TSW. Trichotillomania. Books. Life.

Seven Questions for Seven years with Catherine from @life_after_tsw


This post was completely unplanned and came about by beautiful accident after a woman called Catherine left me a comment under a photo I had shared on a TSW Facebook group recently where I talked about my favourite subject ever (giving it time). She said:


"It took me 7 years to fully heal. It was the hardest road I've ever travelled. Only time healed me. It's now been 10 years since I started TSW and in some ways I forget what I went through but it doesn't take much to remember. In many ways I'm grateful for my experience and what I have learned about myself and the world of medicine."


After seeing that, I knew I had to share her story. Not only is her perspective on TSW incredible, and aligns very closely with how I felt after coming out the other side, but the fact that it took her seven years to recover. 

It seems mad to me when I say that my TSW journey *only* took 26/27 months, but when it comes to TSW, unfortunately it can take much longer than that, and sometimes I feel I am unable to offer adequate support when I can't imagine how difficult it must be to go through TSW for seven years – especially the mental toll it must take. I suffered from doubt so much in the second year, so to keep going after many years, and still believe in this process, takes a lot. No matter how strong your resolve is, over time, the reasons why you started in the first place become a distant memory and you start seeing steroids with rose tinted glasses ... Saying that, if I'd had to go through TSW for seven years, I would, for the simple reason that I knew I had no other option left. It was either a lifetime of being suppressed by medication or take a chance at a life without said medication. I know that might sound scary, but to me, it was liberating knowing that I had to keep going because steroids etc. weren't the answer and just a quick fix that had got me in this mess in the first place.

Something else that I wanted to say is that I think we can lose sight of exactly what we are asking our body to do for us during TSW. This isn't something that can be rushed. Our poor body has to learn how to fend for itself again after sometimes many years of being suppressed by powerful medication. None of us should have to go through this in the first place, but when you go through TSW, try to remember this isn't something cosmetic and instead, a total body overhaul. This isn't a medical opinion, and instead some perspective from a woman looking back on a process that gave her back her skin. 

When Catherine sent me her answers for this post, I couldn't wait to share them with you all, and I hope it gives anyone struggling some hope. Another thing to mention is that Catherine unfortunately doesn't have any photos from the thick of TSW as they were stored on a hard drive that crashed. She has found a few though that she has kindly shared with us – one taken now, after TSW (above), and a photo of her eyes during a flare in the later stages of TSW.  

She also provided a photo of her skin last year (left) after she trialled a steroid inhaler when covid first broke out as she was worried about her health. Even though her body didn't react well to the inhaler, she is totally OK now.

She has also rather excitingly just set up an Instagram account, @life_after_TSW and I can't wait to follow her life after TSW!!

With all that being said, I'll hand it over to Catherine: 


1) Tell us about yourself and your skin journey, before steroids.

My skin journey started not long after I was born. My mum noticed rough patches on my skin when I was a baby. I was prescribed hydrocortisone at a young age, somewhere between the age of 2 to 5. I had mild childhood eczema behind my knees and in the crooks of my arms and used the hydrocortisone on these areas often until I grew out of my eczema around age 16. I had a stint of 4-5 years with no eczema at all but then when I was 20 I noticed dry splits opening up on my fingers. Years later I discovered this was a very mild form of dyshydrotic eczema.


2) What medication did you use and for how long?

I was prescribed many, many tubes of hydrocortisone throughout my childhood but it was the creams I was given between age 20-24 that did the damage. I started with a stronger steroid than hydrocortisone when I went to the dr for my sore fingers. Over time I was prescribed stronger and stronger creams. Around 2 years later I was waking up with swollen eyelids and was covered in a light rash on my chest, arms and back. The creams also seemed to 'bleach' my skin because I would have white dots and areas where I had put it on. That's when I took my first round of prednisone. I was to go on another round about a year later when I felt I needed a break from my terrible skin. This was all before I found out about TSW.


3) How did you find out about TSW?

After the 2 rounds of prednisone my skin rebounded horribly again and the drs I saw had no other suggestions of how to treat me so I gave up and went to a naturopath. I was given a whole assortment of creams and medicines which didn't seem to help me but did stop me from taking any steroids. I was put on an extremely restricted diet to try and rule out allergies and intolerances. My weight fell to 47kgs and I was extremely weak. Little did I know I was going through the early stages of TSW. It wasn't until 11 months later that I discovered ITSAN'S website and saw all the photos and read all the stories that seemed to match up with mine.


4) Tell us about your skin during TSW.

The first 11 months before I found ITSAN were horrible. I didn't know what was happening to me and no dr or dermatologist could tell me either. All my blood tests came back normal. I truly thought I was dying. I had what I now know were many panic attacks. Initially my skin was bright red and burning on my face, arms and legs. Over time these areas shifted around my body. The only part of my body that went unaffected was my scalp. I was extremely itchy. My skin always felt wet and hot. I had lots of tiny pimples covering large areas that could be popped. I had lots of elephant skin on my legs, wrists, face, arms, just about everywhere. 

A photo of Catherine's skin during a flare in the later stages of TSW.


5) How did your symptoms change over your seven year withdrawal?

My symptoms were definitely at their worst in the first year. Burning, redness, extremely sore hot skin. I had the nerve pain, too. I couldn't stand up for longer than a couple of minutes that first year though I somehow completed my post graduate degree! After that I was less red looking but was still covered in rashes that were persistent, especially on my hands and face. I had long flairs that lasted months with maybe a few days grace before another flare started up again. This went on and on over the years until maybe year 5 when the flares lessened in severity. Extremely slowly the intensity reduced but it felt like taking one step forward and then two steps back. Finally my skin was mostly clear by year 6 though I would still have the occasional flare on my face. By year 7 my skin was looking great. I have however not been able to get rid of the mild dyshydrotic eczema that I started with. But this is much more manageable and doesn't come close to dealing with TSW.


