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Red Skin Syndrome – Correlation Does Not Imply Causation

It is interesting to note that all of the primary Facebook groups that were created for the support and treatment of eczema are now instigating new rules that have banned the topic of RSS (red skin syndrome) and steroid withdrawal. Eczema Parents is probably the largest online eczema community and the recently updated rules include the following snippet:

After careful consideration it has been decided that there will be no discussion about topical steroid addiction/topical steroid withdrawal or red skin syndrome, on the group, at all. Topical steroid withdrawal is not a treatment for eczema, and the subject has been the cause of bickering and arguments, and it has all become too much. Any posts will be deleted without notice, and members are at risk of being removed from the group.

The biggest takeaway here is the line that reads “Topical steroid withdrawal is not a treatment for eczema” and it’s very important for parents of children with severe eczema to understand. 

RSS is a real phenomenon in that red skin, separate from eczema, is often the result of the conventional steroid approach to eczema. In short, the conventional approach is a 7 to 10 day cycle of steroids (oral and/or topical) prescribed by a physician for the treatment of eczema. This treatment typically only works during this 7 to 10 day window and then the skin flares with eczema again. Over time, the skin builds an immunity to this approach and more steroids are needed to achieve the same results. For some, this results in additional red skin from the steroid usage and increased pain from the already debilitating condition of eczema. 

The problem with this situation is not in acknowledging that a reaction can occur from topical steroids. The problem is the understanding of what is occurring and more importantly, how to address it. There is a group that has long advocated that immediate cessation from all steroids is the only solution, at the point of developing red skin from the use of topical steroids. Unfortunately, this approach often has the most dire of consequences.

The underlying eczema is not affected by steroid withdrawal. If a child was suffering before, the condition is about to get much worse. TSW not only encourages pain and suffering in a small child having an already difficult time but there are many health implications. 

Anti-steroid groups do a terrible job of informing parents that steroid withdrawal has no effect on the underlying eczema, more often spreading messages of hope, that such an approach is the key to ending the suffering of red, inflamed skin. Desperate parents often become victims in this house of cards – later asking why their child has suffered so severely for months and years without an end in sight? 

“But it worked for my child!”

Testimonials make for the most powerful of arguments but it’s important to understand that correlation does not imply causation.  I recently received an email that stated “I know withdrawal works because it worked for my child!”. Did it? How do you really know? Why did the eczema exist before topical steroids were ever used? Why would using them for a prolonged period and then stopping suddenly heal the eczema that existed long before the topical steroid usage? 

Eczema is a condition that has always seen a percentage get better with time – with our without the addition of using anything on the skin. This percentage is what “sells” people on TSW (topical steroid withdrawal). The pretty “after” pictures and the powerful assurances that “this is the way” can be very persuading to individuals feeling great desperation but there are some very important questions that every parent considering withdrawal should be asking. 

It’s also worth looking at the entire spectrum of eczema sufferers. Some people deal with very mild eczema that requires no topical steroid intervention at all. Some deal with the most severe cases imaginable – and there are many varying degrees in between. How many “mild” cases have existed whereby an individual applied a small amount of steroid cream, witnessed a reaction of some sort, stopped using and the eczema finally cleared up on it’s own – an outcome that was destined to happen anyway? These are the stories that add to the myth of treating eczema with steroid withdrawal. The experiences seem very real to the person who stops using a steroid cream and sees a positive change in the skin but indeed, correlation does not imply causation.

TSW FAQs

Q. “Will TSW heal the eczema too?”
A. No. Withdrawal from steroids does not positively affect eczema. It can only negatively affect it, causing greater inflammation and disruption to the skin. This is the primary reason that the conversation is no longer being allowed in so many eczema groups. There is no cure for eczema. There is zero evidence that steroid withdrawal positively affects eczema in any way. TSW is not an eczema treatment. It is only for red skin syndrome. 

Q. Why does withdrawal not work for everyone? 
A. TSW may, in fact, work for curing the red skin associated with conventional steroid use but even that is unnecessary (see below). A very real problem in dealing with withdrawal is self-determining (because very few doctors support TSW) the line of where the red skin of topical steroids ends and the inflamed red skin of severe eczema begins. Sadly, there are many people who have been going through TSW for months, and even years, still waiting to see the finish line and they are simply dealing with severe eczema, which is unaffected by TSW. Indeed… if TSW works, why doesn’t isn’t it working for everyone? 

