To most dermatologists, steroids and skincare go together like peanut butter and jelly. Steroids are the go-to treatment for sudden irritations and allergic reactions — so I didn't hesitate to try them when my dermatologist prescribed topical steroids to treat a small patch of red, flaky skin near my right eye three years ago. But for some, they actually make the condition worse over time. In rare cases, steroids can lead to chronic acne, permanent skin thinning, and something terrifying known as “skin atrophy," where the skin and muscles underneath stop functioning properly. In short, steroid skin creams can ruin your skin if they aren't monitored properly. They almost ruined mine.
Under normal circumstances, I probably wouldn't have agreed to steroid treatment — something about the aggressive, extra-strength implication of the word just scares me — but I did. Because of a boy.
My first flare up of dermatitis (a skin irritation with no known cause) happened on my second date with a new guy in 2015. We spent the day together, and what was an innocuous patch of redness under my lash line at brunch gradually worsened, until the irritation covered my entire eyelid. It kind of looked like pink eyeshadow? By the time I glanced in the mirror at the bar that night, though, my right eye was nearly swollen shut and decidedly not cute, and I ended up crying in the bathroom. (The guy was super sweet about it… and now we’re married.)
Over the next few weeks, I tried everything to look like myself again: ice to soothe the swelling; Eucerin and over-the-counter psoriasis treatments to moisturize the dry, red bumps; hydrocortisone creams, chamomile tea bags, and coconut oil, too. Nothing helped, so I finally booked an appointment with a dermatologist.
After diagnosing my dermatitis, he prescribed a mid-level steroid to be applied twice daily. While he did say that consistent application around the eyes could lead to glaucoma, he didn't mention any of the other long-term side effects for steroids, and he sent me home with little sample bottles of steroid creams and a prescription for a full-size tube.
This stuff was magic. In a few short hours, my eye looked completely normal. But I noticed that if I skipped even a single night of treatment, the dermatitis would crop up again. In the throes of a new relationship (and certifiably obsessed with having pretty, perfect skin), I kinda sorta became addicted to steroids.
A thin, even application became the last step in my nightly skincare routine — one I relied on for two years straight. My dermatologist refilled my 45 gram fix (which is a lot, by the way) every time I visited, without hesitation. He upped my concentration of steroids twice as well, since my skin was becoming resistant to the original dosage. But in normal cases, "Treating the face twice a day would require 30 grams for 30 days," Dr. Duane Dilworth of DTLA Dermatology in Los Angeles tells me. "I generally have patients use topical steroids for two to three weeks, then take a break for one week to help prevent side effects."
Eventually, my skin became completely immune to the medication, and my dermatitis presented in two big circles over my eyes (known as periorbital dermatitis), and a circle over my mouth (known as perioral dermatitis). Both of these conditions are triggered by excessive use of topical steroids.
I got a second opinion from a new dermatologist, who was shocked that my doctor had allowed me to indefinitely refill a steroid script. She prescribed the most gentle topical cream that she had, but even that made my skin burn and peel. In slathering on steroid creams every night for two years, I had effectively thinned my skin, leaving it vulnerable and extremely sensitive. It simply couldn’t handle treatment anymore.
"Topical steroids are divided into classes based on their potency; with Class 1 being the most potent and Class 7 being the most gentle," Dr. Dilworth explains. "Skin atrophy or skin thinning is the most common side effect when using higher potency topical steroids for prolonged periods of time, and can be seen microscopically within three to 14 days." (In other words, I wish I knew Dr. Dilworth three years ago, when my dermatologist was over-prescribing steroids like woah.)
It might sound dramatic, but I felt betrayed. Dermatology had not only not helped, it had left me with an entirely new set of skin issues. I set out in exact opposite direction: Natural, DIY skincare.
With the book Skin Cleanse by Adina Grigore as my personal bible, I started by “detoxing” my skincare routine; aka, giving up all skincare products (cleansers, moisturizers, everything) to let my skin recalibrate.
I noticed a distinct difference within a week of living the product-free life (I was still cleansing my face with water morning and night). It wasn't perfect, but my dermatitis was healing. It turns out, the skin actually has natural mechanisms to cleanse, moisturize, exfoliate, and heal itself; but the harsh chemicals in many skincare products disrupt these mechanisms, leading to conditions like acne and dermatitis.
This information fascinated me; I started researching natural ingredients that would enhance, not interrupt, the skin’s natural functions. Eventually, I replaced my entire skincare routine with products so pure, I could (and did) eat them: Manuka honey is my go-to cleanser and spot treatment for its gentle antibacterial and anti-inflammatory properties, diluted apple cider vinegar takes the place of harsh acid toners, and jojoba oil stands in for moisturizer, thanks to its ability to hydrate and balance the skin’s natural oil production.
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Since taking my skincare routine completely natural, I’ve been dermatitis-free for more than a year. However, the skin on my face is still thin and easily irritated (and likely always will be — thanks, steroids!). I’m more prone to clogged pores and acne than I was pre-steroids, but I’ve made it my mission to find effective natural alternatives for everything.
For example, while highly concentrated salicylic acid spot treatments can trigger flare ups for me, violet leaves contain a low levels of salicylic acid to gently treat active pimples. I experimented with this ingredient by infusing my own oils at home, and after a year of trial and error, I landed on two key formulas that I swear by to keep my skin as calm as possible: a sage and violet leaf mixture to minimize breakouts, and a combination of rosebuds and frankincense essential oil to reduce redness and inflammation and brighten acne scars.
Eventually, friends and family members starting asking me to make them custom face oils, and I launched my own line of products to keep up with the demand.
Natural remedies aren't the only alternative, though. My second opinion dermatologist suggested a two-month round of antibiotics, which has been shown to help with dermatitis. Some other over-the-counter alternatives to steroids include topical vitamin D — which is thought to help normalize cell turnover, according to Dr. Joshua Zeichner of Zeichner Dermatology — and phototherapy, which Kim Kardashian has said is "life changing" for her psoriasis, a similar skin condition.
I could nerd-out about the power of these ingredients all day; I've found ones that have changed my life. Even though steroid treatments almost ruined my skin, they also led me to my passion... so I’m not too mad about it.