Topical Steroid Withdrawal and Oozing Skin

In this, the second of my special anniversary posts, I am going back to a subject that I discussed previously: Oozing skin. The reason for this is because my post on oozing skin has been by far the most popular post on the whole blog, with almost 5000 hits. In this post I aim to discuss the subject in more detail, but would recommend that you familiarise yourself with the original post first.

What oozing is NOT:

I'm going to start by correcting the common misconception that oozing is toxins leaving the body. I have seen this mentioned a lot on the Itsan forum, where people think that oozing is a good thing because it means that the steroids are leaving the body. Oozing is nothing to do with steroids or toxins leaving the body. Besides, those going through TSW need not worry too much about steroids in the body, as they leave the body naturally within the first couple of weeks after stopping the steroid creams.

Another misconception is based on the fact that ooze can sometimes be a yellow colour, which some may confuse with infection. However, just because the skin is oozing yellow fluid, it does not automatically mean that infection is present. Signs of infection include a raised temperature, localised redness and swelling and a cloudy pus discharge. If you are unsure whether oozing is infected or not, it is best to see a doctor. I should also point out that many of us test positive for staph on our skin. Again, this is not surprising, as a large percentage of the population, especially those with skin issues, have naturally occurring staph on the skin anyway.

What oozing IS:

As mentioned in my previous article, oozing has to do with dilated blood vessels. When we quit steroid creams, our blood vessels dilate after being suppressed for so long. People going through TSW have been shown to have high levels of Nitric Oxide in the blood. Nitric Oxide is a natural vasodilator and is used in medicine to open up the blood vessels in patients suffering from angina. It is also the reason that Viagra does what it does!

Because our blood vessels are dilated, we lose fluid through the skin. This fluid is blood serum because the red blood cells are too large to permeate the skin. It is also known as interstitial fluid or serous exudate. The ooze is high in proteins.

I found a couple of really good articles that I would like to share. The first is a Nursing Times article entitled "Current options for managing the problem of excess wound exudate". All TSW'ers should read this. It explains:

"Exudate is a fluid produced as part of the normal wound-healing process, and is essentially blood from which the platelets and red cells have been filtered out (Thomas, 1997a). It leaks from capillaries in the tissues surrounding a wound as a consequence of increased capillary permeability.


Increased capillary permeability occurs either as part of the early inflammatory response that follows any tissue injury or as part of the host response to large numbers of bacteria in the wound bed (White, 2000). As the single-cell (endothelial) capillary walls are stretched widely spaces appear between the cells and fluid leaks into the interstitial spaces and ultimately into the open wound bed. The fluid varies widely in appearance, consistency and quantity."

The article also goes on to explain that complications, such as infection and maceration can arise from the wetness of the skin and that great care should be taken with oozing skin.

Another really good article that I found was "Serous Inflammation: What is it?" The article again states:

"The inflammatory reaction to injury begins with a dilation of blood vessels and an increased blood flow. This is accompanied by an increased permeability of vessel walls, which leads to the escape of a protein-rich fluid into the interstitial spaces. The fluid is an exudate, forced out of the vessel by increased pressure and leakiness."

Dealing With Oozing Skin

Oozing is by far the most distressing aspect of TSW. It looks horrible, it smells and it is uncomfortable.

For most people, such as myself, the best way to deal with the ooze is to let it air dry. Exposing the wet skin to air tends to dry it out nicely, although it can sometimes cause a crust to form. Dr Sato, a Japanese doctor who is an expert in TSW recommends leaving the dried ooze on the skin and not wiping it off as he believes that the proteins reabsorb into the skin and help it to heal. I too have found this to be the best method. I have found that wiping the ooze off just leads to more oozing and that applying creams to these areas often leads to irritation. It was best for me to leave it alone.

If the area is swollen, it can help to raise the affected limb. I used to raise my legs above heart level and found that it slowed the oozing and swelling.

I used to have a bad wet wound on my leg, which I treated in a different way. I used a moist wound healing technique by applying vaseline to the wound and covering with a dressing, replacing the dressings frequently. This helped the wound to heal, although great care must be taken with this method, as covering an oozing area can be problematic and also create a breeding ground for bacteria. I’m not a medical professional and this is just my account of my personal experience with this issue. Please seek professional medical advice about the best way to deal with your skin problems.

Preparations such as Domeboro, an astringent, can help dry up oozing areas. Epsom salt baths are also soothing and a little Epsom salt dissolved in water can be dabbed on the area to calm it down. Again, speak to your doctor about this.

If oozing is a problem at night, it can be good to replace cotton or synthetic bedding with silk, which is cooler on the skin.

As TSW progresses, the oozing will eventually subside as the skin calms down and the blood vessels return to normal.

I hope that this article will help anyone going through the oozing skin stage at the moment.