Q. Is there another alternative for eczema and/or red skin syndrome?
A. Yes! Red skin syndrome was the new buzz word in the first decade of the 21st century because little was known about it and the only solution seemed to be giving up all topical steroids. Though a long and painful journey, removing all topical steroids will eventually (and obviously) remove the red skin caused by topical steroids (but this still leaves the problem of severe eczema). It hasn’t been until the second decade of this century that the world’s foremost expert on eczema treatment has gained attention. Dr. Richard Aron’s treatment has an astounding rate of success in treating eczema and relieving the associated itch and pain. Visit Dr. Aron online or if you  have a Facebook account, visit the Dr. Aron Treatment Discussion Group and witness the results for yourself. Dr. Aron is treating thousands of patients in the group and despite the severity of eczema, the associated red skin that is sometimes the result of conventional steroid treatment, is no more for anyone. There are files on the Dr. Aron Facebook page that explain his view on red skin syndrome, how it is commonly misdiagnosed and why his treatment works to very quickly resolve an affliction that many are needlessly suffering for. 

If you’re a parent looking into different treatments for the condition of atopic eczema, the overload of online information and options can be very confusing but please be aware that steroid withdrawal is only likely to make an already brutally painful condition even more difficult. 

man suffering from steroid withdrawal

Dr. Makise on Steroid Addiction

I’m fortunate. I have a healthy little boy with beautiful skin. It wasn’t always the case though. My son suffered through 5 1/2 years of severe pain, itching and discomfort with the debilitating skin condition known as eczema. As a parent, I felt completely helpless and wondered if I would ever be able to help my son? I stumbled on Dr. Aron while Googling for answers one day and since that first week of starting treatment, my son did a 180 and got his life back – for good. He’ll be 7 years old this summer and he’s never again suffered with eczema. 

My son had severely red skin from topical steroid use. It always worsened right after using them. Dr. Aron assured me that his treatment would address this known issue. He was right. Regardless of what is sometimes written in personal blogs online or purported by websites advocating against the use of steroids, RSS is very easy to solve for almost everyone experiencing it. Dr. Aron has figured it out – and he’s helped thousands overcome this problem. He’s doing it right now. There are hundreds of children (and several adults) in the Dr. Aron Facebook group experiencing the relief from red skin syndrome. RSS, as it is most commonly “sold” today, is a severe “addiction” that must be overcome by withdrawing from steroids. In truth, it is simply the body’s exaggerated response to abruptly stopping a topical steroid.

Interestingly enough, that red skin is not caused by a steroid addiction, is also the view of my personal doctor and my son’s pediatrician, locally where I live. It is in fact, the consensus among the majority of all doctors in the U.S. Even the National Eczema Association states that true steroid addiction is unlikely and rare. This isn’t to say that there’s not a problem with the way steroids are often prescribed and/or administered. The standard for treatment simply needs to be looked at and updated. I personally believe this will happen one day. Dr. Aron’s approach to eczema reminds me much of the challenges Barry Marshall endured while getting the medical world to acknowledge his treatment for stomach ulcers. There’s every chance we may be looking at a future Nobel Prize winner in Dr. Aron. His eczema treatment is second to none and the word keeps spreading. 

I’ve often considered how absurd it was that I had to turn to a doctor living on the other side of the world (South Africa) so that my son could find permanent relief and healing from eczema.  On one night in particular, this had me wondering what the dominant approach to treating eczema was in other countries? Was it more successful? Did other world doctors view steroid addiction and withdrawal in the same way as US doctors? Did they prescribe steroids in a different manner? 

Tadahiro MakisaI was back to the Google machine. I came across Tadahiro Makise, MD, a Japanese doctor who was slated as “cutting edge” for the treatment of eczema and indeed, his specialty for the last two decades has been atopic eczema. Several internet profiles made him out to be a naturalist so I half expected him to be approving of TSW but if he could prove that TSW could affect eczema in any way, shape or form, I would gladly listen.  

What follows is the exchange we had during several emails. I got the feeling that Dr. Makise could have wrote for days, telling of his experiences with treating atopic eczema. He was generous with his words and it became obvious that he was passionate about his work. 

Q. How do you feel about itsan and their advocacy to never use topical steroids? Will abstaining from all steroids (TSW) ultimately work in to help with eczema in the end? 
—- It is a painful ordeal and it is very dangerous, too. I’m against such treatment.
Q. What are the mechanisms by which abstaining from any steroids might ultimately clear the skin?
—- I don’t think abstaining from any steroids might ultimately clear the skin. I recommend my patients to apply steroidal ointments without hesitation. Later I’ll explain to you why — probably the next week — as I don’t have time now. Please wait for a while.

Six days later, the conversation continued. 