6) Did you find that anything aided your healing?

Time seems to have been the only thing that has healed me. I did stay away from a lot of foods as I had an extensive blood allergy test done in about year 2 of withdrawal that showed about 20 allergens. I now know that TSW puts your whole body out of whack so I am now fine with nearly all of those foods now. I mainly ate fruits, veges, meat and grains other than wheat. Whether this helped or not I cannot say. Alcohol would make me flare, so would chocolate, though I struggled to stay away from that! For a while I was making my own hand balm from beeswax, cocoa and shea butter etc which seemed to help my sore hands. Having my fiancé and then husband with me all the way helped enormously, esp when no one else would believe me when I told them it was my prescribed steroid creams that were doing this to me.


7) What would you say to anyone going through TSW who is scared of a longer withdrawal, like you had?

I would say hang in there. This is one of those times in life where things absolutely suck. Through adversity you grow as a person. Develop your 'I don't give a f#*! attitude about the way you look. Those around you really won't care what you look like. If you know about TSW Facebook groups and ITSAN then you have a wonderful guide to help you through your journey. It was such a relief to find ITSAN in 2011. It gave me hope. Something drs and dermatologists couldn't do. They said I would have to live with terrible skin for the rest of my life.

Surround yourself with kind people. Look after your body and try your best to find the good in everyday. Every day is one step closer to healing. The journey may be long but it is so incredibly worth it!

Thank you so much Catherine <3


To anyone struggling after many years, I truly hope this can give you some hope, and to anyone struggling during TSW, no matter how long it's been, know that you're not alone and this is all temporary. 

It gets better, give it time.

Cara x

Let's talk about: TSW & The Genitals



I have decided to start a new series of posts, which I will be adding to over time, discussing all the parts of TSW that aren't discussed enough. Sometimes, by not talking about something, it creates embarrassment or confusion around it, when really it is just another thing that you *might* have to deal with during TSW ('might' because we are all different and your experience is not someone else's). The problem with anything to do with the whole genital area though is that it's so personal, which makes it difficult to talk openly about any problems we might experience down there. I'm the same. In the past when I've had thrush, my conversation with the pharmacist is in hushed tones, with occasional covert glances over my shoulder to check that no one is listening. That's a failing on my part and honestly, after working on this post, it's really made me review how I'll talk about certain things in the future because it all needs to be normalised. That goes for periods, too – BECAUSE THEY HAPPEN. The other problem with surrounding a subject with secrecy is that it means others will end up feeling like they are the only ones suffering, when it couldn't be further from the truth. Especially with TSW, as there is literally no one else we can turn to, so we have to help each other out where we can.

Apart from one day during TSW where I was so irritated around my vagina (which made the whole area a little swollen) I didn't really experience any symptoms down there, and I've never really mentioned it before because it was just one day out of a nearly 27 month withdrawal – and to be honest, I'd forgotten about it until recently when I started hearing others briefly mention irritation there, too. 

When I mentioned that I was going to be doing this post, I couldn't believe how many people had suffered, or were suffering, with symptoms on or around the genitals. I was also staggered by other people's kindness and willingness to share their experiences with me – all in the hope of trying to help others. These accounts all come from members of our community, and I would like to take a moment to thank each and every one of them for sharing so much information with me for the post. You are truly wonderful x

There are twelve female experiences and four male. I will start with the accounts from the women, then the men. To give you more of an idea, I will also be putting a general age range (i.e. 18-24) for each person.

Lastly, I wanted to mention that the symptoms you are experiencing could be nothing to do with TSW, and the last thing you should do is write them off if you are concerned they could be something else. This post is just to say that TSW can happen on or around around the genitals, too, and you aren't alone. After all, the skin is one organ.

Also, as per, just a little reminder that I am not a medical professional and anything shared in this is not intended as medical advice.


WOMEN

When I mentioned I was going to be doing this post, a lot of women contacted me to say that they didn't realise they could actually get TSW symptoms down there, and any irritation they had experienced, they had put down to thrush or something else. Another woman also got in touch to say that her skin was thinner there and tearing so easily, especially after sex. 


Woman #1 (18-24)

Steroid history: I have used steroids on and off since I was little for my eczema. Maybe Fucibet and then hydrocortisone on my face in later years, primarily the last 5 years. 

I only suffered with eczema down there once or twice and used fucibet on the groin area maybe once or twice, too.  

I started getting TSW down there after my first month of withdrawal. It started off just on my groin area as red patches in areas you would normally sweat. It soon progressed further in, down and around to my bum! The skin would cycle similarly to other areas, from being open and sore to being so painfully dry I could barley walk. I tried not putting cream on and then putting it on regularly. It’s still something I suffer with today, especially when the area gets warm, but isn’t as bad as the beginning. 

Advice: when cuts are open, Dead Sea salt baths helped take the itch out and dried it up. I think too much cream down there just adds to the heat of an already warm area and can make agitation worse! So once a day is definitely enough! Wearing loosing pants is a must to stop the irritation and heat! 


Woman #2 (45-54)

It was one of my first symptoms, unbearable itching that I knew wasn’t thrush as there was no discharge, no smell. I used to scratch so hard I would bleed. I slept with ice packs between my legs for a good year before I went into TSW. I went to the doctors a few times, but every time they said there was nothing wrong, no sign of lichen sclerosis, which is what I thought it must be...thankfully as that course of treatment is steroids!! No yeast infection, I even had bloods taken for further investigation, but nothing ever showed up. Eventually the doctor put it down to my age. It was also one of the first symptoms to go, within a month of stopping topical steroids, it stopped itching. It was truly horrendous, and completely ruined my sex life, as it got to the point I actually thought I was allergic to my partners sperm. 

