[special post] a possible explanation to my latest flare

i’m currently trying my best to recall what happened in the past 2 weeks. it took around 2 weeks for my skin to get really bad, to me, that’s quick enough. nuff’ said, this is a flare. but is this topical steroid withdrawal (TSW)? 

i don’t think so.

now, what’s the definition of topical steroid withdrawal? withdrawal symptoms from topical steroids, of course! but i’ve stopped steroids for 3+ years already, it’s impossible for this to be a “rebound” reaction from the initial cessation of steroids. and for those of you who think that those topical steroids are still within my system.. let’s me just say that it’s not true.

what’s left behind in my body is this: compromised skin that isn’t as strong as normal skin to withstand both the external and internal stimulus.

wait, internal stimulus? am i going about some odd alternative medicine thinking here? you can say so, but it’s not about “detoxing”. my body is not toxic per se. neither are the oozing a sign of my body detoxing by “flushing out the toxins”. that’s just BS. the skin oozes because the mechanism that controls the permeability of the cell membrane, as well as the regulation of osmotic pressure has gone haywire. while i’m not sure of the exact reason why, i can make a smart guess that it’s either due to the inflammation, or due to the aftereffects of using topical steroids. or it could even be the synergistic effect of the two, coming together to give us a hell of a bad time.

we have no idea how topical steroids can change the way our cells communicate, it’s as though they are secret spies that hack into a company’s supply chain system and secretly tweaks the orders without us knowing, for example, they’ll order less of a certain material and pocket the rest of the money to themselves. while they’re still freely roaming in our company, they get to cover up their tracks and nothing seems amiss. once we get rid of them, no one is there to patch up those loopholes, that is when we start noticing weird patterns in the entire company’s operation..

let me define what i mean by internal stimulus – it can be anything from stress, to food intolerance, basically anything that will make my body hyper sensitive. there are two modes: either my body is not manufacturing enough anti-inflammatory materials, or the receptors responding to the anti-inflammatory materials are all having an affair with a third-party (probably a glucocorticoid receptor antagonist), hence they’re not able to “mate” with the anti-inflammatory material and have anti-inflammatory babies. wow, that’s a whole lot of anti-inflammatory talk right here. ANYWAY, long story short, since my cells isn’t responding to the cortisol, inflammation goes out of hand, which could be one of the path ways that led to this flare that i’m currently in.


i have reasons to believe that this is both systemic and external. some possible factors that i can think of.

1) bad air and weather (external)

it could be external because the air in singapore has been bad lately, THANK YOU SO MUCH INDONESIA FOR POLLUTING THE WORLD’S AIR. no offense to any indonesian skin friends. i just hold a grudge towards your government for the lack of control over the fires. don’t take it personally, unless you set fire to the forest which contributed to some of the haze over here, then you’re black listed.

the haze coupled with extra heat just made it a less comfortable environment for my skin. i was itching more, runny nose and all.

2) stimulation of my skin (external)

i did scratch my skin and that sort of caused and exacerbated the situation. they used to be fine even if i scratch it, but this time they became something else.


i think it’s partly systemic because it’s not localized to just one part of my body. in fact, i never irritate any part of my face by scratching or anything (unlike the rest of my body, where i do take pleasure scratching myself subconsciously whenever i can), it just appeared on my cheeks one day and it spread slowly but surely. is this external? maybe, but without fuel to feed to the fire, it wouldn’t have spread – if would have died out soon enough if it’s just due to external reasons.

the fact that scratched areas are suddenly inflamed (when they normally wouldn’t) tells me that my body is in a high alert state.

3) PMS and the hormonal storm (internal)

also, the past 2 weeks just so happen to be day 14 to day 28 of my menstrual cycle. my apologies if this is TMI, but hey, the menstrual cycle happens to be part of the singapore biology curriculum, so it’s academic.

source: encyclopedia britannica

what does this graph say about the hormones at play during the past 2 weeks? well,  we have a falling concentration of estrogen, and a peaking level of progesterone as my body prepares itself for a fertilized egg. sometimes i feel like progesterone is like the mid wife who prepares for labour. sadly, i have let her down once again.