Atopic dermatitis (AD) is caused by various reasons. Examples of causes are:— allergy to specific substances, junk foods, unbalanced nutrition, variation of filaggrin gene, mental stress, etc. But in any case, AD is caused from the inside of our body. It is not a skin disease. For example, Candida albicans (athlete’s foot) and Herpes is a skin disease; but AD is the symptom of an internal problem. Most dermatologists only see the skin and they don’t treat AD as an internal disease. I’m not a dermatologist but a general physician practicing in a busy Japanese town of Osaka and I see AD as an internal disease.

For the past 20 years, I have treated more than 50,000 AD patients at my clinic and I see the number of AD patients increase yearly. The majority of my AD patients have previously visited dermatologists and they understand steroidal ointments cannot solve their problem but are forced to continuously use steroidal ointments. Over time their steroid dosage was getting stronger and stronger and the patients realized the effects of continual steroid treatment to their body is bad. Radical “anti-steroid” therapies have emerged from patients who abstain from steroid treatment. I understand this social phenomenon very well but I recommend my patients to use steroidal ointments without hesitation.

You write ;

[How do you feel about itsan and their advocacy to never use topical steroids? Will abstaining from all steroids (TSW) ultimately work in to help with eczema in the end?]

—- ITSAN is right in the following two points.

1) Steroidal ointments stimulate the production of stratum corneum chymotryptic enzyme (SCCE) that breaks the barrier of the skin, therefore, abstaining from steroids can contribute to the cure of AD.

2) Some patients have allergy to some steroids.

Yes, they are right about these two points to some degree. But they don’t understand the below.

1) Any medicines has a two-edged blade. Steroidal ointment does have merit and demerit. But the benefit of steroidal ointments ( = anti-inflammation effect) surpasses its drawback. AD is ” dermatitis”. “— titis” is inflammation. If the skin barrier is broken, there are many methods to moisturize the skin. But how to suppress inflammation? Besides steroidal ointments, I don’t know a substance that suppresses inflammation as effectively as steroidal ointments.

2) I had a few patients who are allergic to steroidal ointments.

For example; One has allergy to prednisolone valerate (it is contained, for example, in Lidomex Ointment), — Patient A – and the other is allergic to diflucortolone valerate (Texmeten Ointment) — Patient B

If Patient A uses Texmeten Ointment, their skin improved very much. If Patient B uses Lidomex Ointment, their skin improved very much. So, it is not possible to generalize that all steroidal ointments cause allergy. The majority of patients are free from allergy caused by any steroidal ointments. Some researchers claim that around 20 % of AD patients are allergic to steroidal ointments but this figure is exaggerated. From my experience after treating more than 50,000 AD patients, it would be at most 2 to 3 %.

I’m against especially quitting “Cold Turkey”. Why? The reason is as follows:

One of the most dangerous sudden withdrawal effects of steroidal ointments is “cataract”. Patients develop cataract during the period of sudden withdrawal of steroid. Not often, but some, even very young patients, develop it. Doctors don’t know yet why sudden withdrawal of steroid hormone causes cataract.

The origin of the skin is ectoderm and the origin of the lens is also ectoderm. The sudden flare up of inflammation of the skin might have some connections with lens of the eyes, because their origin is the same. Therefore, I guess the sudden flare up of the inflammation of the skin should cause some neurological problems, too, because the origin of neurons is ectoderm, too. Depression is one of the typical symptoms of sudden withdrawal effects of steroidal ointments.

As well if you suddenly stop steroidal ointments, a really painful rebound of itching and scratching will take place. Individuals will not be able to sleep, work, study, or go about their daily life. The worst part is you will not know when this painful ordeal will end which creates heavy mental stress. Patients will be like a passenger of a wrecked boat. They will not know when rescue will come and they will reach an island, all while losing food and water every day. This stress worsens AD symptoms much more. The extreme build-up of stress will further exacerbate their condition, making their situation even worse. Eventually, pigmentation will occur due to the prolonged inflammation, and finally the patient’s skin will harden beyond repair.

Almost 95% of the patients who attempt to withdraw from steroidal ointments give up and begin to use steroidal ointments again. During this painful rebound period, their skin condition got worse, and it takes much longer time for them to recover normal skin.

And what is the crucial point is, I would like to emphasize again, ” AD is not a skin disease, but caused from internal problem”. AD is an “Inside Out Disease”. Dermatologists don’t try to cure inside of the patients. When patients’ internal body improves, they can withdraw steroidal ointment naturally . As the internal problem improves, they will need less steroidal ointments and less, and less, and finally null —> finally reaching a complete withdrawal of steroidal ointment.