I don't mind you sharing it if it helps someone not feel so alone and baffled. I haven’t told anyone about it before. When I first started following accounts, no one ever mentioned it, I thought I was just really unlucky. And there’s a lot of shame and embarrassment surrounding anything vaginal, I don’t know if that’s a female thing. And no, I never used steroids there, I literally just put up with it as the doctors didn’t know why it was happening. Just shows how steroids effect the whole body, it’s actually frightening!


Woman #3 (25-34)

Steroid usage, I'd say 20+ years (unknowingly as I was using a “natural herbal” cream). I never used it in that area as far as I’m aware – never had any prior issues there either. Symptoms: I had oozing, inflammation and itched like mad. Obviously I couldn’t wax or shave down there during TSW, so the hair I think might have protected it maybe, but that’s just what I personally think. I’ve been doing moisturiser withdrawal since the beginning so I didn’t put anything on it at all – no creams etc. I just let it dry out. I used to wear no knickers to bed sometimes, and loose clothing to let it air dry, or sometimes even sleep naked, but I feel like the clothing gave it some protection from the bed sheets etc. I had it on the top and the sides (cracks by your leg) of the vagina, but it’s healed now! Had it happen twice during both of my severe flares and it has healed both times! Originally left with some hyperpigmentation which has faded, too! So crazy what our body can do on its own honestly.

Also, just FYI, after the first flare, and it happened, I managed to actually shave down there again with no issues whatsoever (couldn’t wax because Covid and salons weren’t open) so it does get better.


Woman #4 (25-34)

I can’t remember whether I used steroids in that region, but I’m 90% sure I did. I also used Eucrisa, but not there. Before TSW, when I had laser hair removal, they gave me steroids for the itch after (1% hydrocortisone).

My symptoms during TSW: oozing, swelling, redness, itching.

As far as dealing with the symptoms I avoided underwear for almost a year, and still do. I used tampons during my period, so nothing would rub against the area. Sometimes I used cotton cloths to sleep to place in between my legs, and wore no clothes when it was too hot.

***She has also kindly shared some photos (thank you so much x)***


Woman #5 (35-44)

As for my TSW history, it’s not the typical RSS story. I basically had eczema since I was 13 years old, but never used topical steroids on a daily basis ever, and would probably use them 3-4 times a year when my skin was really bad, but not for more than 2 weeks either. Then, in my mid 20s, I changed my diet after seeing a Naturalpath and did not have any eczema issues. Fast forward to when I was 29/30, I started developing all these health issues out of nowhere, such as back pain, food allergies, enlarged lymph nodes, random rashes. I was told I could possibly have lupus and/or another immune disease. They still have not been able to diagnose me! It’s a long complicated health story.

Then, in 2015, they found that I had a parasite and I was given Ivermectin (an antibiotic) to treat it. I took it for two weeks as prescribed then once I stopped it I started to get a full on skin rash, very similar to TSW. I let my body heal on its own for three weeks, but there was one right near my groin area that was not going away, so I went to see two different dermatologists who gave me a very potent topical steroid, level three I think (Clobetasol cream) & Doxycycline FLM. I took it for maybe two or three days and my skin cleared up, but a week later, it came back even worse – that happened another three times. Then I went on Facebook and saw my friend had posted an article of a little boy (Isaiah) who had TSW. I immediately knew I had RSS and booked a flight to California (all gauzed up, oozing in pain) and saw Dr. Rapaport, who within five minutes told me I had RSS/TSW.

As of August 21, 2015, I started my TSW journey and it took me until 2019 to finally have my skin healed and my life back to normal. But unfortunately last year, in March 2020, I was exposed to mould toxicity and given medication for it which basically set my entire body off with a skin flare, since I am sensitive to any chemicals or toxins and pretty much react to any antibiotics. Considering that topical steroids are a chemical/toxin, my body reacts the same way with any type of antibiotics I take. And then this year I had an ear infection and a UTI and was given antibiotics after explaining to doctors that I react to medication, but they didn’t believe me & now I’ve been dealing with a six month skin flare just like TSW, but the worst flare I’ve ever been through. Both antibiotics I took did not have Cortisone, and the creams I use don’t have any topical steroids! I only use vitamin E oil or coconut oil, so it’s crazy that these antibiotics set my body off into a TSW flare.

Long story short, I only used topical steroids on my groin area or genitals one time in 2015 for a few days, but unfortunately my genitals and groin area were severely affected whilst going through TSW. Symptoms included itching, burning, swelling, skin peeling, oozing. I lost my period for 15 months and now going through the flare again I haven’t had a period in five months. Going through my flare now I have not been able to wear any underwear for six months! The only thing that helps is taking baths with apple cider vinegar and Epson salts and applying coconut oil, tea tree oil, vitamin E oil and Colloidal silver to avoid infections. I find the more you apply things on it the worse it is, that’s just my experience. All you can do really is just have patience and let your body heal the same way as the rest of your body parts. Oh & diet plays a huge factor, at least for me it does. Any foods with sugar or high inflammatory or high in histamine will make me flare down there & everywhere!

Now that I've spoken to several doctors they have told me that it wasn’t the steroids that caused everything, since I barely used them, but that my body was deteriorating and when I took the topical steroids, it was the basically the last straw my body could handle, and set my body off into RSS/TSW, which is crazy that a topical steroid I did not use for more than two weeks could have me housebound for over two years!

I lost my hair & had to shave my head three times as I would have oozing consistently for three months straight! And the fact that I’m going through TSW again after not having taken topical steroids, but just by taking antibiotics and reacting to them, shows how toxic antibiotics and creams can be and what they can do to your body, in all areas, including your genitals. 