“there goes egg #123”, progesterone said as she wept off a tear from her eyes.

jokes aside, here’s what i found about what estrogen does. or rather, what the lack of estrogen does to menopausal women.

“That reduction of estrogen, and the changing ratios of hormones in your body, don’t just slow down your body’s oil production, they also reduce your body’s ability to retain moisture.” (1)

“Estrogens have anti-inflammatory properties, so the loss of these hormones can also lead to increased inflammation, which can exacerbate certain conditions like rosacea” (2)

“Estrogens also regulate GAGs in the skin, and losing these hormones results in dehydrated, itchy skin.” (2)

i remember reading somewhere that progesterone is a glucocorticoid receptor antagonist, it binds to the receptor and prevents it from binding with glucocorticoids our body produces, but i can’t find that source right now.

anyway, if you didn’t understand any of the above, there’s simply a hormonal storm in me for the past 2 weeks. geez. women are hands down the most complicated creature ever. there’s so much going on in there, i don’t even know what’s going on.

4) stress (external and then internal)

stress can be good or bad. i think my skin reacted in a negative way, it went into over drive. truth is, my skin was already showing signs of inflammation 3 weeks ago, but it was very mild. i thought it’ll just go away like the previous time. and then 2 weeks ago, i received a phone call from my brother asking me for help. i spent that day touring around singapore’s hospitals in the ambulance.

i think my cortisol level went off the charts that moment. and it probably didn’t help with my body that much.

5) signs of chronic inflammation (internal)

there’s another hint that my body have been showing me lately, but i missed that sign. i’ve been having this neck ache for the past 2-3 months. initially it’s a shoulder ache that evolved from me sitting in front of my laptop for 8+ hours a day, doing design works with my right hand and arm a lot, but then it mutated into something else. i never gave it much thought, thinking it’s the carpal tunnel from using my laptop too much. i did all the stretches i can possibly do, but it didn’t relief it much. only then did i realize it feels different from the past – i used to only have an aching shoulder when i am on the laptop, but now that ache follows me even after i take a day off. it only struck me a few days ago that.. it’s actually a sign of inflammation.

you see, inflammation can take many different faces. it’s just like mystique from x-men you know? inflammation can cause cardiovascular diseases, cancer, and all sorts of diseases we never really link inflammation to. i remember i had a case of piriformis syndrome during my TSW days (which went away on its own after a few months as i progressed), that could be attributed to the systemic inflammation as well.

so now i’ve got two ticks on my list of chronic inflammation – skin rashes, and muscle aches. the alarm only went DING DING DING in my head 2 days ago. is it too late? i don’t think so.


things always happen for a reason. i haven’t been careful with my diet ever since forever, i got complacent thinking that i can get away with it. hey, life’s short! i want to enjoy the food that i like! this is just life telling me “sorry, but no. you want good skin, YOU HAVE TO WORK FOR IT.”

it’s so ironic thinking how strict i used to be when i tried a low carb diet (although it wasn’t for my skin. my motivation to lose the weight i gained during TSW was apparently very strong.), i literally cut off my favourite bread from my diet. T.T but it didn’t last.

even though i’ve always known the side effects of eating too much refined carbs and sugar, for example, premature aging of skin, and also promote inflammation. but just like a doctor who knows the side effects of smoking, drinking, and doing drugs.. i continued eating refined carbs anyway.

so, thank you steroids, you are nudging me into the healthier path i know. i know that all along, but changes don’t just happen because i know how it may impact me, or when i feel like it. changes can only stay for good because I NEED IT. this flare is a fucking hard kick on my ass to get my notice and to take action for real, RIGHT NOW, PRONTO.

also, thanks to this latest flare, it has spurred a meaningful post that i’ve longed to write but never gotten my ass around it. i don’t know if anyone will read this thousand word essay – i don’t care. i needed to get this out of my head while it’s here.