But on the contrary, complete withdrawal of steroidal ointments doesn’t cure the internal problem at all. As you write, “I don’t understand the mechanism of the curing effect of complete withdrawal of steroidal ointments”. You are perfectly right in this point. That’s why to improve the inside of the patients, I prescribe various combination of supplements, such as vitamins, minerals, and herbs, and healthy foods. But some dermatologists who advocate TSW don’t mention even one word to cure inside.

Then, one question arises. Why can some patients who do TSW be free from AD without taking any action to heal inside? There seem to be some reasons as follow;

1) They might change their eating habit —> more vegetables, less meats, more fish, less sweets. Consequently they cure inside.
2) Some of them really had allergy to a specific steroidal ointment. And avoiding any steroidal ointments leads to cure.
3) The eczema was due to fungus infection. For fungi infection, steroidal ointment are useless. Rather steroid worsens the infection.
4) The eczema and red skin were due to Seborrheic Dermatitis (SD). The cause of some SD is attributed to fungi infection, too.
5) Thanks to a specific mechanism which is similar to Short-Term Prednisolone Therapy (So-Called Steroid Rebound Therapy) in the treatment of Hepatitis B, they are cured.

OK, I’ll refute these reasons here.

1) Patients can change their eating habit at once without experiencing this painful ordeal. TSW is not necessary at all to change the meal habit.

2) If the patient seems to have allergy to a steroidal ointment, change it to another one. Not so difficult to find a steroidal ointment which suits the patient. It is not necessary for the patient to give up all steroidal ointments.

3) If fungi infection, use antifungal medication. This has nothing to do with TSW. It depends upon the careful observation of the doctors.

4) The same as fungi infection. What is important is the careful observation of the dermatologists. That’s all.

5) This is worth discussing. “Steroid Rebound Therapy” for hepatitis B requires very careful control and observation by doctors. Without them, it’s very dangerous therapy. The same is true of the treatment of AD by TSW, even if the same theory can be applied to TSW. And if the patients undergo TSW, they should be hospitalized. Otherwise TSW would be very dangerous.

At this moment, I don’t know if the mechanism of “Steroid Rebound Therapy” for hepatitis B can be applied to the treatment for AD by TSW or not. It would take a lot of time to verify it but I’ve never heard that those who advocate TSW argue this theme. Probably they are too much specialists of the skin to get to know the treatment for hepatitis B. (Recently “Steroid Rebound Therapy” for hepatitis B is getting obsolete because better treatment by interferon is going to be established). Personally I’m interested in this theme. But even if verified, actually who can stay in hospital for a half year for eczema?? Very few!! If they were dying of cancer, they would be staying in hospital even for a year. But just by $5 steroidal ointment the eczema is alleviated.

Recently medical science has become too much specialized to diverse fields. The contact between dermatologists and physicians are getting less and less and almost nothing. This is never good for general health. I treat not only skin diseases but also menopausal women, hypothyroidism, depression, prostate cancer, lumbago, ADHD (attention deficit hyperactivity disorder), to rheumatoid arthritis, etc, etc, at the same time at my extremely busy clinic. I don’t distinguish diseases by the category to which the diseases belong.

To prevent Ebola, scientists of virology don’t care about a very simple fact, because they specialize only in virus. They seem to be occupied in producing an effective vaccine. But the simple fact is that Ebola virus is transmitted through the skin. Why don’t they try to strengthen the texture of the human skin to prevent Ebola and why don’t they try to improve our immune system against the virus? There should be effective methods to stop its infectious power. Later I will discuss about it. If you have any further questions, please feel free to ask me.

I wrote one more email with questions, as I hadn’t yet asked Dr. Makise what he thought about red skin syndrome?

“Dr. Makise,
Would you comment on what is commonly known as Red Skin Syndrome? Almost all proponents of TSW say that severely red skin is a sure sign of steroid addiction.

When you see a patient with severely red skin, after taking steroids, what are your thoughts? I assume from your previous emails that you don’t believe this is steroid addiction or that TSW is necessary to restore the skin to health? “

First of all, “Red Skin Syndrome” is not an accurate medical term for diseases. We don’t find it in orthodox textbooks of dermatology — at least in the Japanese text books. I have one English textbook of dermatology, but I don’t find it in the book, either. Red Skin Syndrome is the word for symptoms — like stomach pain. Not a word for a disease. And for the word for the symptom of “Red Skin”, ” Erythroderma ” is appropriate. And several kinds of skin diseases cause Erythroderma

So, from the beginning, arguments between conventional doctors and TSW doctors seem to be confusing. “Steroid Addiction” is also not an accurate word. Two ambiguous words, ” Red Skin Syndrome” and ” Steroid Addiction” are being used among them. So, more confusing. This is my general impression.

