A-Z of Corticosteroid Withdrawal: Oozing

O is for Oozing

Oozing skin is by far one of the most distressing symptoms of topical steroid withdrawal. It feels so unpleasant when the skin is wet and sore. The ooze is runny and smelly and clothing and bedding have to be changed often.

Dr Rapaport, who has extensively studied the withdrawal process, believes that the oozing, which is often accompanied by edema, is caused by dilated blood vessels, which cause the skin cells to leak fluid. Steroid creams suppress the blood vessels, so when we stop using them, they dilate, due to the buildup of nitric oxide, causing the skin to blister and ooze fluid. Alternative practitioners treating this condition believe that the oozing is a way for the body to eliminate waste that cannot be processed efficiently by the kidneys, so there are lots of different views on why we ooze.

Charting my own experiences with oozing, I have noticed three distinct types of oozing. Patients undergoing steroid withdrawal may experience one or more of these types, although some are very lucky and don't have any oozing at all, as symptoms vary depending on duration and potency of steroid use:

1: Clear ooze. This clear ooze (serous exudate) resembles sticky sweat. It is the virtually same consistency as sweat, and affects large areas of skin. When this ooze appears in areas where the skin cannot breathe, such as under tight clothing, or under a bra strap, the skin can start to smell really bad. I am not sure whether this is due to the effect of bacteria on the ooze, or whether it is the ooze itself, although I would imagine it is bacterial.

 Clear ooze tends to form at night, when I am lying in bed. It forms on my neck and in my skin creases when I lie on my side. I also get it behind my ears. When the oozing skin comes into contact with the air, the ooze dries up very quickly, leaving the skin tight, with a powdery layer on top. If I rub or scratch the affected areas, which are usually very itchy, the oozing starts again and can seep through clothing and bedding. I have to change my pillowcase every day because my neck oozes fluid in the night. I also have oozing on my chest, so have to stuff my bra with tissue at night to mop it up. I have found that a silk scarf or pillowcase wrapped around the neck can help mop up the ooze, or if the condition is more severe, a towel can help. Dr Rapaport recommends domeboro, or burrows solution applied as a compress on weeping areas, although this product is not readily available in the UK.

This is a photo of my skin very early in withdrawals, when my neck and chest had been oozing a lot of clear fluid and then dried to give a "plastic" appearance. Thankfully, it looks nothing like this anymore!

2: Vesiculation. This is what I call the "nasty ooze" and is a lot more persistent and problematic that the clear ooze. Wet wounds and blisters appear on the skin, which do not dry up. They commonly appear on the legs or knuckles. The wounds ooze a thick yellow fluid, which can continue for many months. A papery scab sometimes forms, but quickly falls off or is rubbed off, revealing wet skin underneath. Although the ooze is yellow, Dr Rapaport says that the skin is rarely infected, although most doctors would see the yellow ooze and presume that there is an infection present. 

 The skin looks like a volcano, ready to ooze magma. The best way to treat this type of oozing is by using the moist wound method. I like to smear a cotton wool pad with shea butter, before fixing it over the wound with microporous tape. The moisture encourages the skin to form new cells and heal up. You can also use Vaseline or hydrocolloid dressings for the same effect, although I didn't find the hydrocolloid gel to be very good on my skin.

This is a picture of the wet wound on my leg, which illustrates what I am talking about. The skin has been like this since January. This is an older photo and although I still have the wound, it looks much better these days.

3: Blisters on the hands. These tiny blisters can form on  the palms of the hands and soles of the feet. This is sometimes known as dyshidrotic or pompholyx eczema, although in my case, it was not a true eczema, but a direct result of the steroid withdrawal. The tiny blisters ooze a clear fluid, which can easily get infected, as the hands are in constant use. I try to keep my hands as clean as possible, and moisturise often. The blisters are very itchy and uncomfortable.

Here are some of the comments that members of the itsan forum have made about oozing skin:

"I have two continually weeping/oozing open wounds on my feet/ankles and another, on one of my knuckles that I have had for about 3 months now (I am in my 8th month of withdrawal).  I have tried soaks, manuka honey, left to the open air, bandaged up (wet wound treatment) but nothing has worked. "

"It's amazing how just two days ago I had ooze dripping down my arms and today it's settled. The changes are so extreme and the emotions are on the same roller coaster ride."

" I mostly get the clear ooze
now - when I scratch or behind my knees when the skin rubs, like you said -
but mine can take several hours to dry up (from scratching) and I find that
the clear ooze is not smelly, only the yellow ooze. I rarely get the yellow
ooze now, only around my ankles occasionally, but in the early weeks I got
it around my neck a lot and boy, did it stink!"

Oozing is a nasty and persistent side effect of topical steroid withdrawal, which is extremely distressing and can persist for many months. it is important to find a way of coping with it and dealing with it the best way you can. Healed veterans of TSW report that the oozing does go away with time.