***After sharing her story with me, she then voice noted me to say (and I'm quoting her verbatim because she put it so well!!), "You are welcome to share my story with my name as people should not be ashamed of saying that their genital areas were affected or flared. It's a horrible thing to go through, and the reality is that when you have, or when you are going through, Topical Steroid Withdrawal, or any skin flare, that area can definitely be affected, and it's also very scary. I remember first thinking, what's happening?! I had the swelling and I was freaked out, and then realised that it was just, whatever was going on with the rest of my body, is going on down there and it really sucks.

Thank you to Maria Vrontos (@mariavrontos) for sharing this with me x


Woman #6 (18-24)

TSW around my genitals appeared a little while after I noticed swelling of my lymph nodes. This problem still persists. Swollen lymph nodes is something incredibly unconfortable, especially when I'm lying down. One herbalist mixed a cleansing tea for my lymphatic system so I hope it will get better. Genitals being itchy is a big struggle between you and your mental health because when you scratch it, that's a long healing progress, full of pain. I'm just hoping it will improve over time.

I only ever used steroids down there, just once, when I had vaginal problems, and didn't know what to do to get better so I used steroids and the problems disappeared.


Woman #7 (25-34)

Personally, I've never used any Topical Steroids “down there” for ANY reason ever! Never struggled with eczema there. When TSW started though it was a new ball game. It felt as though my vulva was CONSTANTLY itching and on fire, and I had to quit shaving for a while. It burned when any urine would touch any of the folds and creases between my vagina and inner thighs. My labia even became swollen for an amount of time while going through TSW, and wiping at one point was impossible.

Tips! Quit shaving if necessary: do whatever makes you most comfortable in that region! Also, DON'T WIPE! PAT DRY ONLY! Wiping the skin down there when using the bathroom made it sooo much worse than if I carefully patted dry. Also, spread those legs on the toilet! Do whatever you need to in order to keep the urine off of your skin (for me that was literally torture).


Woman #8 (25-34)

When I had eczema I experienced irritation down there. This was during the period close to TSA (where I became reliant on steroids). I remember I did use steroids there, including the groin area where the torso joins the leg. All these areas were bad during TSW likely because of the lymph nodes there as well. It remains one of the last few places to heal, and although my body feels 70 to 80 percent well, down there continues to be irritated, almost on a daily basis. Embarrassing to share, but I know it will help someone else out there feel less alone, because if you looked at my Insta you would never have guessed it. Nothing much has really helped and I just know it needs time. I try to wear cotton, comfortable underwear – lace feels horrible and I avoid it at all costs.


Woman #9 (35-44)

I used steroids since I was a child (I don’t know what steroid I used when I was young, I just remember a white cream for eczema). Throughout high school and college I just used hydrocortisone. Fast forward to my second pregnancy when I got a bad “eczema flare” (hindsight – I was flaring and had been having flares for a while, but didn’t realise it). Got Triamcinolone from the Derm and used sparingly (I knew it was bad so maybe once a week). After his birth, I had another flare, and started to do research and found TSW. I went back to a Derm in the middle of what I would call my second flare and he made me feel stupid and told me TSW didn’t exist, and I said ok I’ll try steroids one more time and he gave me a class seven steroid (Clobetasol?). It cleared up in like a day, but of course it was back full force immediately. I only used it on my crotch (pubic hair area, and on the crevice near the lymph nodes) when I had razor burn from shaving and only used hydrocortisone there. I couldn’t tell you amount of times, but maybe once a month, or a little more. So my crotch constantly burns, tingles, itches and has a indescribable feeling where I almost have to constantly touch it or scratch it. I have been able to maintain work, but I have had to tell people sorry I have to do this because of the feeling and embarrassingly scratch there at work. I have scratched off all my pubic hair.

I do have some on my labia, and what I will say about that area is that it’s hard to scratch (HA) and that my vagina is very dry. I also have flares around my upper thighs and under my bottom, so it becomes super sore and hard to sit.

It seems to be a nerve pain/itch. Saint Johns wort seems to help a little. I sleep with no underwear and just wear lose clothes all the time. Sometimes ice packs help and scratching with a comb helps, too. No moisturiser has really any affect. Of all body parts, this is one that keeps me from sleeping and annoys me at night.


Woman #10 (25-34)

Life with TSW is unlike any other. Anyone who has experienced it, or is currently going through it, can attest to this. Not everyone knows this, but TSW can affect some of our most private and sensitive regions, even if you never applied steroids to those areas! (Hi, the insides of my eyelids went through TSW).  

TSW on your private parts is so uncomfortable and painful. It can feel embarrassing, and be difficult to talk about, especially with medical professionals or a spouse.

You are not alone, this is TSW, and we know healing is not linear. Seek medical help if it's too hard to do alone – I myself, had to have medical gauze and tape in places on my body I never expected to be affected by TSW.

It is not to be ashamed of, and you WILL heal from this. Show your body love and respect for all it is doing for you.


Woman #11 (25-34)

I am a few days away from reaching one year of TSW, and my groin and vulva area are very affected and every day it gets worse. I have gone to the doctors, and one of them told me it was inflamed eczema and another told me it was psoriasis. It worries me since lesions so typical with TSW are not seen.

To my knowledge, I have not put steroids in that area. After my delivery I had problems with the episiotomy and the doctor left me an ointment, I don't know if it had steroids in it – I looked for it, but I can't find it. The only skin problem in that area was mild irritation from the sanitary pad, but nothing serious.

A month after I started going through TSW, that area became very red and inflamed. It was very red, and it stung me a lot, but only to the right of my groin.

I think it's important to comment that I used steroids for many years (I don't know exactly, maybe 5-8 years) on my hands. My hands from month 8 have improved a lot, and are now 90% recovered.

To treat the area, I use zinc cream and cotton to avoid infection, but it doesn't help much with the oozing.

