The Moist Wound Healing Method

Last week I briefly mentioned the Moist Wound Healing method in one of my posts, but didn't go into much detail, because I presumed people were familiar with the term.

My bad.

I later realised that unless you have read the whole blog in full (which is unlikely at over 400 posts!), you may have never heard of the term before. So let me go back to basics, rewind in time and explain what this technique is all about and how it worked for me.

To do this, I need to backtrack in time to the very early months of TSW. At the time, I had lots of swelling in my legs and I developed a "wet wound" (a phrase coined by blogger Juliana) on my left calf. Unlike other wounds which would scab over and heal, this particular wound formed thin, papery scabs which would rub off, leaving wet skin underneath. I tried various methods, such as drying the area out, calamine lotion, domeboro, epsom salt baths etc but NOTHING worked. Weeks turned into months and the wound stayed put. It was a mystery.

I then got a message on the Itsan forum from Rochelle (a healed TSW veteran), who was working as a nurse at the time. She asked me if I had tried the Moist Wound Healing Method. Initially, it sounded like something that went against the logic of TSW. After all, wouldn't a moist environment make the wound more susceptible to infection? But after reading a lot of information about it, I decided to give it a go. After all, nothing else was working.

The website Overview of Wound Healing in a Moist Environment explains that:

"The idea of moist healing was born in 1962 when George D. Winter discovered that epithelialization would proceed twice as fast in a moist environment than under a scab.
Cell growth needs moisture and the principle aim of moist wound therapy is to create and maintain optimal moist conditions. Cells can grow, divide and migrate at an increased rate to optimize the formation of new tissue. During this phase of wound healing an aqueous medium with several nutrients and vitamins is essential for cell metabolism and growth.

The wound exudate serves as a transport medium for a variety of bioactive molecules such as enzymes, growth factors and hormones. The different cells in the wound area communicate with each other via these mediators, making sure that the healing processes proceed in a coordinated manner.

Wound exudate also provides the different cells of the immune system with ideal conditions to destroy invading pathogens such as bacteria, foreign bodies and necrotic tissues, diminishing the rate of infection.

Moist wound treatment is known to prevent formation of a scab, allowing epithelial cells to spread horizontally outwards through the thin layer of wound exudate to rapidly close the wound. In addition, pain is significantly reduced when wounds are covered with an occlusive dressing. Concerns that moisture in wounds would increase the risk of clinical infection over traditional therapies are unfounded. The use of hydrocolloid occlusive dressings in maintaining a moist wound environment has proved to be a useful adjunct in facilitating wound healing. "

The doctor explains that when this technique is used, wounds can heal up to 50% faster, there is no scarring, lower rate of infection and no pain when the dressing is removed.

In addition to this the site contains some amazing, albeit graphic photographs of the process in action. If you are brave enough to take a look at them, please do, as they are awe inspiring. There are cases of burns, scalds and bloody wounds, all treated with this method and the skin returned to a near perfect state.

So how did I get on with the moist wound method? Well again, a picture says a thousand words, so I will show you the process from beginning to end. Sorry about the different lighting in the pictures, by the way, but it is still easy to see the overall effect of the treatment.

 

 

 

Cool huh? The moist environment caused the skin to repair itself without forming a scab. The whole process was amazing to witness.

 

The healing happened quite quickly once I'd started the dressings and my skin has been perfect in that area ever since, with no recurrence of symptoms,

 

How I Did the Moist Wound Technique

 

I would carefully clean the area with a wipe and then apply a generous layer of vaseline of 50/50 white soft paraffin/liquid paraffin. I would then apply a dressing pad, like the type you can get from any pharmacy. I secured the pad to the skin with microporous tape.

 

I would change the dressing frequently to avoid maceration due to accumulated ooze.

 

Moist wound healing is even easier if you use the hydrocolloid dressings available nowadays, although they can be a bit expensive and I found the vaseline technique worked just fine for me. I did try the newer hydrocolloid gels (not to be confused with the dressings), but didn't find them as good as the vaseline as they can dry onto the skin and stick the dressing to the skin. Ouch!

 

If you want to read more about this technique, here are some useful links:

 

http://www.realself.com/mohs-surgery/answers/vaseline

 

http://www.ncbi.nlm.nih.gov/pubmed/8109679

As with all of my blogposts, I leave it to the reader to form their own opinions based on the evidence presented. I am not a doctor and do not wish to give advice or opinion on how individuals should treat their own personal TSW symptoms. I am just sharing my experiences in the hope that someone may find it useful.