i should just take this flare as a little break from my usual work so i can find some inner peace and scientific discoveries.

speaking of which, i’ve decided to visit my TCM doctor tomorrow to bring the fire down faster. since this isn’t a case of the TSW that i’ve come to know of (meaning, it’s not triggered by the cessation of steroids, rather, it’s a manifestation of steroid damaged skin, the external environment, and my state of health. that’s a perfect storm right there.), there is actually something that i can do, on top of getting back to a cleaner diet.

there is always something i can do. after a day of feeling like doing nothing, i’ve got my shit together to make myself feel better. and.. i’ll be ready to face the tough morning time tomorrow again.

it’s been a while, but tough mornings can’t stop me this time round. i know all to well that it’s not gonna last the entire day. and i hope you remember too – the morning is usually the worse, but it can’t get any worse than that. your day will get progressively better.

it’s always the case, in fact.

don’t stop believing, my fellow skin friends.



(1) http://www.webmd.com/menopause/features/menopause-dry-skin-hormone-connection

(2) http://www.dermalinstitute.com/us/library/76_article_Hormones_and_Your_Skin.html



29 thoughts on “[special post] a possible explanation to my latest flare

  1. As a researcher (not in bio field though), I always loved your scientific explanations! The science behind all these is helping me to believe in seeing the end of the tunnel! we may all have down times. Hey, but isn’t this showing us how wonderful the good times were, and will be 🙂 maybe you are right, this is a reminder for you to work on your healthy life style :p keep believing:)

    • aww thank you so much for the heads up! I was trained in the science field, and it’s almost second nature to try to find a scientific explanation for all the things I observe, so much so I’m worried that it’ll bore you all. but hey, at least you like it and understand what I’m talking about! hahaha I’m not in the bio field either. but I enjoy science as a whole. hehe! and knowing the possible scientific mechanism behind our skin does come across as a proper “closure”, a way for us to accept what is happening easier, right? this entry is a sort of that closure for me, trying to make sense out of something that may be totally random. and you’re absolutely right, episodes like this reminds me of the good times, and I’ll enjoy them so much more again when I’m done with this flare! woohoo! can’t wait!

  2. Hi Juliana, are you feeling better now? Just wonder how’s the weather is like in SG these days? I am flying there for a weekend and I am so scared that the pollution will set my skin backwards. I am now in 18months, can’t say I am healed but definitely improved a lot… And, I agree so much with you on the PMS part. I tend to take lots of fish oil when I sense “it” coming. Not sure if it really helps but it at least makes me feel better, psychologically.
    Hope you’ve healed by now! 🙂


    • hey Brenda! I think you shouldn’t burden your mind and worry about the air. I think your skin must be stronger than that to withstand the slight haze! plus it rained today, the air seems cleaner already!!! hehe if fish oils makes you feel better, even if it’s just psychologically, do it! there’s no harm 😉 and thanks for your well wishes! hahaha but for my skin to heal within a day, it’s impossible! hehehe you will hear it from me for sure when I’m done with this flare 🙂

  3. Ah man sorry u are flaring. I think,later stage flares can happen even after months of feeling good. Just keep going!!! Did u get my Facebook message about using some pix from your blog for my amazing race video to explain rss? Lmk if it’s ok!!! Xoxoxo Loren and Kline

  4. Hi Juliana, I’ve followed your blog for sometime for inspiration and understanding the nature of tsw. I’m sorry you are going through some form of flare. Just a couple of questions, how many serious flares did you have(waves) during tsw? Was there a third and a forth and so on and was it more manageable?

    My fingers are so swollen, and rotten. They ooze some form of liquid every time the skin breaks or falls apart which when dried up is yellow in color. How long did your fingers take to heal and do we share similar symptoms?

    • hello Ian, thanks for your concern 🙂 I had 2 big flares that both lasted quite some time. within those serious flares are minor cycles which I didn’t count as flares. I define a flare as a definitive deviation from good healing skin. this is my third flare so far, I must say my second flare was my worst, the first and third seems more manageable.

