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What’s the best Topical Steroid Withdrawal treatment? It’s still tricky to say, but we’re definitely getting closer to answers.
If you’re dealing with TSW skin symptoms, know that Topical Steroid Withdrawal (TSW) is one of the most challenging and misunderstood skin conditions out there.
It’s unfortunately common to feel dismissed by doctors as you struggle with extreme skin symptoms that go far beyond your original eczema or dermatitis. TSW might be the real culprit—but this drug-induced condition rarely gets the attention it deserves because many derms don’t believe it is real, nor is there any approved diagnostic criteria for it.
As a result, those suffering from the full-body storm that is Topical Steroid Withdrawal (TSW) deal with extreme symptoms that range from unbearable skin itch, excessive skin flaking, “zingers,” insomnia, elephant skin and a full body rash to severe depression and anxiety. To put it bluntly, topical steroid withdrawal symptoms turn your entire life upside down.
In this episode, we’re diving back into the world of Topical Steroid Withdrawal treatment with one of the most compassionate and data-driven Traditional Chinese Medicine (TCM) dermatology acupuncturists I know—Dr. Olivia Hsu Friedman. She’s seen it all, and she’s not afraid to share exactly what she’s uncovered.
Dr. Olivia Hsu Friedman, DACM, L.Ac, Dipl.OM. She is the owner of Amethyst Holistic Skin Solutions and treats eczema, TSW, psoriasis, and acne patients all over the world via video conferencing using only herbal medicine.
She earned a Doctorate in Acupuncture and Chinese Medicine as well as a diploma in Traditional Chinese Medicine Dermatology. She is the Chairperson of the American Society of Acupuncturists, and serves on the Advisory Board of LearnSkin as well as the faculty of the Chicago Integrative Eczema Support Group sponsored by the National Eczema Association.
Dr. Olivia breaks down how TSW can mimic—but is fundamentally different from—severe eczema. She explains what TCM offers that Western medicine often misses, including her multi-layer diagnostic model and how “toxic heat” can show up in wildly different ways.
We also talk about her groundbreaking research (co-authored with THE Dr. Peter Lio!) that aims to legitimize Topical Steroid Withdrawal as its own diagnosable condition—and what that could mean for you.
So if you’re tired of being told “it’s just eczema” or feel like nothing is working, this episode will offer a fresh and validating perspective.
Let’s dive in!
Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android
In This Episode:
- What Topical Steroid Withdrawal (TSW) is—and why doctors often misdiagnose it as eczema
- How much topical steroid use triggers TSW?
- How Traditional Chinese Medicine views Topical Steroid Withdrawal symptoms
- TCM Topical Steroid Withdrawal treatment options
- What “toxic heat” means for patients (and their TSW symptoms)
- How long does it take to heal TSW skin using the Traditional Chinese Medicine system
- The emotional + social toll of TSW (and why it’s often invisible)
- Why acupuncture (with needles) isn’t always a good idea for TSW skin
- Thoughts on doing TCM with pharmaceutical meds (to reduce TSW symptoms)
Quotes
“The worst thing that can happen to you is to be given a life, but not to be able to live it.”
“TSW knows no boundaries. It's not selective, it can happen to anybody at any time.”
Links
Find Dr. Friedman online | Facebook
389: Topical Steroid Withdrawal Treatment Using Traditional Chinese Medicine {NEW RESEARCH} w/ Dr. Olivia Hsu Friedman, DACM {FULL TRANSCRIPT}
Jennifer Fugo (00:17.772)
Dr. Olivia, it is such an honor to have you back here on the Healthy Skin Show to talk about topical steroid withdrawal treatment. I feel like it's been four or five years, to be honest with you, so welcome back.
Olivia Friedman (00:27.297)
Thank you. Thank you so much. It's an honor to be back, and I'm so glad that we get to talk about my favorite topic.
Jennifer Fugo (00:34.35)
I mean, let's be honest, it's not usually the favorite topic of those who are dealing with topical steroid withdrawal because they just want to get it done, get through it, get past it, get back to life. But for those who haven't heard our previous episodes and who aren't familiar with what is topical steroid withdrawal, can you just share a brief synopsis to kind of bring everybody up to speed? Because we have a lot of cool things to update people on, but I just want to make sure we're on the same page.
