The Moisturiser Withdrawal Debate

Whether or not one should use moisturiser during TSW is one of the biggest debates (and in my opinion, one of the profound mysteries) of this world. There are people who swear it was what kickstarted them into healing, while others say it is too agonizing and/or that they did not see sense a noticeable positive difference. I have tried both routes and here are my two cents worth.

One of the first things we learn when we discover we have atopic skin (ie, prone to eczema and other dermatitis) is that we ought to moisturize the shit out of our skin to protect it and thus prevent it from itching. Accordingly, when we go through TSW and suffer severe eczema-like symptoms, the common sense approach is to lather on [enter moisturizer(s) of choice] to alleviate symptoms and make yourself more comfortable.

That is not wrong per se, but TSW is such an unstoppable beast that you will feel like the moisturizer is doing nothing to stop that crazy, itching, flare that cuts deep to your bones. Also, depending on the choice of moisturizer, you are probably very wet or oily or sticky all the time, which cannot be comfortable, and when you scratch, the skin breaks or sloughs off very easily, leaving what’s left behind raw and tender.

That is where the idea for MW comes in. There are several views on why stopping the use of any moisturiser is positive during TSW. The first is actually comfort. To be precise, eventual comfort. When you have used moisturizers all your life — my mother started lathering in on all over my body when I was just a baby — if you suddenly stop it, things can get quite nasty, especially if you are going through something as traumatic as TSW. In other words, your skin will get really dry, and it will itch really bad from the dryness, and you’ll probably be in pain from scratching, and of course the flaking will get even worse. For some, the skin gets so dry that it cracks or splits, which is why it is not surprising that a lot of people can’t stick with MW for more than a couple of days.

However, the MW gurus will insist that, if you stick with it, your skin will eventually feel more comfortable, and it will get very rough, tough, and scratch resistant — once the cracks and splits heal over and the skin starts producing natural oils of its own. If you lose control and go on a scratch fest, chances are the damage will be much less than had you continued with moisturising. How long does it take to get to this point? Most people say a couple of weeks.

Mind you, for some people MW came as a necessity because their skin, especially in the early stages of TSW, could not tolerate anything on their skin. Some even go as far as to say that water would sting. I don’t doubt that for a second because the hypersensitivity is insane during TSW.

The second reason is that MW supposedly speeds up the recovery of the skin. As TSW expert Dr. Fukuya puts it on his blog:

Moisturizing increases the micro-environmental humidity very near to the skin surface. It means the protection by moisturizer works to delay the barrier function recovery.

and

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

and

The epidermis is proved to produce more cortisol in the dry atmosphere by the experiment using cultured keratinocytes…When the procedure of TSW prolongs and the redness of the skin continues, withdrawal from the whole topical agents sometimes works though it is accompanied by another rebound just like withdrawal from steroids. The mechanism may be the facilitation of recovery of production of inner steroids.

There is a third reason that often gets forgotten, and that’s that moisturising encourages the proliferation of staph bacteria on the skin, which some (such as Dr. Aron) believe is the culprit for the spreading redness and itch seen in RSS. If you stop using moisturiser you don’t give the staph an opportunity to thrive and spread.

On the other hand, there are those out there who believe depriving yourself the comfort of moisturisers is unnecessary and harmful. It just feels non-sensical for some that stopping moisturisers is supposed to help, when the skin is already so dry that it feels like sandpaper and is cracking and splitting, putting the victim through further pain and stress. Furthermore, it is the belief of TSW expert Dr. Rapaport that there is no such thing as moisturiser addiction — ie, the skin cannot get “addicted” to moisturiser like it can to steroids no matter how much you slather on, so it’s not a problem in the long run. In fact, Dr. Rapaport explicitly lists “No moisturizer” as one of the “Misguided Therapies” on his website. And above all, when your face is flaking like crazy (like mine is now), you look like an absolute freak without moisturiser.

