Sunday, 13 October 2013

Moisturiser Addiction

So today I am going to revisit a subject that I touched on last year in this post.

The subject of the post was moisturiser addiction. At the time, I had considered a lot of evidence to show that the skin can get dependent on moisturisers and decided to stop using them. I only lasted a couple of days. The tightness and cracking kicked in and was unbearable. I applied moisturiser and got sweet relief.

However, I read a really interesting report over on Tommy's Skin of Rose Blog, which I think everyone should read. The post was about a conference in Japan all about TSA. In Japan, they are a lot more advanced than the West when it comes to steroid addiction. Two doctors, the Doctors Sato, are pioneers in the field and have helped cure many people.

When I read the post, one particular quote jumped off the page at me:

"I personally have an impression that moisturiser withdrawal is still seen as an unfamiliar idea even among TSW patients. However, the doctors on the event all agreed that moisturiser withdrawal was 'usually essential' rather than 'encouraged'. I knew it was a good thing to do, but thought it was optional at the time I wrote the post. They explained that only about 10% of TSW patients healed without moisturiser withdrawal, and they were all mild case patients. TSW patients who recover well are usually doing moisturiser withdrawal strictly, according to the doctors. Even children can be addicted to moisturisers. Dr. Sato said that wiping off oozing or picking up scabs could be 'moisturisers' to your skin.  "

OK. This sounds quite worrying. Only 10% healed without moisturiser withdrawal? Eek.

As you may guess, the itsan forum has been positively buzzing with debate on this issue.

I am not a doctor and certainly not in any position to offer medical advice on this subject. People have to decide what is best for them. However. I though I would write a list of Pros and Cons on the subject to help get things into perspective.

  • The idea of moisturiser addiction makes sense. Think about it. If you apply moisturisers to the skin, the body will feedback that it is getting enough moisture. The skin will then stop producing as much natural oil because it falsely detects that it is getting enough. As the skin's natural moisture levels decrease, the patient has to apply more moisture to the skin, thus creating a cycle of moisture replenishment.

  • The doctors Sato have a lot of experience treating TSW in Japan. Their findings are a result of many years studying those going through TSW.

  • Moisturisers are full of nasties. Preservatives, fragrances and other ingredients can irritate the skin. One can be applying a moisturiser without realising that they are allergic to one or more of the ingredients. Ingredients in moisturisers can be highly irritant or even carcinogenic. I read an interesting study in the New Scientist, showing that when researchers applied certain creams to hairless mice and exposed them to UV light, they developed cancers. Of course, they argue that mice and humans are very different, but would you want to take that risk?


  • Its all very well saying stop moisturising, but the fact remains that it is very difficult to do. I tried it. My skin was tight and flaky. I gave in! In the case of full-body TSW flares, movement may be severely restricted without moisturisers.

  • We can't all hole ourselves away in the house. I have to take my kids to school, go shopping and generally interact with people. I wouldn't feel comfortable doing that with a cracked face.

  • Letting skin dry out will damage the natural skin barrier. The skin will crack and may even bleed, leaving the skin at risk of secondary infection.

  • Dr Rapaport and Dr Fukaya are also leading doctors in the field of TSW and have treated thousands of patients with the condition. Nowhere in their medical reports have they mentioned moisturiser withdrawal. *It has however, been brought to my attention that Dr Fukaya has since mentioned moisturiser addiction in his personal blog. The overall thought conveyed by his blogpost is that moisturisers are probably best avoided, although should be applied sparingly if necessary to comfort.

  •  I also personally know of quite a few fellow bloggers and Itsan members who have healed whilst using moisturisers. Jake, Rochelle, Tracy, Juliana, Karen and Keira to name but a few, now have clear skin but did not have to resort to moisturiser withdrawal.

In Conclusion:

I am on the fence really! I do not think MW is essential to healing, but it may certainly speed it up. Those who have managed to break through the pain barrier and tough it out seem to have had good results.

I think the body sorts itself out when left to do its own thing. During the course of TSW I have found that my skin oils have returned by themselves and now I do not have to moisturise my body at all. The skin on my face is still tight though and I do apply a very thin layer of cream once a day to my chin and cheeks, purely for comfort and movement.

Again, I want to mention that Dr Rapaport claims to have successfully healed over 2000 people from TSW without having to resort to moisturiser withdrawal.

As far as I know, there are not any published medical studies on this subject (unless there are any in Japanese). I hope that this will change into the future and that studies will shed further light on the matter.

My opinion of the issue echoes that of Dr Fukaya, who seems very balanced in his approach. He states:

"...They recommend not use any moisturizer though they know the method is really a hard-landing......So if utilizing any moisturizer is comfortable for your skin, it is not necesarily wrong to apply it. However, it is not a right idea if you think moisturizing is absolutely useful or necessary for the damaged skin. "

I would love to know your opinion on this subject and please feel free to comment below with your experiences of moisturiser withdrawal.


wendy said...

Hi Lou, Dr F distinguishes hyaluronic acid from moisturisers. He says it's a skin nutrient, not a moisturiser.

Any joy with trying to access Atopic's forum in Japan ? The no moisture technique seems a different animal entirely, my imagination runs wild, it would be good to link with a few who have tried it.

Tracy Scarpulla said...