Music to Help Us Through Topical Steroid Withdrawal

Last week, I had posted about how sad and helpless I was feeling during the TSW process and in response, one of my lovely blog readers, Ozzy, wrote a post especially for me to cheer me up! The post included a Jessie J video, "Who You Are" which had lyrics especially appropriate to our situation...


I stare at my reflection in the mirror:
"Why am I doing this to myself?"
Losing my mind on a tiny error,
I nearly left the real me on the shelf.
No, no, no, no, no...

Don't lose who you are in the blur of the stars!
Seeing is deceiving, dreaming is believing,
It's okay not to be okay.
Sometimes it's hard to follow your heart.
Tears don't mean you're losing, everybody's bruising,
Just be true to who you are!

There is a brilliant thread on the Itsan forum about TSW anthems and music to get us through TSW. Here are some suggestions:

Fighter by Christina Aguilera:

Makes me that much stronger
Makes me work a little bit harder
It makes me that much wiser
So thanks for making me a fighter
Made me learn a little bit faster
Made my skin a little bit thicker
Makes me that much smarter
So thanks for making me a fighter

The Drugs Don't Work by The Verve:

Now the drugs don't work
They just make you worse
But I know I'll see your face again

Beat It By Michael Jackson:

You better run, you better do what you can
Don't want to see no blood, don't be a macho man
You want to be tough, better do what you can
So beat it, but you want to be bad

Just beat it, beat it, beat it, beat it
No one wants to be defeated
Showin' how funky and strong is your fight
It doesn't matter who's wrong or right
Just beat it, beat it

Last week I went with my daughter to see the new Disney movie, Frozen. The songs in the film are really good, but a couple of lyrics  made me think of my TSW journey.


It's funny how some distance makes everything seem small
 And the fears that once controlled me can't get to me at all
 Up here in the cold thin air I finally can breathe
 I know left a life behind but I'm to relieved to grieve

Let it go, let it go
 Can't hold you back anymore
 Let it go, let it go,
 Turn my back and slam the door
 And here I stand
 And here I'll stay
 Let it go, let it go
 The cold never bothered me anyway

I hope you enjoyed my TSW anthems! Please feel free to share yours in the comments section at the bottom of the post.

Adrenal Fatigue and Sleep Disruption

One thing that I noticed when I started TSW was that I felt sapped of energy. I remember sitting on the sofa feeling absolutely wiped out and not really understanding why.

I later found out that my tiredness could be linked to the state of my adrenal glands. These little glands are responsible for producing cortisol, a natural steroid that helps to regulate various bodily functions, including blood sugar levels, the immune system and bone formation.

When we use steroids, our body senses that there is an adequate supply of cortisol available, so the adrenals stop making it via the feedback mechanism. When steroid use continues over many years, cortisol production is dramatically affected.

When we stop using steroids, the body quickly has to start making its own cortisol again. That is why people should never quit oral steroids cold turkey, as it can kill in extreme cases. In the case of quitting topical steroids, the dramatic change in cortisol levels can result in extreme fatigue.

Another problem caused by cortisol imbalance is that we may get a cortisol production "spike" in the early hours of the morning, typically at about 4. a.m. This can really affect sleep. It is common for those going through TSW to have very disrupted sleep patterns and to wake in the early hours, only to fall asleep again around 7 a.m.!

 It is well worth googling the topic if you are curious how adrenal fatigue affects the body. One really good suggestion that I picked up was to have a small snack before bed to help regulate the blood sugar. Another was to discuss with a doctor about increasing intake of magnesium, which can help insomnia. An Epsom salt bath may help some to get a dose of magnesium before bed as it is absorbed through the skin.

Final Thoughts After a Week of Not Moisturising My Skin

Hi folks! I'm finally at the end of my week-long experiment with no moisturisers. Here is today's photo.

...and yes...it does look exactly the same as every other photo I have posted this week.

I have seen ZERO improvement in my skin and to be honest, it has got a little worse, with dry patches spreading into previously good areas of skin.

Which either means that MW just isn't working for me, OR that I would have to give it a lot longer than one week to see any improvements. Some people have suggested giving it a month. Do I want to look like this for another month? Hmmmm..I will have to give it some thought....