The crucial point of this argument between conventional doctors and TSW doctors is “whether steroidal ointments cause dermatitis or they don’t cause dermatitis”. My opinion is that steroidal ointments don’t cause dermatitis. As I wrote, even if they cause dermatitis, very few. And it is not difficult to improve the dermatitis by changing the steroidal ointment to another steroidal ointment.

Whenever the patients withdraw any steroidal ointment abruptly after long use, of course, it causes rebound, and the skin gets red. This is not dermatitis caused by steroidal ointments themselves. This is due to quitting “Cold Turkey”. Any drugs, for example, cholesterol lowering drugs such as, what is called, statin dungs, cause “rebound”, too, if the patients stop taking the drug abruptly. I’m strongly against statin drug and I let my patients stop taking it, but not abruptly. They should stop it very gradually. Dermatologists should know any drugs can cause dangerous withdrawal phenomena, if abruptly stopped. Not only steroid, but any drugs.

[When you see a patient with severely red skin, after taking steroids, what are your thoughts?]

— I would like to know the true cause of the red skin. — Is the patient suffering from drug allergy, or atopic dermatitis (AD), or seborrheic dermatitis, or psoriasis, or malignant skin cancer (mainly lymphoma or leukemia), or etiology unknown (idiopathic)? And if they suffer from AD or psoriasis and they withdrew the steroidal ointments abruptly, I let them try a different steroidal ointment — usually the unique steroidal ointments that we produce at our clinic. I never recommend TSW. If they suffer from serous itch (often the itch is really abnormally serious), it might be onset of skin cancer such as Sézary syndrome or Mycosis fungoides and I let them go to university hospital to check thoroughly. If drug allergy, careful listening what drugs they have been taking solves their skin problem very easily — don’t take the drug!! If seborrheic dermatitis, change the steroidal ointments to anti fungus ointment. If contact dermatitis, try to find the substance that causes dermatitis, though not so easy to find it actually, I know well. Therefore, apply steroidal ointment to reduce the inflammation.

For AD patients and psoriasis patients, I recommend them to take the combination of several vitamins, minerals, and herbs to cure their inside while reducing inflammation on the outside. Although steroidal ointments are very necessary, they are mere symptomatic treatment. Steroidal ointments cannot cure the problems of their inside. Just like TSW cannot cure the problems of their inside.

I have some AD patients who never want to undergo steroidal ointment. They choose TSW. But they well know that only TSW cannot cure them. And they want to try a unique combination of vitamins and minerals and herbs. It takes long time for them to cure AD by only vitamins, minerals and healthy foods without steroidal ointments. Most will show improvement but most will not be cured 100%. Even in such a case, it is not the TSW that is curing them but the lifestyle changes made during this time.

I also prescribe ointments that contain very fine powder of several kinds of stones. When wild animals get injured, for example, when the foot of a bear is injured, the bear puts the foot into the earth. Because he or she knows the natural healing power of the earth — soil and stones. Deer lick rocks to supplement trace minerals. Monkeys bathe in hot spring to heal injured body (at least in Japan!). They understand the water from the earth is effective. Let’s discover the natural healing power!!

Best regards,

Tadahiro

I thought our exchange was finished until I received another email from Dr. Makise just a few days later. This was information on a specific patient who had gone through TSW and how his life had diminished before seeking treatment.

Dear Mr. Kastner

Male. 21 years old. University student. He was diagnosed as atopic dermatitis (AD) at the age of 3 years old. Without AD, his general health is excellent. I have attached pictures

He underwent TSW in September 2012.

He came to us April 2013. So, he was undergoing TSW for 7 months. His IgE went up to 70,000 IU/ml (seventy thousands) !!!
(Normal IgE should be under 170 IU/ml).

He was diagnosed even with “Hyperimmunoglobulin E Syndrome” by a physician, because the physician didn’t know that he was undergoing TSW. Of course, he didn’t suffer from “Hyper IgE Syndrome” but just because of radical TSW.

While he was undergoing TSW, he took Chinese herbal medicine to cure the problems of his inside but it didn’t work ( Personally I don’t trust the application of Chinese herbal medicine for AD. Not effective. I saw a lot of unsuccessful cases ). During the treatment of TSW, he could not go to school at all, not possible to sleep, too itchy like hell. Now all are OK. But still sometimes eczema will appear and he needs steroidal ointment, because his inside has not been cured perfectly but the amount of the steroidal ointments are getting less and less with vitamins and minerals. He can go to school, and he passed the employment examination to one of the prestigious insurance companies in Japan and he will work there the next year.

If he had continued TSW, there was really no future for him socially, too.