I am VERY intrigued by this!!! Funny thing is I spent 5 days at my mom's last week during a bad time of flaring. I didn't bring any lotion or my dead sea salts (her tub is broken). I only had my Neosporin with pain relief for the really painful spots. By day 4 I was commenting to my husband that my skin had a strange feel to a film. It was bizarre to me - my sin was still dry and scaly but had a thin film of something oily. I then realized it was my own oil! It felt weird because I have been using TS for 30 years since I was 10 yrs old. I never had oily skin or oily hair. I never had a pimple....just super dry skin. When I got home, I read the post about MW. It hit me that I went 5 days without any lotions/Vaseline and no baths (just quick washing). So now I am 10 days with no bath (just super quick showers with soap only in armpits and private areas)....and no moisturizers of any kind. I am in a break though so the pain has been minimal. I have only used a bit of Neosporin with pain relief on the back of my knees maybe 3 times a day.

This makes sense to me as well because every time I put anything on my skin (no matter what I tried), I would itch intensely within anywhere from 10 minutes to 2 hours. I would try really hard not to rip open my skin, but it would tear so easily. If I flare again, I plan to not put anything on my skin and tough it out. Maybe there is something to this.

Elaine D said...

Sorry - I meant Louise, not Wendy...
Louise, are you cured now?

louise uk said...

Hi Elaine,

Yes, I feel I am cured for the most part!

Did you see my photo update at 21.5 months?

At the moment, the only rashes I have are some pink marks on my cheeks and chin. The rest of me is clear.

I am living life as normal. I hope I am done with this, but you just never know with TSW....

johnboy said...

realy intesting post .

in my opinion i think that if you are able to go dry then it would benifit the healing . it has to due to the way the bodys own healing powers behave . the problem here lies with what many have said before , which is that its just too damned hard and painfull . i am now a year and 2 weeks into recovery . since day one ,all i have used is vaseline . the reason why i stopped the moisturisers is that my skin just couldnt take them . my skin wouldnt absorb the creams due to the swelling which was caused by many factors including not being able to sweat .i personaly think that , because we cant sweat due to inflamation the skin cannot rid itself of the toxins it needs to . i was using 1000g of moisturiser a week until i started full ceasation of the roids . i did both together . now , all i need to use is a little vaseline on my hands and neck . remember that vaseline is not a moisturiser as it isnt absorbed into the body . i only ever used it for ease of movement when my skin was too dry to move without splitting . i still think i have a way to go . im hoping another 6 months . im going to do an update of my blog in the coming days . H H to all .

louise uk said...

Hi johnboy,
Good to hear from you. Look forward to reading your blogpost. X

Lisa Leung said...

Hi hi
I have done both.
I have done moisturiser withdrawal for a month and a half from month 2 on and my oils came back and i started washing and moisturising again cus i was working out and it went to hell back into flare.
I am back to not moisturising and this time im trying it for 3 months.
I must say, without moisturising, my skin healed fast. Though my flares were really drawn out, it was my vanity that made myself worse. When skin started piling up i would strip it but you have to just let it pilr up. Its really gross and get really itchy but when it sheds naturally, it does take the redness away.
Right now im about 2 weeks into not moisturising and the skin is piling grossly.
i do think it heals faster but thats just for me and im no doctor. But my skin piles up until it sheds so im not sure if everyone is like me. Im having a tough time with little bumpy pimply things right now so.... Hoping no moisturisers will dry them up and flake. Sorry for the long post.

Nivea said...

I'm 21 months off steroids. For my case, is better not to moisturise. However i've tried applying moisturiser on the surrounding areas of the affected skin. Which means applying on the normal skin surrounding the affected skin area. I find that it helps abit to reduce the itch and the spreading. I hope someone can find some relief using this method.

Jenny Stradling said...

I briefly touched upon this subject on my own blog recently. I was suffering from MRSA and although they say you should keep the wounds protected with a layer of Vaseline, my skin would not stop weeping so I ceased using it and let it dry up. Low and behold the weeping stopped! I think for anyone going through the weepy stages they should cease using moisturisers just to see what happens. It's painful as hell and for a couple of days I was bound to the couch only able to lay in one position because of restricted movement. I have however been using white soft paraffin slightly more frequently because I'm still so very dry. Now whether this is because I'm using it to help with movement whilst I'm at work and such, instead of staying dry, I don't know. But I seem to be especially itchy and can't seem to get rid of wounds. It also doesn't help now that the weather has changed that the skin will become drier anyway.

megan said...

Hi Louise,

I would agree that trying the non moisturizing thing was terribly uncomfortable and I couldn't stick with it. On the other hand, I did have that experience where putting on too much moisturizer made my skin's integrity feel compromised somehow and since TSW started I've been very concerned about all the additives we're unaware of in lotions these days.

To that end, I decided to make my own cream (blogged about it if ur interested) and have been relying on it for the last month or so and it has been working great. Also use Dr. F's hyaluronic acid on my healed bits once a day. I only moisturize once a day now and try to last till the next morning even if I feel a bit dry and I think that moderation has helped strengthen my skin.

I think it comes down to a balance of everything. Going extreme in one direction or the other is not a great thing for our bodies and it's interesting to read these empirical descriptions but in the end take them with a grain of salt to find what works for us individually.


louise uk said...

Great feedback everyone, it is really interesting reading about your shared experiences and opinions on this fascinating subject.

Thank you all for taking the time to post on here. I love hearing from all the blog readers out there. X

Jason said...

Great post and comments. When I was on cyclosporine I quit using most moisturizers for... i don't know, 10 months or so. However when I stopped the cyclo, I went right back on the moisturizers as my skin went crazy. I would have to take time off work to even try and attempt this no, and that might just happen because i'm getting worse at 16 months steroid free.