344: NEW RESEARCH On Topical Steroid Withdrawal Symptoms + TSW Red Skin Trigger w/ Dr. Ian Myles

The Healthy Skin Show

I’ve discussed topical steroid withdrawal symptoms and TSW skin concerns extensively on the Healthy Skin Show, but there is still so much about this condition that isn’t well understood.
Partly because we don’t yet have much research on TSW.
So when I heard that Dr. Ian Myles was looking into topical steroid withdrawal symptoms, I had to get him on the show to break it down for you in layman’s terms (because his paper is complex).
Topical Steroid Withdrawal (aka. TSW and also sometimes called red skin syndrome online), is a condition triggered by the use of glucocorticoid steroids often used topically (and typically prescribed for chronic skin conditions like eczema and psoriasis).
Because topical steroids are the standard of care for these conditions, many people unfortunately end up using them for extended periods of time (sometimes without any breaks and with increasing potency). And some go on to develop TSW, which is a horribly debilitating condition with symptoms that can drag on for years after stopping all steroid exposure.
The research we’re discussing in this episode has yet to undergo peer-review, but is in the process. Either way, the ideas are fascinating, albeit complex (especially for those with little to no experience with nutritional biochemistry). So we’re hoping that this conversation helps you understand the ideas while also adding context to what’s next for TSW research.
My guest today is Dr. Ian Myles! He did his undergrad at Colorado State University, received his M.D. from the University of Colorado, then trained in internal medicine at The Ohio State University prior to beginning fellowship training in allergy and clinical immunology at NIH. He became a commissioned officer in the United States Public Health Service Commissioned Corps and has supported several US and international missions.
Dr. Myles received his MPH from George Washington University before becoming the head of the Epithelial Therapeutics Unit to evaluate the efficacy and safety of a topical, live bacterial treatment for eczema.
In This Episode:

• How Dr. Myles’s interest in topical steroid withdrawal and TSW skin began
• Study about topical steroid withdrawal symptoms
• Niacin and TSW connection
• Topical steroids impact on your cells’ powerplants (aka. mitochondria)
• Which type of steroids may be to blame
• Treatment ideas for topical steroid withdrawal symptoms
• What may be driving TSW symptoms in your brain
• Thoughts on oral and topical berberine for TSW skin

Quotes

“So we're saying… what distinguishes patients with TSW and patients with atopic derm? And you can say, what's too much, and then what's too little? And so the thing that's too much, like we said, was niacin, the nicotinic acid. And then what was too little was tryptophan.”
“Kynurenine shuts off your ability to sweat, and we hear a lot from the patients that during the height of it they would be beet red, they'd be flushed, they'd do all this, but they're not sweating. They'd be feeling super hot, but they wouldn't sweat.”
Links
Find Dr. Ian Myles online here and on Twitter
PAPER WE DISCUSSED: https://www.medrxiv.org/content/10.1101/2024.04.17.24305846v1.full
Dr. Myles’s TSW deep dive on YouTube: https://www.youtube.com/watch?v=TSFiKlrIDUI
Healthy Skin Show episodes on Topical Steroid Withdrawal
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1. Introduction (00:00:00)

2. Study about topical steroid withdrawal (TSW) (00:03:39)

3. Niacin and TSW connection (00:07:21)

4. How topical steroids impact your cells’ powerplants (aka. mitochondria) (00:14:08)

5. Which type of steroids may be to blame (00:16:44)

6. What may be driving TSW symptoms in your brain (00:24:35)

7. Thoughts on oral and topical berberine for TSW skin (00:33:25)

8. Final thoughts (00:46:41)