But we must know that he had had conventional treatment ( I mean “applying steroidal ointment for eczema and rash”) before he underwent TSW. But he got to know conventional steroid treatment would not cure his dermatitis. Then he was trapped by TSW. But his symptoms got much worse by TSW and he gave up it. So, the crucial point is that the conventional steroidal ointment treatment does have defects, too, for some cases.

AD is probably more difficult to cure than psoriasis. Not so easy disease because so many complicated factors are involved. Not so simple disease as cured only by TSW.

Best regards,

Tadahiro

PS: I previously wrote that I have treated more than 50,000 patients over a span of 20 years. To clarify; of the 50,000 patients a lot are repeat patients and I meant to say that I have treated AD patients over 50,000 times which equates to around 10,000 different patients over 20 years. Surely my experience is small compared with old experienced dermatologists. But I can treat AD patients from the internal medicine view.

This ended the question/answer relationship between Dr. Makise and I. We exchanged a few more emails about stone powder, my son’s asthma and some off-eczema topics. I really enjoyed his conversation and appreciated his willingness to respond to any questions I had. I’m always amazed by the number of English speaking people in other countries.

As far as eczema, RSS and steroid addiction, I can’t say there were many surprises. Dr. Makise seems to share the same beliefs as most doctors in the US (albeit, he encourages natural healing a great deal more as I think all doctors should) in that TSW simply isn’t accomplishing very much, there are more dangers than benefits and there are better ways to deal with red skin. Don’t trap yourself in the prison that is TSW for the sake of suffering naturally. It’s simply unnecessary and it will not affect the underlying eczema in the slightest – and the eczema is the problem everyone should be focused on.

9 months of treatment by Dr. Aron

It’s Probably Not Red Skin Syndrome

There’s a distinct difference in red skin (RS) vs red skin syndrome (RSS), the former being an actual result of improper steroid use as defined by medical doctors and the latter, largely a phobia born of ignorance and propagated by self-diagnosed bloggers. It’s most often described as the red skin that appears after using a round of steroids. I can’t count the number of times I’ve seen this description given by TSW advocates on different Facebook groups for eczema. Sadly, this one simple misunderstanding is what seems to have led to the recent phenomenon of enduring TSW (topical steroid withdrawal) and causing much unnecessary suffering.

Dr. Aron wrote the following in regards to TS (topical steroids) and defining TSW:

There has been much discussion about the issue of TSW so I would like to shed some light on the matter. In patients where topical steroids ( TS ) have failed to provide a solution to the AE , there are many, it is the inappropriate use of these products that cast them into disrepute , not the TSs themselves. Potent steroids for short periods of time followed by reintroduction after the inevitable rebound of the AE is not a good treatment approach. Mild, dilute TSs for long periods of time is a much better option but this is a subject for a future post.

Now to the nub of the issue. Whatever regimen of treatment is advised , unless the bacterial infective element of the AE is treated effectively, the therapy will fail sooner or later and it this repetitive failure which leads to parents giving up on TSs. However, researchers have published an article in the respected journal Nature ( November 2013, Google alpha toxin staphyloccoccus in atopic dermatitis ) in which they note, inter alia, that 90% of patients with AE have staph infection. Yes 90 % ! These bacteria secrete a toxin ( poison ) which damage the cells relating to itching and burning and therefore it is essential to eliminate these bacteria . How best to achieve this will also be the subject of another post.

There is a doctor in America who advocates TSW as a treatment of choice, he notes on his website that .. it may take, weeks, months or years … for the eczema to subside, he takes no cognisance of the issue of secondary infection and thus is, in essence, is condemning the patients/parents who in desperation follow his line of reasoning to weeks,months or years of chronically infected skin with the attendant implications which all who read this post will be well aware. I have the greatest sympathy for followers of TSW but there is a better way .

The short of this it that Dr. Aron is acknowledging the inappropriate prescription that is standard for eczema (high doses of steroids for a short period) and pointing out that the resulting red skin is exactly what is to be expected. This isn’t a “steroid addiction” as so many have been led to believe. This is the logical outcome.

Dr. Aron’s 30+ years of expertise and treating eczema aside, those who have chosen to use the Aron Regime have the advantage of additional insight into this issue. The vast majority have all suffered with what TSW advocates have coined Topical Steroid Addiction or Red Skin Syndrome. Yes, our children (in most cases) all received topical steroid prescriptions prior to Dr. Aron and we all experienced rebound. On Dr. Aron’s Facebook Discussion page, we’ve seen children with red, flaming, oozing and leathery skin. We’ve seen bright red sleeves and children who were hot red from head to toe – almost always worse after quitting a round of prescribed steroids. We’ve witnessed this in infants, toddlers and even adults. We’ve seen it hundreds of times since the Facebook group formed in early 2014. In almost every case (and as an active admin in the group, I don’t personally recall any contrary to this), the red skin has never been an issue when the skin is treated properly, with topical steroids, as prescribed by Dr. Aron. It goes away.