***She has also kindly shared some photos (thank you so much x)***  


Woman #12 (25-34)

I've been suffering with some kind of mystery condition for the past 4 or so years, which I'm now pretty sure is TSW. A few years ago I had a bout of thrush. Just normal thrush, nothing unusual. I saw the nurse and she gave me some Canesten which had 1% hydrocortisone in. At the time I thought nothing of it – I was familiar with hydrocortisone as I'd been using it all over my body for my 'eczema' since I could remember. I slapped it on and it cleared up. A month or two later I started to develop papercut-like splits either side of my vulva. Incredibly painful and stinging! Thinking it was thrush again, I put some more Canesten on. This time it took a little longer to go away, but eventually it went. A few weeks later, it came back, the slits deeper and longer than they were before. I went back to see the dr – they gave me some oral thrush tablets this time and told me to take one as well as use the cream. 

It's continued in this cycle for the past few years. Every time the splits got bigger and bigger and more and more painful. Anything seemed to set them off. Sometimes I would just be sat down and I'd feel the split actually opening up. One time I sneezed and it happened! I'd go to the chemist or supermarket and buy myself some Fluconazole and some Canesten - sometimes just the normal Canesten, but usually the one with hydrocortisone because I thought it was more effective. (How stupid I feel about that now!) It got to the point where I had these horrible stinging cuts either side of my vulva most of the time. I can't even remember how many times I've been to the dr about it and every time they've sent me away with more pills and more cream. I've had to beg for them to do a swab to check that it's actually thrush, and whenever they've done a swab they've said there's nothing there. Yet they still prescribe thrush pills and cream to "be on the safe side" because it'll apparently get rid of whatever is going on. I've also had tests for diabetes and every STI going, and they all come back clear. It's been driving me mad and nobody seems to be able to help, and it's been so hard trying to get any useful information as nobody wants to talk about it. I've trawled through countless photos of manky fannies online, trying to find the answers, and it's been impossible! 

Then, in December 2020, I had my worst "eczema" flair that I've ever had as an adult (what I now realise was probably a TSW flair). I've always had eczema since I can remember and have always been told that that's just how I am – a familiar story for lots of people with TSW! My arms, hands, neck and backs of my legs turned bright red, along with the bone-deep itch. And the slits on my vulva got worse, too, but at this point I didn't make the connection. I still thought that they were a seperate, mystery thing. I went to the drs for my skin – they prescribed more steroids for my "eczema", and when I mentioned that I still had the slits on my vulva they gave me some Daktacort. The dr didn't tell me how to use it or warn me that it was a steroid. Thankfully, I read the leaflet when I got home and was wary of using it on such delicate skin. I didn't open the tube and I'm so glad that I didn't touch it. I'm horrified that they gave it to me to use on my vulva, but even more so that they didn't warn me about the dangers of it at all. Not a word.

In early May this year I decided that I was going to try and get my skin under control by whatever means possible. After searching for eczema tips on Instagram I stumbled across a photo of someone with TSW on their arm. I thought it was a photo of my arm – I actually did a double take thinking it was me. It was insane how similar my skin was. I stopped using steroids immediately and haven't used them since. Now I've started the long process of learning about TSW it's made me wonder if that's really what's been going on, starting off with the innocent-looking hydrocortisone I was given for thrush years ago.

It's been (and continues to be!) the most difficult and embarrassing thing and has made me feel incredibly low at times. I've been with my patient and understanding boyfriend for nearly 10 years, and we haven't been able to have good sex for a long, long time. On the rare occasion that I feel brave enough to give it a go it ends in tears because I'm in too much pain, and I feel incredibly embarrassed and upset – even the night we got engaged earlier this year, which was heartbreaking. It's been an added thing to deal with on top of the physical pain. Of course sex isn't everything, but I do think it's important for our wellbeing and for connecting intimately with our partners. But it's often trivialised. Whenever I told the dr on my countless appointments that sex was painful and I was feeling really low about it, it was usually shrugged off as if it wasn't important, or I was made to feel like some kind of sex-crazed maniac! 


MEN

Man A (18-24)

So I started using it when it first started getting itchy a few years ago (hydrocortisone). It would be fine for long periods of time, but come back. Then, in the last year, it was bad more frequently (really itchy) with rashes, and it would flake all around my private area. I then started to use Betnovate around that area, and from August 2020 (ish) it would never fully go away. It got worse in February 2021, with a very itchy and flakey rash. I went to the doctors, they thought it was fungal. I've had the same antibiotics (Flucloxacillin) a few times over the past 10 years, but each time they got less effective. So the antibiotics didn’t work. I used a fungal cream, that didn’t work. Then, I was using literally anything I could get my hands on in panic because it wouldn’t go. Sudacream, Germolene, steroid creams ... but nothing was working. Then, in April, it was my worst month, and I had to take a week off work. Full blown TSW, I couldn’t walk. It was oozing everywhere on my privates and after that I decided to fully commit to TSW as my whole body flared up.


Man B (25-34)

So I did use steroids on my private areas, mainly on the groin area, and if I ever groomed etc, it would get itchy so would apply some, and usually strong stuff like Betnovate. 

It has been one of the areas that has really taken its time. Constantly itchy and obviously it doesn’t see the light etc.

At first I would scratch and shed and peel and it was just horrible. It's getting stronger, but still itches a lot and just goes red. 

There isn’t anything I really use for relief, nothing seems to work really.


Man C (45-54)

My eczema started at 35. 

“Treatment” recommended: Clobetesol applied to affected area 2x daily for 10 days. This did make it go away, but several months later, repeated the above. 