Olivia Friedman (01:03.553)
Yeah, absolutely. And you know, it's interesting because topical steroid withdrawal doesn't have any diagnostic criteria at the moment, but there are so many people who have it. And I've seen so many of these patients that I can say with some amount of confidence that a lot of the things that I can talk about are definitely what it is. So essentially, topical steroid withdrawal comes about when people have been using steroids. And what they find is they sort of build up a tolerance, or even an intolerance, to it. And it doesn't have to be a long period of time. It can be a longer period of time, but it can be a short amount of time too. And what happens is when people are taking the steroids, it's usually to bring down the inflammation of a particular skin condition. But what's interesting is that some people actually have a reaction that causes them to have a worse skin condition than they actually started to take the topical steroids for in the first place.
So it can be anything from all of a sudden having rashes in places that you never had before, it can be something even more drastic where your skin actually looks like you've been splattered with gasoline and lit on fire. And the whole entire body can look like that, even though you may not have even had steroids on those parts. You can have a really oozy presentation where you have a lot of different lesions that have exudate coming out of them, you can have a super dry version of it where you're flaking like crazy, and you're leaving what we call snow all over the place and constantly vacuuming your house.
So there's many different presentations of it, but most people who have it know they have it because it is so completely different than the skin condition that they were originally taking the topical steroids for in the first place. So, oftentimes, it's the patient who's driving the seeking of the topical steroid withdrawal treatment because a lot of the doctors are not necessarily aware that there is such a thing, since it's not something that's taught in medical school right now.
Jennifer Fugo (03:06.478)
And I feel like a lot of people have said to me, and I've seen within Facebook groups, a lot of times they're diagnosed with very severe eczema. Except I know, years ago, I think it was my first, what I came to realize, was topical steroid withdrawal case that I worked with, this poor woman had symptoms that didn't make any sense with severe eczema, and looked like these really rare kind of weird diseases or genetic issues or something. Like it just didn't make any sense. But her doctor just kept saying you have severe eczema.
And so for somebody who might be experiencing topical steroid withdrawal symptoms, where the rashes spread way beyond where they are, or where they were originally, they existed, so maybe you only had issues on your hands, but now it starts to spread everywhere else. You need increasingly more potent steroids in order to try to control the rashes. People will develop things like elephant skin, where it looks like the skin folds are, especially in the elbows and the wrists and the knees and such, where the skin gets kind of, it looks like it's just, like I don't even know, it's totally inflamed and rippled almost, like you were bunching up a sweater.
Olivia Friedman (04:13.157)
Yeah, like they lose all the elasticity in their skin.
Jennifer Fugo (04:14.478)
Yeah, that's not eczema. And I would assume from a TCM perspective, when you look at that, you're like, that's not eczema.
Olivia Friedman (04:26.157)
Yeah, and I think it goes beyond what it physically looks like too. A lot of the different symptoms that also come up are like thermodysregulation, all of a sudden people are super hot, radiating heat or feeling freezing, back and forth. There's also a lot of issues with sleep, the inability to fall asleep until maybe five o'clock in the morning. There's also a lot of lassitude, just this loss of energy, fatigue, and it's not just from sleep, just this inability to really be motivated to get up and do anything, this exhaustion. There's also a lot of emotional fluctuations that come with it.
And as much as, you know, I really can't say that I have met too many people who have had chronic eczema who really had suicidal ideation. That's not usually something that comes up together. So I think it's a lot more than what, oftentimes, it's being diagnosed as. I know it is, actually. But on the same note, I think a lot of doctors just are not even aware that it exists, and as a result, they're just looking at what they have learned in school, and this is the best thing that they can come up with based on what they know. So it's really a condition that needs diagnostic criteria so that the awareness of this condition can continue to grow and more people will understand it. And again, that was one of the reasons why I wanted to write this paper. I do think that the more that's out there in the medical journals to bring awareness, the better we are all to understand what it is, and to do a better job of helping our patients.
Jennifer Fugo (06:25.72)
Yeah, so your paper that everybody, I think, who listens to the show or watches the show knows Dr. Peter Lio, he's one of the co-authors of this paper. And I love the fact that he's really helping to also get the information that you have kind of uncovered, and that you're looking at, out there is so important. So the paper we're talking about today is called Treatment of Topical Steroid Withdrawal Syndrome with Traditional Chinese Medicine: A Case Series of 5 Adults, which I'll link in the show notes. And I hear you, like we need to get this information out there partly for awareness, but also to help build the case that this needs its own diagnostic criteria. We need people to know that this is its own separate thing.