If you’ve bought into the Topical Steroid Addiction hype for any amount of time, this is where you should be scratching your head asking how this is possible? It’s only possible, of course, if the diagnosis of red skin syndrome is most often wrong – and it is.

Many of the Dr. Aron Facebook members have put their kids through the emotional and physical toil of TSW before finding Dr. Aron. They’ve seen their children suffer months and years for a condition they never even had, before trying Dr. Aron and seeing the itch and suffering of eczema go away in days (in most cases). Indeed, Dr. Aron’s patients have earned their optimism whereas none of the Dr. Aron skeptics have earned their skepticism.

This has all led to a better understanding of what Red Skin Syndrome truly is and it’s something that the majority of all skin doctors have been telling us all for a long time – a condition that is possible by an enormous amount of inappropriately prescribed, high-potency steroids being used on the skin for many years but unlikely to be found in most all adults having used topical steroids and even more of an anomaly in children. If we are to use the sample size of patients that have come to be treated under Dr. Aron by way of Facebook (several hundred), a case could be made that nearly every case of self-diagnosed red skin syndrome is an incorrect diagnosis. That’s frightening as there are a great number of babies and children being forced to endure the hardships and high risks of TSW because of advice their parents found on the internet.

It’s worth mentioning that most parents that have come to adopt the philosophies of Dr. Aron have done so hesitantly. They’ve heard so many stories about the horrors of steroid addiction that they are very slow to accept the facts as Dr. Aron presents them. Many are still expressing doubt when they start treatment under Dr. Aron – often doing so out of the sheer desperation that parents of children with severe eczema often feel. It is in seeing the results for themselves and letting go of their former beliefs, that these parents (myself included) finally come to fully understand the realities of TSA and the horrors of TSW.

In a recent Facebook post, one group member describes her experience in using and coming to understand Dr. Aron’s Regime:

From all that I’ve read (I’ve been in this group since its inception), from what Dr. Aron has told me himself, and from my own personal experience with my two children, there is no rebound. The skin is never in the state that it was before.
  
I think what makes the difference between Dr. Aron and TSW is that Dr. Aron fixes the skin barrier almost immediately while TSW waits for the body to do this on its own, which is a huge ask and is so variable from person to person. He stops the itch, and so stops a number of knock-on effects of the itch, including the constant scratching, which further infects and inflames already broken skin, the lack of sleep, which has been proven in study after study to have a huge impact on healing, growth, development, and immunity, and the stress, the hormonal effects of which are not always immediately visible to the naked eye but nevertheless have a massive impact on a body’s functioning, including immunity, inflammation, and healing. He also calms the inflammation and nixes the incessant trigger of natural skin bacteria, which is not a problem for non-eczematous skin but a major irritant for us/our kids.
  
So he achieves what TSW aims for but much, much quicker and with no suffering. And I think we have to be frank about what TSW claims to be able to do in terms of giving people perfect skin and a steroid free life. I did a ton of research on TSW before I decided to go with Dr. Aron, and I was hard pressed to find even half of the cases where they had perfect skin ALL THE TIME and were steroid free. Perfect skin most of the time, sure, occasionally (though I must say, these seemed few and far between–the odd very lucky case that had got through ‘the process’ in under a year and could boast skin without a single flaw) but ALL the time? I can think of one case I read where the little girl had gone through TSW in about 9 months and didn’t have any eczema after that. Many would say that once her skin had healed, the predisposition for eczema had gone into remission and so that was why she didn’t have any flares. But she was about 6 or 7 (the age at which most docs say kids will usually ‘outgrow’ eczema)–to be totally sure that TSW has delivered on its ultimate promise of clear skin for life with no steroids, we need to wait six or seven years for her to go through puberty, or another dozen to see how pregnancy affects her.
  
My point is, TSW has not been happening for long enough for ANYONE to claim that it cures TSA and underlying eczema and guarantees people normal skin forever. What I see, from the ‘success’ stories I’ve encountered, is that SOME people will eventually achieve the clear skin, but they will still ‘flare’, however far and few between these flares become, or have patches of eczema that they just live with without treating. This is no different to what Dr. Aron achieves in the long term for pretty much ALL of his patients, except that the flares that occur with his patients following treatment are nothing like the horror of the TSW flares, and he recommends treating them briefly with steroid because, in actual fact, he has proven steroids aren’t the scary devils that so many believe them to be. When used effectively, pretty much anyone, including those who have previously been in TSW, can respond well and taper down.
  
