Topical steroids as a management therapy for skin conditions is similar to chemotherapy, for cancer.
There are the good and bad parts for Chemo. The good part is that it kills your cancerous cells. The bad part is that it kills your healthy cells too. (There is also frontiers on highly targeted chemotherapy, but that is not in this context of discussion).
Use chemo on a perfectly normal person and you get disastrous effects, just as TS causes skin atrophy to healthy skin as well as unhealthy skin.
Both methods and drugs are highly relevant in the medical context. They have their appropriate uses for the appropriate situations.
And that is where their similarities end.
The major differences are in the process/management of drug prescription by the practitioners and more importantly, in the nature of the disease itself.
In Chemo, the disastrous effects are short term and highly visible.
In TS, the disastrous effects take time to manifest itself.
In Chemo, the doctors are highly aware of the risks associated (partly due to the short term/high visibility/well studied averse effects). And thus they spend plenty of time educating their patients clearly on the usage of chemo.
In TS, most doctors don’t want to know, don’t choose to know, or simply do not know the risks involved (also partly due to the longer term nature/confusing diagnostic patterns/less studied fat-tailed risks).
In Chemo, it is a life and death decision to use the therapy.
It is not a life or death situation for skin conditions that involve the use of TS, but more of a cosmetic / low level urgency situation. Use TS or not, honestly, it doesn’t matter significantly.
When we look at it in this perspective, we start to realise that our TSA predicament is a function of the nature of the disease, the urgency of the disease, and even the nature of the risks of the medication involved.
Eczema/Steroid-induced Eczema is NOT Cancer. And this is possibly more than enough to effect a multitude of complex decisions, justifications and agendas for the entire medical ecosystems – the medical establishment, the pharmaceuticals, governmental regulators, researchers and academics – so much so that at the end of the day, everyone comes out knowing way less on steroid-induced Eczema compared to chemotherapy.
So we ask, what is the real problem then, and how and what exactly should we define to be the problem? I do not have the exact answers yet.
Do we need people to start dying from steroid-induced eczema before people start noticing?(which as a direct cause – would not happen in reality. People may die due to indirect causes associated with steroid-induced eczema, think HPA axis damage and the likes of it).
Or is the current level of awareness and attention on steroid-induced eczema appropriate for its apparent scale : that TSA sufferers form only a minority and thus deserves the level of attention it deserves? (My opinion is that there is a big umbrella of actual TSA patients under this main subset of broadly categorized Eczema patients. And under this big umbrella of TSA patients, there are a huge group of people who do not know about TSA, and there are those who know. And within this group who knows about a TSA, only a vocal minority like me and fellow similar bloggers are commenting about this problem. We can similarly extrapolate this same idea for doctors too.)
In a highly complex problem like TSA, it pays to rethink what is the actual problem we want to solve.
Perhaps all we want is just good skin, then all of us should refocus less on TS and more on other natural lifestyle stuff/diet/exercise and what not, and do our very best to derive the optimal way to achieve that.
Or perhaps all we want is to recover from steroid addiction skin.
Or perhaps all we want is to have a means to differentiate between Eczema and Steroid-induced Eczema, so the appropriate and directed treatment procedures can occur.
Or is it just as simple as an awareness problem (as if increasing awareness by itself is enough to effect changes?)
As seen, defining the problem differently will result in a different solution path. And all different solution paths have different ROIs. If we go all out and try to do everything at once, will the effort be diluted and wasteful?
Or should the community (or individuals like myself) go for the most efficient and highest ROI solution path to solve a specific, well-defined problem (and what exactly?)
These are just snippets of thoughts derived while researching and writing for my book on TSA.
Working on this project led me to more questions than answers.