spreading like wildfire affecting almost my entire leg.
With the help of my dermatologist, I first underwent a skin biopsy procedure to establish a correct working diagnosis. This is essential to make sure that the treatment plan will be appropriate for my skin condition since some clinical presentations of dermatoses can be atypical.
After getting the confirmation, we did a blood test to make sure it's safe for me to do phototherapy. Once cleared, we then proceeded with my treatment.
Phototherapy is a kind of therapy wherein the body part affected by eczema is exposed to narrowband UVB light. (Please note that this treatment requires commitment because you need to go 2-3x a week otherwise, it won't be effective.) It is given in outpatient clinics wherein you will be asked to get inside a walk-in cabinet containing fluorescent light bulbs. The starting dose that was given to me was 100 mJ which lasted a few seconds only. It was then increased gradually, lasting to almost 2 minutes. Having light therapy is similar to sunbathing so expect your skin to get really dry after each session (a liberal amount of moisturizer should be enough to address this issue).
The effect of phototherapy won't be visible right away. It will take weeks before rashes would clear up. Sometimes, the first few weeks of treatment could even make your initial skin condition worse, which actually happened to me. But fear not, for 70% of atopic dermatitis cases actually respond well to UV therapy. Hence, patience is key. For a more detailed information about phototherapy, please CLICK HERE.
*Photo credit
Apart from light therapy, the following also helped me manage my eczema:
1. Ditch the soap. People with eczema usually have very dry and sensitive skin, and regular soap can aggravate it furthermore thereby, causing a flare. Give your skin the TLC it needs by using a mild and fragrance-free cleansing bar like Cetaphil or Dove.
2. Moisturize. Moisturize. Moisturize. Slather an emollient (creams are better than lotion; I use Nutraplus cream and Cetaphil moisturizing cream) within 3 minutes after taking a shower to lock in moisture more effectively. Re-apply moisturizer as often as needed (twice a day should be the minimum). Remember, dry skin triggers flare-ups so be diligent about it.
3. Wet wrap therapy. Itching, which is more pronounced at night, is probably the worst symptom associated with eczema -- it wakes you from your sleep and makes you scratch your rashes endlessly. It's a total nightmare! Wet wrapping with Vaseline petroleum jelly helps a lot in calming the itch and therefore promotes a good night's rest. (Using topical steroid for wet wraps should only be done under the careful supervision of a health professional.)
4. Diet modification. Eczema is also known as "skin asthma". It's a condition wherein your skin reacts to certain allergens that cause the itching and rashes. Sometimes, these allergens can be found in the food that you eat. Try eliminating the most common allergy-causing food in your diet (eggs, seafood, dairy, nuts, soy) or better yet, get yourself an allergy test to identify your "triggers" and totally avoid them. (Allergy patch testing is very expensive in Abu Dhabi and it's not covered by insurance, so I was not able to do it.)
5. Use plant-based products. When all else fails, try natural! Natralia is a steroid-free alternative to relieve itchy and uncomfortable eczema flare-ups. Made of homeopathic, natural herbs and essential oils (free from coal, pine tar, paraffin, parabens, and nut oils), their cream helped me keep my sanity when I can't stop scratching my skin. It's safe and effective!
6. Dress for comfort. Forget about skinny jeans, leggings/jeggings or anything tight-fitting. Make your skin breathe by wearing loose and soft fabrics that won't rub against your skin like maxi-dresses and palazzo pants. Believe me, your skin will thank you for it.
[August 2018] This is my left leg's skin condition after 3 months of phototherapy. As you can see, I now got a black scar from the biopsy site and the rashes caused my skin to become hyperpigmented. It's temporary and will eventually fade according to my dermatologist. Well, to be honest, I don't mind not having flawless legs like that of a VS model. As long as I'm not itching and my skin isn't fiery red because of eczema, I'm good!
Anyway, it has been three months since I totally stopped using topical steroids. I still get a few rashes every now and then but they can now be managed by moisturizers alone, so I'm happy! I suppose the phototherapy helped a lot in putting my eczema into remission.
If you're battling this chronic skin condition and you want to get rid of steroids then talk to your dermatologist and ask about light therapy. I promise it's worth giving a try.