So how have I found this week? In a word: Terrible. I absolutely hated it. I hated the tight feeling of my skin. I hated the way it looked and I hated the way it felt. The skin kept flaking in very thin papery flakes, which rubbed away to reveal raw, wet skin underneath. The wet skin would flake over and the whole cycle would repeat itself, which is why my skin looks no better today than it did last week.

The last time I got the papery scabs was at the beginning of TSW, on my legs. At the time, no attempt to dry them out worked. they just kept papering over, dropping off and revealing new wet skin. The only thing that helped at the time was the moist wound method, which is the polar opposite to MW. The idea of moist wound healing is that a moist environment promotes healing. And it did. for me, it worked and my wet wounds healed up, revealing healthy skin.

I really don't think MW is the way to go for me personally. I know it works great on some people, but the problem is that you get a handful of people who have seen vast improvements through this method and then they assume it works for everyone. TSW works very differently for individuals. Some like baths, some showers. Some like heat, some cold. Some like moisturisers, some don't. Nobody is right or wrong. We are all just different. In my case, my skin just craves sunlight. If you look at my photos from summer this year, you will see that I had lovely smooth skin, without having to resort to anything as extreme as this. And just because sunlight works for me, I wouldn't tout it as a cure-all for everyone, as I know that some TSW'ers react badly in sunlight. That's my point. We are all different and all have our own ways to cope with TSW.

So...on to the results of my poll. Drumroll please......

Here are the results of 56 votes.

I asked TSW'ers if they had tried moisturiser withdrawal and whether it worked for them.

33% said no, they hadn't tried it.
10.5% had tried it, but it didn't work for them.
17.5% had tried it and it worked great.
19.3% had tried it but were still undecided about whether it helps TSW.
19.3 tried it but cheat occasionally.

I hope you find the results of my poll interesting. and again, it just goes to show that whilst MW is fantastic for some people, others remain unconvinced.

Over the week, I have read a lot of quotes and comments about the subject of MW and before I close the topic for good (I'm getting really bored talking about it now and feeling like a stuck record!). I will close my piece with some quotes from various sources, giving both positive and negative views of MW. I hope that in reading these quotes and reflecting on my experiences this week, readers can come to their own conclusions about the efficacy of moisturiser withdrawal.

Positive Quotes About Moisturiser Withdrawal

"It takes at least a month for normal skin to fully adjust to moisturizer withdrawal. Let alone tsw damaged skin, or skin in the midst of a flare. However mw makes the entire process much better in the long run and as per the Japanese studies, shortens tsw...after completing my tsw I was 100% fully healed at 15 months, without needing any moisturizers whatsoever. I cannot fathom going at this for years."

"from not using moisturiser parts of me that were disaster areas have actually miraculously healed pretty fast"

"For me "dry and itchy" was better than "moist and itchy" because if I scratched soft, moist skin I tore it up and inflamed it more than if I scratched dry skin--this was an immediate improvement. My skin does seem to have toughened better without "moisturizers", but like everyone else I am not my own double-blind study, so I don’t know what would have happened if I hadn’t stopped. "

"I decided to quit using moisturizers. Turns out, it was the best decision I've made so far. Within 3 days all the oozing completely stopped. The places that would not heal are healed! I am still red, itchy and flaking, but nothing like before. I'm not lying on the couch all day and I'm sleeping at night. I hope this progression continues, but you never know with tsw. The first week sucked. I looked horrible and felt worse. I had to keep splashing cold water on my face and legs to help with the dryness and pain. I was shedding like crazy. It was like stopping steroids all over again. But, it was totally worth it. to see such a big improvement in 2 weeks is a welcomed change."

"By the fourth day however, I am starting to feel pretty good! My face looks like the desert and my whole body is shedding like crazy but feels ok and the skin underneath is soft. By the end of the week I can get in and out of the shower and not feel like I am shriveling up after. My skin has gone from feeling like leather to as good as it was when I was using moisturisers! Only my face is still badly scaly but it is anyway after a flare – regardless of what I use. It is so exciting to see it producing its own oil and I am so glad I put faith in my body – the feedback mechanism worked!!"

" TSW patients who recover well are usually doing moisturiser withdrawal strictly, according to the doctors."

"My wife has the most silky smooth awesome skin imaginable and she takes lukewarm showers and never ever has used moisturizers in her life"

"After two weeks it was soft almost everywhere. One month it's fantastic and the best part is 1) saving money on creams 2) no greasy bed or clothes 3) no redness. I'm still tight around my hinges but not red. "

"So excessive moisturizing do harm to skin recovery by delaying keratinocyte proliferation. I reccomend you should use no or less moisturizer if you want to advance recovery of the skin barrier" -Dr Fukaya


...And the Other Side of the Argument...