For me, doing MW was a daunting challenge but also kind of made sense to me. We humans did not use moisturisers for thousands of years and we ended up just fine, so surely our bodies just find a way to cope with the natural elements. Slathering our skin in moisturiser just prevents your skin from developing that coping mechanism.

Surprisingly, the initial phase of moisturiser withdrawal was not that bad for me. I started about 2-3 weeks into TSW, when my body was at the worst it had ever been, completely red and inflamed and itching like a bitch. In the beginning, I used an assortment of different creams, emollients and oils supposed to keep the skin hydrated — some had antibacterial properties and anti-inflammatory action and added lipids or some missing shit back into your skin — but none of it was working. So I stopped moisturiser cold turkey, and of course it was very uncomfortable, but when your discomfort level is already at 10 out of 10, there’s nowhere to go but down.

So I stuck with MW for the entire second month, most of which was when I was in Japan. I was initially worried because Japan is especially dry during the winter, but as I didn’t take many baths or showers there I wasn’t particularly worried. I did get some splits in my foot from the dry skin and all the walking, so I applied some thick moisturiser there and bandaged it up, but it wasn’t an area affected by TSW.

When I came back from the trip and was entering month 3 of TSW, for some reason I thought I’d try moisturising again. I had this La-Roche “anti-irritation/anti-itch” cream that I had been dying to try. I tried it and nearly died. The cream stung as soon as it was applied to my skin, and then made it itch all night, as badly as that first month had been. I must have scratched away about a month’s worth of healing in that one night.

So it was back on the MW bandwagon again after that, though I didn’t last long again because it was so uncomfortable. A few more weeks later, I got the lauded Avene Xeracalm cream, which is also supposed to be anti-irritation and anti-itch. I spot tested it first this time and it had a calming effect, so I applied it to my entire body. It wasn’t bad, but I couldn’t tell how much it really helped.

Since then, I have gone back and forth between moisturising and MW, and each time I second-guess myself, wondering if I’ve made the right decision. Sometimes I moisturised my body and did MW on the face, and other times I did the opposite. Right now, there is no question: My skin feels much better when moisturised. I have been going through a major face and neck flare for over a month now, and if I don’t moisturise, the skin gets so dry and thick and tight that I can’t move my face or neck without feeling intense discomfort or pain. When it gets real bad I can barely open my eyes in the mornings or open my mouth to eat.

Choice of moisturiser is another huge can of worms.  A lot of say the only thing that doesn’t irritate their skin during TSW is Vaseline (petroleum jelly), and a lot of products are petroleum based, like Dr. Fukuya’s clofibrate ointment, Catrix 10, and several TCM herbal topical remedies I’ve used. However, there are those who say petroleum based products are bad for your skin and overall health, while there are also those who claim it is one of the safest substances around. I don’t know the answer and it’s very frustrating when there is so much conflicting information out there. My personal feeling is that I would avoid it if I could, only because it feels very oily and sometimes can make me itch and hot because I feel like it is sealing in the “heat” under my skin. That said, many have criticised the other “scientific” creams, balms and ointments that I use or have considered using too, citing harmful chemicals in the ingredients. We’re already trying to get rid of on toxin in our bodies (steroids), so why put in another one? It’s all very blood confusing.

If I could offer a parting word of advice, it would be to not worry too much about moisturising or not moisturising and which mosturiser to use — just go with whatever makes you most comfortable at the time. I know it’s sometimes hard to tell because you’re always uncomfortable anyway, but try to listen to your body and do spot or patch tests before slathering stuff on everywhere. Like right now, I’m moisturising my hands and arms because they’re getting so dry an scaly that they literally sting, but I’m not putting anything on my legs because they’re generally fine. The face is still a tough one because it just looks so damn terrifying when it is peeling and flaking everywhere, but putting moisturiser on seems to make it redder and more aggravated. TSW just stinks so bad.

 

 

 

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