And for some in this very group, in spite of its youth, (can’t comment on the old timers as there may well be many more), Dr A has brought them to exactly that end that TSW promises: clear skin and no creams.
  
Doing this treatment requires a major shift in thinking if you have a phobia of steroids, however that phobia came about (experience, hearing stories of others’ experiences, extremely poor treatment from medical professionals in the past, etc). It required a massive leap of faith for me, especially considering this group didn’t exist when I gave it a go. And it has taken months for me to relax and really believe that we were never going back to square one. But we aren’t. After years of rebound, increasing potency of steroids, spreading eczema and hopelessness, my children have completely clear skin, have tapered down their doses from 5x/day to once every 5 days for my eldest and once every 3 days for my youngest. On the rare occasions that they do flare, they calm down quickly and are straight back to their maintenance routine. I would bet good money my eldest at the very least will be off the creams all together after this winter. Nothing short of miraculous. It is the real deal. Really.


This sums up my feelings to a tee. I firmly believe that Dr. Aron just gets people to the same place that TSW gets them in days vs months or years. My own son was once suffering from the symptoms of RSS – red, oozing skin which always presented itself in the worst manner after a bout of steroids. Today, his flares are even better than the first 2 years of his life when my wife and I didn’t use any steroids at all. They’re like small rashes now, that he is barely bothered by, and they only appear once every couple months or longer.

The below video was the actual video I sent to Dr. Aron in October of 2013, when he requested pictures of my son for an online consultation. This flare was just a few days after we had stopped using a steroid – what many would call RSS (and what many did when I was posting to several different forums asking for advice) but what Dr. Aron informed me was grossly infected skin I needed to address immediately as to avoid further complications. Had I gone by the definition of Red Skin Syndrome, as it’s most often described by various internet sites today, there would have been no disputing that my son had RSS – as steroids always worked to clear the skin but as soon as we discontinued their use, the skin turned red while burning, itching and swelling almost immediately. Thankfully, I demanded more than an internet description for a diagnosis of RSS and such was not a diagnosis my son’s dermatologist was willing to give.

For those who do reach the end of TSW, many report small flares that are very easy to maintain – same as my son. Some (though it seems few) report a complete remission of eczema – just as there are few people using Dr. Aron’s regime that can claim this — because neither method is curing the eczema. Both get it to the same place and then there are those statistical cases where people truly outgrow it, as has always been documented with eczema.

9 months of treatment by Dr. Aron

After 9 months of treatment by Dr. Aron

90% of my son’s condition was made better in the first week of treatment with Dr. Aron – using topical steroids, despite the fact that the previous round of stopping topical steroids was what caused him to flare so badly.  As Dr. Aron explained above, it’s not the topical steroids causing the red skin problem – it’s stopping the steroids all at once, rather that’s due to irresponsible prescription (the case with my son) or application.

If you have previously bought into the belief system of TSA, I would challenge you to consider how you came about that diagnosis? Most tend self-diagnose on the same day they read about TSA and are unwilling to consider any other opinion that is contrary to TSW at that point. The very nature of the TSW ‘treatment’ (or lack thereof) requires the ‘patient’ to view all steroids in a negative light – but also dermatologists, doctors, and anyone who expresses a belief contrary to those held by TSW advocates as untrustworthy. The primary site for TSW information (as well as the TSW Facebook groups) censors and boots members that express an opposing view. What is there to fear if the truth is so indisputable? In Dr. Aron’s Facebook group, by contrast, all questions are welcomed – even on the topic of TSW/TSA.

What if the information you’ve been hearing is simply wrong? Why are there so few doctors and dermatologists writing about TSW and choosing to recommend topical steroids instead? What does your doctor, dermatologist or GP say? TSW advocates are generally in strong opposition to what most doctors believe and just maybe – that should be a red flag in itself?

I truly believe that Dr. Aron’s regime provides the least amount of suffering and pain for children with the least amount of side-effects – TSW included, as that is so hard on the metabolism/immune system and self-confidence. My son doesn’t itch, scratch or suffer in the slightest anymore. His skin looks immaculate. I cannot thank the good doctor enough.

For the majority of red-skin sufferers, let’s start calling RSS what it really is – RS resulting from steroid rebound due to the skin not yet being properly treated. This is by no means an indication that your body has become dependent on steroids. Get the skin properly treated and the suffering ends. It really is that simple in most cases – at least for those who are being treated by Dr. Aron.