"So if utilizing any moisturizer is comfortable for your skin, it is not necesarily wrong to apply it."-Dr Fukaya

"Last week I was lucky enough to have a holiday in warm, sunny, humid Gran Canaria. My skin was instantly happier. I practically stopped all moisturising immediately I got there. My skin was perfectly happy for me to do that and did not 'crave' the vaseline in any way. Now I'm back in cold, arid UK, my skin is totally prone to dessicating again, and I'm finding I need the Vaseline once more. I am confident that once my skin is happier, I will be able to stop using the vaseline without any problem at all."

"Personally, I would not have made it through TSW if I couldn't moisturize/lubricate. My skin felt 5 sizes too small and I often couldn't turn my neck (dangerous to drive) or bend my fingers without some good lubricant usage. "

"I've seen so many heal while using moisturizer and not one came back and said they now have to use it daily to keep their skin from flaring etc.... I use no emollient on my healed skin and never need it period in those areas and used buckets and buckets of white palm oil and various other non-chemical emollients."

"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."
 
I hope you all enjoyed reading the quotes and the results of my week experiment. For my final quote, I have chosen the one that mirrors my own feelings most accurately. It is from the moisturiser withdrawal thread on the Itsan Forum:

"Personally, I don't think there's a single answer that applies to all of us. Just like we have found different ways to deal with all of our symptoms, moisturizers (more than one type) are just more items in our bag of tricks. It may work for some of the people some of the time - or like me right now, on certain parts of my body but not others. Or certain moisturizers might work for some people and not others. And it might depend on severity if symptoms on any given day, or temperature/climate or a lot of other variables.

The only constant in this whole crazy experience seems to be that there are no absolutes. I am experimenting every single day to figure out what works best. Whatever works today, tomorrow might be different. And what works for me might not work for you. And so on..."


I wish happy and swift healing to all those going through the hell of TSW right now, whatever method they choose....

*Since I posted this, Dr Fukaya, a leading TSW doctor has been quoted as saying:


Mototsugu Fukaya2014年1月22日 8:43
It is not a so complicated problem. Some patients become addicted by topical steroids while others not. It is the same thing that there are some patients whose recovery can be accelerated by disuse of moisturizers. I admit that it is a fruitless effort for the others to refrain from moisturizers. Disuse of moisturizers is not suitable for all patients but worth to try if recovery from TSA is extraordinary delayed or the patient intends to withdraw from TSA as rapid as possible regardless of hardness. (It is my opinion. Dr .Sato recommends disuse of moisturizers more strongly than me from his own experience. Most dermatologists will think that disuse of moisturizers is crazy. I am between the two. )
I couldn't agree more.

Day 6 of No Moisturisers on Skin

I've tried to take the photo in the same place and in the same light as yesterday, as I can appreciate that it can be hard to make comparisons in different lighting.

...and I've done a bit of a smile for Siegfried who is always kind enough to leave a comment on my blog. The smile will be bigger when I can stretch my mouth more!

It feels the same as previously-very dry. The dryness now seems to be extending up my cheeks to just below my eye area and there is no sign of the feedback mechanism kicking in yet; the skin is still not producing its own oils.

The flakes seem smaller, so I don't look as grim as previously and I am really happy with the colour of my skin right now.

I seem to keep catching areas on my chin by scratching and the skin is so fragile, it bleeds, which is why I have lots of bleeding areas like this...

 

I will hit one week "No-Mo" tomorrow. It has been a tough week. If you compare the photo above with the previous photos over the week, I don't think there has been all that much improvement.

I am seriously thinking about going back to moisturisers, as I don't honestly think that the experiement has been that successful, but I do want to give it a whole week for the sake of fairness.

Day 5 of Moisturiser Withdrawal Experiment. Turning a Corner?

See the question mark in the heading? That's because I hope that I am turning a corner, but I will let the photo do the talking. Maybe it is in the eye of the beholder.

So if you compare that to the previous couple of days, I don't think it looks so bad today. And yes, it is flaky, but it isn't overly red, which has to be a good thing. I'm really pleased with my skin colour right now.

On the left hand side of the picture, you can see the red marks where I have scratched the skin away prematurely and it has left a raw patch underneath. These raw patches are skin that is not ready to appear yet and they generally take 2 days to calm down and merge with the rest of the skin.