4 years later, the sides of my body and other areas of my body where I never applied TS started itching. Yes, this includes the scrotum. I didn’t think anything of it other than perhaps me being allergic to something in the air as it seemed to happen during season changes. Anyhow, I continued to apply steroids, or get it injected or take the internal steroid, as that did temporarily relive the itching and such, but it always came back. CeraVe and Vanicream seemed to help the itch some, but still itchy on the sides of my body and scrotum area. The itch seems to be sub-dermal, if that make sense. 

Age now: 45

I got led to this TSW Facebook group and only now realise all that I experienced above seems to be TSW and minor RSS, so I've been steroid free for about 2 months. I am trying to do NMT as much as I can, but on my hands it’s difficult as I can’t open and close them without the skin breaking.


Man D (18-24)

My entire body – even today – is effected by TSW, including my genitals. The severity of my skin seems to lessen the further down my body you go, with my scalp, face, arms and torso being particularly bad, whilst my feet and ankles look more like a normal eczema flare up than TSW. My genitals, then, are probably what most would think of as a mild case of TSW; red and flaky, but not especially weepy and without any cracks in the skin or raw patches. 

I say ‘not especially weepy’ as that area has been known to weep, but very rarely and only when I’ve really attacked it during an itch-fest, usually due to over-heating under the duvet at night. I would say that of that area, my testicles and anus are the least effected, with neither being itchy, my penis is almost always red and can be quite itchy, and the creases in my groin as well as the area connecting the anus and the scrotum – apparently called the perineum, thanks, Google – can get quite hot and itchy. 

I haven’t had penetrative sex for as long as I’ve been dealing with TSW, but during my time on cyclosplorine there were a few moments of some relief when I was on the receiving end of oral sex and I did notice that after this my penis would be especially dry and red. TSW has, surprisingly, never really effected my sex drive, and I suspect that masturbation may account for the difference in quality of skin between my penis and testicles. 

I’ve spoken to guys about the issue of underwear in the past and most seem to prefer going commando for comfort, but I’ve always liked the feeling of wearing underwear, I feel like cotton boxer-briefs or briefs help to wick away some of the moisture in the creases. I’ve also spoken to guys who have large thighs and/or large genitals and they seem to exacerbate moisture and itchiness around the groin. 

For the record, I never applied any topical steroids or Protopic on or around my genitals, and only very rarely moisturised the area.


Man E (25-34) *This account was sent to me in late 2022, which can also be found in my LET'S TALK ABOUT: PROTOPIC (TACROLIMUS) post (here)*

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I'm currently 33 years old, and I started using tacrolimus ointment when I was 28. I had developed a dry red rash on my penis and went to numerous doctors before seeing a dermatologist. The doctors tested me for STDs (the test came back negative, and I was tested again to be sure) and prescribed me triamcinolone, which was only mildly effective, and tried treating me for fungal infections, which didn’t help, before I saw the dermatologist. I was also in a long-term relationship at the time, and my partner was fine.

I had a biopsy taken, and the results didn’t really show much except for a lack of melanin. My dermatologist diagnosed me with vitiligo with inflammation and prescribed me 1% tacrolimus ointment. I wanted a second opinion, so I saw another dermatologist, and she said it was genital psoriasis. Protopic was deemed to be the solution to both problems.

I used it for about 5 years, and over time it was becoming less effective and my condition was spreading. I kept having to use more of it, and I was applying it daily, sometimes twice a day. I was worried something else was wrong with me that was only being masked by the Protopic, so I decided I was going to stop using it in February 2022. My dermatologist was pretty dismissive of my concerns, assured me it was vitiligo, and prescribed me desonide. I saw a urologist during this time also, and he didn’t have any answers for me either. I used the desonide some, but I didn’t want to put anything on it, so I stopped everything. It was about two weeks later that my psoriasis got really bad on my penis, and it was very red and bumpy. Over the next month, it got much worse: red, bumpy, swollen, oozing, and scabbing. I had pain, trouble urinating, and the folds of my skin were fusing together. I didn’t really know what was going on, I thought I had some disease that was repressed by the Protopic, and now it was back with a vengeance. I was just determined to leave my body to fight it. I only just realized that it was TSW that I was going through.

After about 2 months off the tacrolimus and steroids, I started to see improvements. It would get better for a while, then worse, but the first two months were by far the worst. I got a new dermatologist during this time, and he never mentioned anything about TSW. He didn’t know what it was, or what to do, and just told me to put Vaseline on it, which I did for a month then stopped. It’s now November 1, 2022, and my condition is doing quite well. I’d say it’s better than it was before I started taking the tacrolimus. I think I’m pretty much over the TSW now, and I’m just dealing with the original psoriasis like symptoms. I have started eating better, drinking less, and I quit smoking. Currently, I’m thinking that cigarettes caused my psoriasis or made it worse. I was never a heavy smoker, I just smoked moderately, sometimes once a day, sometimes none, sometimes up to around 3 on the weekends. I’m honestly quite embarrassed that it seems like I have gone through all this suffering for an occasional cigarette. Anyways, I’m feeling optimistic that eventually I can go back to completely normal, but time will tell. I feel very fortunate that I didn’t use Protopic in other places, and it has been a fairly fast recovery. 

The most depressing part of it all was that I didn't know what was happening. I was looking up a lot of stuff, and thought the tacrolimus was suppressing some other disease and it was coming back really strong after stopping the tacrolimus. I was determined to try and let my body fight off whatever was happening to me on its own. I didn't know about TSW or Tacrolimus withdrawal, and my dermatologists didn't tell me about either. It was scary not knowing what was happening.

A few weeks later, X contacted me to say that his skin is flaring right now and he’s feeling pretty demoralized as he thought it was over. He said, I mean, I know a lot of other people have it much worse, but it just really sucks to have this issue where I do as a man.

