(Written by Dr. Kenji Sato)
I was treating a primary school girl with severe atopic dermatitis. She was erythrodermic (*1) because of frequent application of topical steroids on her whole body. She was complaining of severe itch and pain. Her skin had atrophy (*2) and telangiectasia (*3). To alleviate her symptoms, I decided on two choices of treatment at that time. One was an application of stronger steroids, and the other was a more frequent application of steroids which had been used. However, it was apparent that both of the choices would soon result in more atrophy and more telangiectasia. To avoid further adverse effects, I decided to stop using steroids. Symptoms of topical steroid withdrawal such as exudation, crusting, fissuring (*4) of the body was anticipated. To alleviate her symptoms, Vaseline was prescribed.
Topical steroid withdrawal symptoms presented themselves on the first day and increased severely during the first week. After the first week, dead skin began to peel off the next two weeks. However, itch was still severe and erythroderma continued with brighter redness. Her top-level skin was so moist that it was easily scraped off by scratching on the affected area. When a layer of skin was removed, stronger itching sensation occurred causing constant itching that continued on for one week. The use of Vaseline did little for her itching sensation but relieved some of the pain. My concern for her symptoms intensified as my search for itch-alleviating care methods took some 5 days to discover.
One day, I was thinking about my personal history of atopic dermatitis. By the way, I had atopic dermatitis, the symptoms of which disappeared at the age of 13 years old. When I was a primary schoolboy, I had dry skin and scratched my body on a normal basis as I got dressed in the mornings. I scratched off white pityriatic (skin rash) scales from my body but no bleeding occurred. When I reminisced on my childhood situation, I took it to thought that dry skin might be stronger than wet/damp skin. Therefore I suggested that she discontinue the use of Vaseline.
During the first 5 days of Vaseline withdrawal, her symptoms resembled the extreme skin conditions presented with topical steroid withdrawal. I did not anticipate the discontinuation of Vaseline to cause exacerbation. However, after another 7 days, I noticed that her skin overcame some dryness and exudate less. After 3 more days, her skin started to become more dry. Over the next month, the skin on her whole body improved gradually with the healing of skin lesions. Only minor signs of skin flaking were observed and pain and itching decreased dramatically.
After undergoing the total process, I understood that successful treatment of topical steroid withdrawal needed “ointment withdrawal” as ointment withdrawal developed severe symptoms that mirrors topical steroid withdrawal. Now I use the words “No Moisturizing Treatment.” This is due to the following reason.
While treating many TSW sufferers, I noticed that they tried to moisturize their skin to alleviate topical steroid withdrawal with different methods such as oil applications, applying wrapping sheets, covering with gauze or Tubifast as a substitute to ointments. Furthermore, I noticed that any issues which give humidity to skin can become a type of moisturizer. Thus, I have changed the name from ointment withdrawal to “No Moisturizing Treatment”.
Dr. Kenji Sato
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Tokuko’s Footnotes
*1 Erythrodermic – a condition of an inflammatory skin disease with redness and scaling
*2 Atrophy – decrease in size of body parts, cells, organs, or other tissue.
*3 Telangiectasia – small, widened blood vessels on the skin.
*4 Fissuring – a narrow opening or crack of considerable length and depth.
Tennoji, Osaka
-My deepest thanks to Dr. Kenji Sato for spending your time on the awareness of TSW.
-Mr. Willie Bryant, I sincerely appreciate your helpful advice to me.
Tokuko