Your Eczema is getting aggressive
Hey there! This is my story and experience with this nasty thing called Topical Steroid Withdrawal.
My Eczema Story
Before going into detail of my TSW journey so far, I think its important to recognise that I have been experiencing Eczema or Atopic Dermatitis for the majority of my life. Eczema is nothing new to people, about 20% of children and 11% of adults in Singapore have some form of Eczema.
The photo below kinda is one of the earliest photos I can find with my skin being inflamed and red (Look behind the folds of my arms). Eczema really was something I got used to very early on in my life. It was really common to hear things like "eeyer you chicken pox boy." in primary school. But it was something I really got used to. Surprisingly, eczema really never stopped me from pursuing various sports and activities in school, and this perhaps because my eczema was never really the severe kind. At its worse, the BSA (Body Surface Area) was maybe 20%. Tbh, only bad memories I had those humid Singapore nights as a kid, and requiring my Mum to scratch me to sleep :')
In secondary school and in JC, I would take part in sports activities quite often, be it Basketball or even Dragonboat in JC (that was my CCA in JC lol). My skin condition never really stopped me from taking part in those things. Looking back, I think it was all only possible because of my usage of topical steroids. In those earlier years, all I really had were creams from a neighbourhood GP, and these creams kept everything at bay.
Somehow I was never really very diligent with my steroid cream usage. That meant that I would always apply the creams till the inflammation subsided, and till I was no longer that bothered with the eczema. The underlying eczema was always there and I never really outgrew it.
This really carried on into my 2 years of National service and all the way into my working years. Somehow I always was able to rely on the creams the GP gave and it never really posed an issue for me.
My steroid cycle
In 2020, something within me seemed to shift significantly. Perhaps it was the mounting stress, my transition to a new job, or the change in environment, but it led to one of the most severe eczema flares I've ever experienced. Strangely, this was also the period when I took up running quite fervently. However, even as I tried to stay active, I noticed that the creams my GP had always prescribed were losing their effectiveness. Despite multiple visits to the GP, the routine remained the same: apply the creams diligently, twice a day, until my skin returned to normal.
As the GP-prescribed creams continued to fail me, frustration and desperation set in. Having the means and aided by medical claims from my workplace, I decided it was time to consult a dermatologist for the very first time. This decision led me to a pivotal moment – the prescription of Elomet cream. Almost miraculously, the effects were swift and remarkable. Within a mere week, I found relief from the incessant itchiness and flaking skin. I vividly recall sharing my success story with a close friend who also battled eczema. Back then, it genuinely felt like I had finally triumphed over an issue that had haunted me for ages. While my friend warned me to be cautious about steroid usage and moisturizer application, I didn't pay too much heed – everything was working perfectly for me at the time.
Over the course of two years, I made regular visits to the first dermatologist, relying on Elomet each time a flare-up occurred. However, the efficacy of the steroid diminished progressively, and the affected areas began to expand – encompassing my scalp, face, torso, and more. The pattern was all too familiar. Then, in 2022, I decided to seek another dermatologist's opinion, driven by the realization that Elomet was no longer my savior. This new dermatologist introduced the concept of rotating steroids, which seemed logical at the time. With renewed hope, I embarked on a treatment plan involving Fucicort and Supricort creams.
As the months rolled on into 2022, I couldn't ignore the waning effects of these creams. By August of that year, my professional life took an unexpected turn as a significant layoff hit my team. This prompted me to address my skin condition before diving into my next job. During a dermatologist visit, oral steroids (prednisolone) were prescribed, and they worked wonders, granting me a clear respite within a week. Yet, as anticipated, the relief was short-lived. By December, during my second round of oral steroids, their potency had already significantly diminished. It was during this period that I found myself on my honeymoon in Hokkaido, struggling to manage my condition while savoring the trip. Reality hit hard after my return. My dermatologist confirmed that my eczema was escalating aggressively, compounded by excessively dry skin and relentless peeling. Even the steroid creams had lost their effectiveness. The unsettling truth was presented before me – the option of biologics treatment, a decision I found myself on the brink of making.
Biologics
The options laid out to me were the following:
- Dupixent - ~ 1200 SGD a jab every 2 weeks
- Rinvoq - ~ 75 SGD a pill every day
Holy crap! Financially this did not make sense to me. I decided to try alternative treatments at this point, such as TCM, and the first advice I got was to stop all forms of immunosuppresants and steroids. Stopping did all sorts of nasty things to my skin, basically every part of my skin except my palms and feet were peeling and flaking. My skin also started to ooze at this point. Even my family could tell I was suffering tremendously. My inner thighs weeped and oozed so bad, I really could not walk and keep up with them. All day and night I was feeling chilly, even during the hottest of summer afternoons.
It was only at this point did I realise.. What I was experiencing was probably not eczema or atopic dermatitis...