A little point I wanted to add is that whilst symptoms vary and range from full body to more isolated areas, suffering is suffering, and the mental toll of it can be devastating, no matter how small the area. But, to anyone reading, just look at what can happen with time, and how quickly things can change. Hold on x

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Thank you so much again to everyone who shared their experiences with me <3

Working on this post has made me fall in love with our ever-growing community a million times more (didn't know it was possible), and I hope it has shown how so little of this could ever be called anything other than TSW. TSW is raw and unpredictable and painful, but it does get better eventually. 

Together, we will create change, and one day our experiences will mean that others won't have to suffer.

It will all get better in time x


Other posts in the series:

Let’s Talk About: Eczema Herpiticum (here)

Let’s Talk About: Protopic (Tacrolimus) (here)

Let's Talk About: Elidel (Pimecrolimus) & Eucrisa (Crisaborole) (here)

Let's Talk About: Oral Steroids (here)

Let's Talk About: The Nipples (here)

Let's Talk About: Mould/Mold (here)

Let's Talk About: Pregnancy (here)

Five Questions With: Kaitlyn


I am back with another 5 QUESTIONS WITH, featuring the beautiful Kaitlyn (aka @k8loveslife on Instagram). Her story is slightly different from others I have shared in the past because whilst she openly discusses her skin struggles, I am sharing her story because her strength, positivity and spirit is so inspiring, especially when you learn of all she has been through because of steroids, especially the oral steroid Prednisone.

I have known Kaitlyn for a few years now, and very quickly fell in love with her uplifting, beautiful (and food porn-worthy) Instagram account (here). But sometimes, when people share their story with such positivity and grace, you don't realise all they have been through. After I mentioned in an Instagram story recently that I was triggered when someone had suggested using Prednisone for their mental health, Kaitlyn replied and told me things about her experience with steroids that truly shocked me. I couldn't believe everything she had been through, which was made even more heartbreaking by the fact that it all started with hydrocortisone when she was a baby. 

After fighting against Dr Sandra Lee's Super Cortisone+ last year, it made me realise just how many people had developed Topical Steroid Addiction because of hydrocortisone: a drug that is considered 'mild', and even prescribed to babies (I was one of them). Hydrocortisone is used for everything from eczema to sunburn and bug bites – and even recommended after shaving your bikini area (shudder).

I think it is important to mention that not everyone who uses steroids in their life will end up having to go through TSW, but it is something that everyone needs to know about because TSW is very real and it is not rare or something created by a bunch of steroid phobic people on the internet.

Please note that most of the photos shared in this post (apart from the photo above and the last photo) were taken in 2015 and only represent a small fraction of her journey - and were certainly not taken when she was at her worst, as you'll find out in this post. She said of the photos taken in 2015 that they are what her skin was like on an average day for many years. Like most of us, we never took photos of our skin before we found out about TSW, or at other times in our life when our skin was at its worst – but at the point these photos were taken, she couldn't work and was in and out of the hospital several times a week. 

I would also like to add a disclaimer as some of Kaitlyn's photos and experiences with her skin could potentially be a trigger.

I just wanted to add that Kaitlyn is currently using Dupixent to manage her symptoms, and whilst it's not something I'd recommend using during TSW (in my non-medical opinion), I respect her decision as it's right for her. We are all different. 

Lastly, I wanted to say that whilst I totally understand if you need to use medication like steroids again if you cannot go through TSW (trust me, I get it), or you have personal/work commitments, please be aware of the language you use when you suggest using a strong steroid like Prednisone to combat mental health. It can be very triggering to those who have had bad experiences using it. Any of these drugs we use for eczema, or to alleviate symptoms of TSW, are not designed for mental health, and were in fact the drugs that caused our mental health problems in the first place. 

With all that being said, I'll hand it over to Kaitlyn:



1) Tell us about yourself and your skin journey.

I'm a 31 year old dog mama of two, currently residing in the frozen tundra that is Alberta, Canada. I have a full time job in the Recreational Cannabis Industry as well as running my own company full time - KaitDoesIt (here). Which is essentially a business where I do the things I am great at, and passionate about - Professional cleaning, healthy custom meal prep, commission art pieces, and social media consulting and content creating (and more!). I came about all of these skills in an honest way - when you are too sick to work in public you cleverly find ways to pay your bills by using your given talents and staying behind the scenes.

My skin journey started long before I even have memory of it. I was about 3 weeks old when my rash and redness started to appear on me. By 3 months old it had covered most of my little body. Pictures were few and far between as my skin continued to flare off and on for the majority of my childhood. I must have been about 3 years old when my parents were first prescribed topical steroids to apply on me. "It might thin her skin" was the warning my parents and I received for years after that point. I used topical steroids from about that age to the age of 17 years old - at first, sparingly on 'problem' areas. By the age of 15-17 I may as well have been bathing in buckets of topical steroids (not to mention creams, Vaseline, oils and whatever else I could get my hands on). The oral steroids started when I was about 14 - at first just to get me through the bad flares. Then it just became something I was on a low dose - high dose loop of, for years. I finally stopped taking long term oral steroids when I was almost 28 years old, when I got the Okay to go on the medication I am on now.

I had tried everything over the years. Every cream, therapy, food/allergy elimination, so many medications I can barely keep track, doctors from other places, hopes and dreams - you name it, we tried it. And I say 'we' because skin disease and TSW truly IS a team event - don't try to do it alone. At one point in my journey, with my 'mysterious' skin issues, and plethora of other ailments that graciously haunt this little human body, I had 17 doctors on my team of specialists who had no idea what to do or how to keep me alive other than pumping me full of steroids to suppress my immune system. 17 specialists who 'unknowingly' just dug my hole deeper, and deeper, for years.