When I wake up in the morning, the skin looks really good, it think because of the humidity and warmth of the bed, which help the flakes to adhere to my face. Within a few minutes of hitting the dry air, however, the "adhesive" between the flakes dries out and the flaky skin is more prominent.

I have been doing "No-Mo" very strictly and can proudly say that I have not used so much as a drop of moisturiser on my face since starting this process. I'm always amazed how much dry skin the body can produce though!

On the downside, I am still oozing badly behind my ears and my hair is all matted and sticky in the mornings. Yucky yuck.

Thanks everyone who has shared experiences in the comments section of the blog. Please keep them coming. I want to gain an accurate picture of whether MW is helping people or not. I have had a lot of responses, some good and some not so good, which is leading me to believe that MW works great for some people, but maybe not everyone. I hope to find out more about percentages by running a poll on the Itsan forum. If you haven't voted in the poll yet, please do, as it will help me gain an idea of exactly how useful MW is (or is not!) to people going through steroid cream withdrawal.

When I get enough responses, I will post the results on the blog. Remember, the more people that vote, the more accurate the result will be, so PLEASE VOTE. It will only take a couple of seconds of your time. The results so far have been very interesting. It would seem that about 70% of people polled have tried moisturiser withdrawal. But did it help them? Well, you will have to wait and see the results of the poll in a future blogpost....

I regard this as a scientific experiment on myself and have no preconceptions about what the eventual result may be. I hold my stand as completely neutral when it comes to the subject of Moisturiser Withdrawal and have no intention of touting it as a "Miracle Therapy" for TSW unless research proves otherwise. I hope my readers appreciate my balanced, unbiased approach on the subject.

Day 4 of Moisturiser Withdrawals

OK, well done me. I made it to day 4 with my sanity just about intact.

Here are today's photos.

I've got a big wet gash under my chin where the skin has flaked off and is raw and wet underneath.

You can see that my skin is extremely dry on the lower half of my face.

 

 

 

The "No-Mo" method has certainly sapped my self confidence. I have stayed at home pretty much, although I did have to do the school run yesterday (head down, hoodie up!) and amazingly, I did actually go out on the evening with my family. I wasn't going to go but my daughter said I didn't look too bad. I was quite self conscious all the time I was out and I didn't want to speak to people, but I think that getting out of the house did me some good.

 

 

One thing I have noticed with "No-Mo" is that my skin is very flaky in the morning when I get up, but it does get better as the day goes on. By the evening it is usually a lot calmer and less flaky.

 

I really hope the feedback mechanism of my skin kicks in soon and that the skin starts to make its own moisture after detecting that it isn't getting any from outside.

 

I have a meeting with a teacher at school tomorrow morning, which I am dreading, because of how I look. Yes, I could slap on some cream, but I don't want to undo my hard work! I may send the hubby instead, or reschedule.

 

I want to talk briefly about MSM today. I had a comment yesterday from blogger Tracy, saying that MSM supplements helped her with her withdrawals and that a lot of people were getting benefit from it. I was initially keen to give it a try, but after a LOT of thought, I have decided not to for now, for the following reasons.

 

1. This whole moisturiser withdrawal is a bit of a science experiment for me. I don't want to add another variable into the mix. That way, if I heal, I wouldn't know whether to attribute the healing to the MSM or the moisturiser withdrawal.

 

2. Check out some of the comments left on yesterday's post. It seems that MSM is potent stuff and can affect the liver if taken in too high a dose. Also, I was told that it makes you feel worse before you feel better, so the timing isn't great for me right now!

 

3. I don't want to become dependent on something else. I have been dependent on steroids, dependent on moisturisers...I feel like I just need to let my body heal itself without interference from anything external. I don't want to be dependent on MSM supplements forever to keep the ooze under control. I think the body does have the power to heal itself if left alone.

 

4. I recently found out that I have another, potentially serious health problem, completely unrelated to TSW. I don't know if taking MSM would cause any further complications in this regard.

 

However, I would encourage those in TSW to at least do a bit of research and decide whether MSM supplementation is something that they would like to try. MSM reduces inflammation and helps the skin, bone and airways in the body. I have read a LOT of really positive things about it and I would be genuinely interested to see whether it is effective for relieving TSW symptoms.I have not ruled out trying it at some point in the future, but at the moment, I am just sticking to the moisturiser withdrawals.

 

Have you tried MSM or Moisturiser withdrawals? How did you find it?