      I did have the finger symptom as well, it took me almost a year to heal from my second flare, which includes my fingers.

  5. Hi Juliana,

    Thank you for keeping us posted on your progress. It helps a lot.

    As you mentioned, this might not be TSW. After all, we started using TS because of skin issues. We may need to root cause the original skin problem after TSW is done.

    Per many books/information, a weak Immune System may root cause to Gut problem (digestion system got compromised) and/or Imbalanced hormones (e.g. started from spiked blood sugar). Perhaps if we can address the root problems, then can rebuild a stronger Immune System, then to “heal”.

    This site has some videos that I found easy to understand:

    Thanks again for your sharing, and hope your current flare will be gone soon.

    • you’re most welcome ling! i’m on my way to figure out the perfect balance for my body. this is the best time to experiment 😉 thanks for the info, i’ll check them out.

  6. Hi Juliana
    Your blog iis awesome.. U provide a lot of info on tsw..
    I’m currently past month 2 of tsw. While I was visiting the local pharmacies, I found this cream called egoderm cream which contains the icthammol. It claims to be lanolin and corticosteroid free.. I’ve tried using it and it does soothe the inflammation.
    Just wanna ask have u heard of this cream b4 and does it have any side effects
    I’m from malaysia

    • i’ve already replied to your question via email, but i’ll answer it here again in case others read it and find this useful.

      ichthammol is a natural alternative that has anti inflammatory properties. i don’t remember reading about its serious side effects, but it definitely doesn’t thin the skin like steroid does.

  7. Hi, really interesting article, hope is getting better by now :). In relation to the point on whether your body is not manufacturing enough anti-inflammatory materials, which may explain the flare, or the other explanation on whether its just the receptors in the skin; I found out grape fruit will help the adrenal glands produce cortisone levels naturally, so if the former is the case, eating grapefruit in the evening could help(based on the human circadian cycle). I am yet to try this but i will start today. I don’t know lots about biology so if i’m completely wrong do tell me haha. Just to let you know (although you probably know this already), you should not eat grapefruit whilst taking other medications


    • Also just to add, my twin brother has a skin condition like mine, used topical steroids and is most likely out of the withdrawal stages, but he also had a flare starting a approx 3 weeks ago. So skin conditions of this type could be seasonal like humans susceptibility to common cold etc.

      • hey alex, try it out and let me know how it went for you! i guess we’re just more susceptible to skin flares since the skin integrity is compromised. i’ll just have to amp up my precautionary measures such as keeping up with my health! gotta start healing from within from now on.

      • Hi Juliana, hope ur good. Just an update to see how the grapefruit juice thing is going (in relation to cortisol levels) , and my skin has definitely improved. But the correlation may be just a coincidence…My skin has gone from a 4 to an 8 in 2-3 days. So i personally think its worth something!

      • ahh! glad it worked for you! keep doing it!! do you squeeze the grapefruit juice on your own? hahaha sounds so sour and bitter to me. :/ not a fan of grapefruit..

      • Yeah I know what you mean, initially I would sip a glass although now I like the taste and can drink it normally. I just buy it from the supermarket but the carton I drink contains a high amount of sugar..Also I’m contemplating whether i should only drink it when i flare up to reduce the chances of me getting used to the effects or something.

      • i’m not too sure, there may not even be added sugar i think grapefruit just has really high sugar content. Although maybe in waitrose or a kind of organic supermarket there will be a not from concentrate, as mine is from. But yeah the juice is one of a few “sweet” items during my day because of this…has your skin recovered yet from the latest flare?

      • grapefruit has low sugar content compared to say, an orange. you don’t have to worry about that 😉

        my skin has not recovered from the flare yet. you should know it takes longer than just a few weeks to get over a flare like that!

  8. Pingback: MONTH 43 | juliana's topical steroid withdrawal journey

  9. Pingback: [special post] i went on a fast | juliana's topical steroid withdrawal journey

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