I've gone through so many extremes with my skin, have spent more time in the hospital than I can even fathom, and still experience PTSD from it all. I can't even go into the head trip it is to have a skin disease and TSW for most of your life. Let's just say I stay medicated. A group of nurses 'lovingly' used to refer to me as Lobster Girl because my skin was always that red. People regularly asked if I had been in a fire, or how I got a 3rd degree sunburn. I would always be itchy, scratching off the skin that wasn't already falling off. My skin would fall off in chunks from head to toe, even while slathering myself in anything I could get my hands on and wrapping my skin. I would ooze from head to toe, constantly smelling like rotten skin for years. I had cuts all over my body that my body seemed to create by itself. My neck, my ears, eyes, nose, any part of my body that was supposed to bend. My feet and ankles have permanent scarring to this day from the hell they endured. My inner eyelids and eyeballs would peel, I would literally cry tears of blood. My eyes were so bad I had been given glasses for years before an ophthalmologist told me that I was experiencing eczema inside my eyes the whole time and my cornea was actually cut up so badly, my vision was blurry because of the damage. I lost about 40 pounds when I was at my worst, on bed rest at 21, in so much pain I was barely able to move. My parents were taking care of me - wrapping my wounds, helping me bath, making sure I got some food in me, taking me to the hospital several times a week when things would get too bad to handle. My asthma was always flared, my alopecia would flare and I would lose my hair. I wasn't able to regulate my body temperature without having skin, I would shake and shiver all the time even though to the touch I was on fire. My gums and bones have degraded from years of Prednisone use, something that has definitely affected me as I have started breaking bones much too easily within the last couple years.

I have had MRSA for almost 8 years now due to contracting it in a hospital while I had no outer skin layer to protect me. For years I was COVERED in MRSA pustules. Hands, feet, face, body, vagina - literally everywhere. I remember counting 41 open pustules on my body at one time. I still test positive for MRSA, I likely will my entire life, though I am grateful to not have it actively affecting me anymore.

My skin has been mostly clear for 3 years now as I've been on Dupixent. For me it was a complete game changer and has given me a life I never thought I would be able to have. I still have slight flares, but for the most part they are easily controlled and don't last long. The years of TSW will likely always haunt me, and remind me of what I've been through. 


2) How did you find out about TSW?

I found out about TSW through Instagram, and I was late to the party. It was only about 3 years ago I came to discover it. You, Cara, were, and continue to be, so helpful. And then I found Louigiskin and finally realized I was not alone. As I emerged from the shadows with My own experience, I found an entire community of TSW sufferers, some who have become such close and wonderful friends. I was never alone, which is both comforting and also terrifying knowing that there are so many others experiencing a hell I would not wish upon my worst enemy. I unknowingly went through bouts of TSW at least a dozen times from the age of 10-25, including years of my life hospitalized and on best rest.


3) How has your experience with your skin changed you?

My experience with my skin has helped to make me empathic towards others' struggles, skin related or otherwise. I'm kind, and understanding when others need help. It helped me realize that my childhood goal of growing up one day to help others really is still my goal. But it's far from all love and light. My experiences with my skin and immune disease have also left me with PTSD and frequent bouts of anxiety. I still don't see myself the way others do, the redness, scars and peeling is still a visual that flashes before my eyes daily. I'm always on edge - I wonder if and when I will flare again, how long it will last, and if I will be capable to handle my life on my own. I wonder if I will not be able to afford the medication I'm on if I will go back to how I was. I wonder if I'll be able to survive that if that happens. My skin journey has affected every single part of my life, it genuinely has shaped who I am because it's been my whole life. I'm 31 and just figuring out who I am and what I am supposed to do in life, because I've never had the chance to focus on that before. 


4) Sum up your skin journey in five words.

Isolating/traumatizing/all-consuming/hopeless/healing (because it does finally come).



5) How would you like the treatment of eczema (and TSW) to change?

I believe for the treatment of Eczema to change we need to keep fighting for the realization that TSW is VERY MUCH a thing. That topical steroids do not just possibly 'cause skin to thin', and that topical and oral steroids can cause the most horrific and long term experience you could possibly imagine. My life was stolen from me, for years. And I am one of SO MANY. The numbers are the proof, and we as a community need to fight back to try to never have anyone go through what we've all endured. Doctors should not be allowed to prescribe topical steroids lightly, and there should definitely not be topical steroids available over the counter or insanely added to 'beauty' products. Eczema, TSW and skin disease need to be taken so much more seriously.

To follow Kaitlyn's beautiful account, click (here). 

Thank you so much Kaitlyn <3


Links to my previous 5 QUESTIONS WITH:
Henni @rawsomesoul (here)
Alice @healthy_healer (here)
Maleeha @TSWHealed (here)
Nina Sloan (here)
Nick @Eczemacism (here)
Stephanie & Isaiah Quinn (here)
Stephanie @TheItchyConundrum (here)
Josh @Redskinrecoverydiary (here)
Briana @PREVENTABLE (here)
Melanie Lynch (here)
Stephanie Miller (here)
Holly Dillon @GetYourSkinOut (here)
Me (here)
Keisha Gregson (here)
Douglas Maddy & Charlie (here)
Gillian Breslin (here)
Jasmine and Jennifer (here)
Robyn (here)
Brittany Hallberg (here)
Emma (here)
Zip (here)
Imogen (here)

Hayley (here)

8 YEARS TSW

 

And so I have somehow reached 8 years since I stopped using all steroids and immunosuppressants, and oh my goodness it's been quite a ride.

I have been better nearly three times longer than I was in withdrawal, and there is not a day that goes by that I don't feel grateful that I didn't give up and kept going.

I don't know how it does it, but somehow it gets better, and the skin learns how to fend for itself again. 

I wish I could give you a better answer than to give it time, but that is the only thing I am truly sure of. 

Time heals.

Cara x

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