TSW Timeline and Phases
Jay has been treating TSW for 18 years and counting, and in this time he has seen many cases and logged enough data to form a theory on how a person’s TSW healing timeline could look like.
While reading this, do keep in mind that this is just a theory describing a general pattern observed of most cases. It may not apply to all and certainly should not be taken for the absolute truth. There are also factors that contribute to inaccuracies, due to natural faults in our memory. For example, it is nearly impossible to say with absolute certainty how many grams of steroid creams you have used or how many days you have applied them for!
There are 2 ways to calculate your natural healing timeline:
1) Number of days of usage - 1 day of application = 10 days of full recovery
For example, person has used topical steroids daily for 10 months, this means 100 months until full recovery
2) Grams of topical steroids used -
Class 1-4: Number of grams used / 7.5 x 10 = number of months for total recovery
For example: person has used 75 grams of class 2 topical steroids
75 / 7.5 x 10 = 100 months for total recovery
Class 5: Number of grams used / 7.5 / 2.5 x 10 = number of months for total recovery
For example: person has used 75 grams of class 5 topical steroids
75 / 7.5 / 2.5 x 10 = 40 months for total recovery
Protopic with no burning sensation: Number of grams used / 7.5 x 10 = number of months for total recovery
Protopic with burning sensation: Number of grams used / 5 x 10 = number of months for total recovery
This may sound extremely daunting and scary, as many of us have used large amounts of topical steroids and for long periods of time. However do not worry, as this does not mean you will be suffering the full extent of the symptoms for the entire healing duration. The healing timeline is divided into 4 phases.
For example, if person’s full healing duration is 100 months, these 100 months are divided by 4. Each stage is 25 months.
Below is an explanation of what the 4 phases mean.
Phase 1
During Phase 1, the full extent of your symptoms are present. You are firstly going through the initial withdrawal from topical steroids. Depending on the potency used, you may experience some or all of the withdrawal symptoms explained here.
The severity of the symptoms gradually improve until you reach Phase 2. However the skin will be very reactive, easily wounded and susceptible to infections. Flares take a long time to heal, and can be severe even when provoked by small triggers.
Phase 2
At Phase 2, you are at the “look good” point. Your skin finally reaches a place where it looks normal, and many mistake reaching this phase as being “healed” or “having eczema”. During this phase, your skin looks normal but it is still very sensitive. When faced with any of the flare factors explained here, it flares up easily. When the flare factors are strong, the skin can flare up and look like it is in Phase 1. If unaware of their triggers, most mistake their flares for “anniversary flares”. However, all flares have a reason - it takes practice and lots of self-awareness to identify your flare factors and avoid them.
Phase 3
During this phase, the skin continues looking normal but is a lot thicker. It is less sensitive - a combination of flare factors can cause it to flare. For example, fatigue from a late night out, PLUS the consumption of lots of alcohol, can cause a flare. However at Phase 3, the skin is stronger and flares are not as severe. Flares can look eczematous.
Phase 4
By Phase 4, the skin is almost normal. People at Phase 4 can live more or less a normal life, with the exception of tiny “eczema” flares occasionally.
Can different parts of the skin be in different phases at the same time?
Yes! If you had used topical steroids more on some parts of your skin than others, these areas may heal slower than other areas. You can be in Phase 1 on your face (which is a common area people use lots of TS on) while being in Phase 2 on your tummy (where most people use less of it on)!
Anomalous cases
Not all cases seem to follow this timeline. In his time of treating cases, Jay has come across some who do not follow the typical patterns. Some of these include people who make a quick and sudden recovery in the early stages, then encounters a large flare up later on in the timeline. There are also some cases whose timelines are a lot shorter than what would be expected based on their amount and potency of steroid usage.
How does CAP treatment and the CJAY serum help TSW skin move through the timeline?
Ultra-Pulse CAP treatment and CJAY serum help TSW skin move through the timeline quicker by improving your skin’s rate of healing. TSW skin heals a lot slower than healthy skin. By increasing its speed of healing, thinned TSW skin can thicken back up to normal quicker. The CAP treatment does this by increasing the energy in your skin cells to regenerate faster, while the CJAY serum does this by providing essential nutrients for skin cell regeneration.
It is hard to say by how much CJAY Serum increases the skin’s rate of healing - most users of the serum alone without CAP therapy report quicker wound healing (scabs forming overnight vs over a week), stronger skin (less prone to flaring and more resistant to physical damage from scratching) and eventually thicker skin that looks less thinned.
The timeline is shortened by approximately a factor of 5 with the Ultra-Pulse CAP treatment. For example if your natural healing duration is calculated to be 100 months, your healing on Ultra-Pulse CAP treatment will be 20 months. Your Phase 1 would be 6+ months instead of 25 months. It is important to note that this is if no other complications arise.
Complications that delay and prolong the timeline are:
1) Certain flare factors - allergens/irritants, physical and emotional stress, excessive alcohol
2) Hardened skin from continuous moisturiser use / prolonged irritant exposure / prolonged scratching
3) Fungal and bacterial infections
4) Poor mental health/support
It is hard to estimate how long these factors can prolong the timeline, as infections and flare factors can come and go throughout the journey.
To conclude, the skin does naturally heal with time and patience, however it can be long. The treatment and serum are not miracle cures, but they do assist the skin to do quicker what it is already naturally doing, which is healing! Someone with a naturally longer timeline will need longer treatment, some people who have used for many decades may need an extremely long time on treatment. Needless to say, complications do arise in TSW due to our compromised skin barrier and weakened ability to fight infections, but we can help ourselves with the right knowledge and give our skin the right care to prevent this as much as possible.
What can I do if the Ultra-Pulse CAP treatment is not accessible to me?
Knowledge is key to healing. Educate yourself as much as possible about TSW and on what to do to speed up your healing rate and on what to avoid to prevent complication. All the information is available on this website.
There are several other therapies out there that can speed up your healing or alleviate the symptoms to make the journey more bearable:
Therapies that can speed up your healing:
1) No Moisture Treatment, or NMT is a protocol you can follow at home. This protocol limits the skin’s exposure to water, drying out wounds and increasing its ability to regenerate. Many have seen good results with NMT.
2) Cryotherapy is another therapy available in many countries that involves the use of cold air chambers. The cold can boost your metabolism and rate of healing - it is particularly effective for reducing inflammation during early withdrawal or at the start of a bad flare up during your journey
3) Red Light Therapy helps boost your proliferation rate and is suitable for those who have no open wounds. It works best when the skin is not inflamed, but just flaky. Start with short sessions of 10 mins 3 times a week and work your way up.
Therapies that can alleviate your symptoms:
1) Immunosuppressants can relieve the pain and discomfort from the symptoms of TSW. There are many different types of immunosuppressants that work with different pathways. Speak with your doctor about these options and explore all pros and cons including side effects, make an informed decision for yourself!
2) Traditional Chinese Medicine and Acupuncture can be very helpful as well. Every TCM doctor has a different approach regarding skin conditions. I personally recommend herbal remedies and acupuncture over any topical creams or solutions. It would be important to look for doctors who understand TSW and have had good results with TSW patients, as not all doctors are equally equipped with this knowledge.