So as I was going through the paper, and it's, I think, a fairly easy read, because it's not like 25 pages long, which is really nice. You mentioned something really interesting about there being kind of different layers of the body that TCM specifically works with or looks at, in terms of those who have topical steroid withdrawal. Can you talk a little bit more about what are those things?
Olivia Friedman (07:40.045)
Yeah, so this is a diagnostic tool that we use in Chinese medicine, and it's not just for TSW skin, it's for every single condition that exists, and it just so happens it works incredibly well for dermatology. So the way we look at the skin in TCM is that there's many different layers that exist, and depending on where different dysfunction is occurring, will then dictate what kind of lesions, presentation, that you're going to have. On top of that, it helps us also determine what kind of herbs do we actually select to address those particular problems.
So, if you start on the outermost layer of the skin, we talk about that as the Wei Level. And that to us is anything that's external, and there's a lot of different things that you would see, like hives, or something where maybe you have more unilateral kind of lesions versus bilateral. But as you go deeper into the levels, and there's four, as you mentioned, you'll see completely different types of lesions appear. And so the deeper you go, the more disruption you'll basically see. So when we talk about TSW, we're talking about the deepest layer being obstructed or having issues, but then that also causes all the above layers to be problematic as well, oftentimes. So what is really interesting about TCM is that we can actually ask a lot of questions beyond looking at the presentation to get a better understanding of where exactly are all of these different problems existing, and then we can start to treat.
Now, depending on where each of these different levels are being affected will also determine other problems that are happening. So I was talking about earlier, thermodysregulation. That definitely happens when we're talking about the deeper layers being affected. When I was talking about sleep, oftentimes that can start happening on the second layer. So as you can see, all these different symptoms will indicate different layers that can have been affected. And so that's why, when you see a typical TCM dermatologist, they will ask you millions of questions that you will probably think, what does this have to do with my skin? We will ask you things about your digestion, we will ask you things about your sleep, we will ask you things about your period. We will ask you things about all these different systems of your body to better understand what layer are we talking about here, and to what degree is your entire system being affected.
Jennifer Fugo (10:29.89)
One interesting thing that you also brought up in that paper is the concept of a toxic heat pattern. And it seemed like, from what I read, that it is fairly common for topical steroid withdrawal. Can you talk a little bit about what toxic heat is?
Olivia Friedman (10:48.343)
Yeah, so toxic heat, again, a lot of this terminology is not exactly as well-translatable. And so I think sometimes when people hear these kinds of words, they're like, gosh, that sounds terrible. That sounds like you were in Chernobyl or something. I think we have to kind of step back and just understand that translation is not perfect, and second of all, a lot of the ways that the terminology for TCM came about was because it was done 4,000 years ago. It was based on, oftentimes, observing the world and using analogies. And so, you know, terminology like wind and things like that will come up in the discussion of TCM, and people are kind of like, well, what is that? But it's kind of taking from nature and trying to understand, this is something that I see in nature, how can I use that to describe the skin? Because there was no medical terminology.
So anyway, that's how a lot of these words came about. So the word toxic heat actually comes from the idea that there's this heat that's in one of those layers that is just not having the ability to vent. And as a result, it's getting locked in that layer and it has no place to go. And as a result, that heat just continues to build and build and build, because it's not going anywhere. And as a result, then a lot of other problematic things happen. So if that continues to happen, let's say on a deeper level, that's oftentimes when you'll start to see these lesions with a lot of exudate, with a lot of oozing. You'll see people who have these very dark lesions. and just all kinds of stuff is coming out and weeping constantly, and they can't seem to stop it. If we go to a very rudimentary description, the way we look at it in Chinese medicine is like there's so much heat that you're basically burning the skin, so to speak. And so that's kind of like how we describe it.
But again, these are terms that are sort of simplified because that's the way it was described 4,000 years ago without medical terminology. So toxic heat is a big proponent of TSW, I would say a lot of different presentations have that come up, and it can show itself in different ways. So a lot of times people think of heat as being hot and therefore red and inflammation, but you can also be so hot that you're actually super dry that you don't see that redness anymore. And now it's actually affected all the bodily fluids, the circulation of the blood, and therefore you start to see somebody who has this very dusky kind of skin, who's very, they have a lot of flaking, and again we go back to that idea of snowing where everywhere they walk around they're leaving a trail of dead skin. So one thing can lead to another, and as it continues it will affect other things. So toxic heat can show up as super red or erythema throughout the body, but then if it continues it can lead to that next phase where you're super, super dry.
Jennifer Fugo (14:04.802)
So one thing I noticed, because you had this nice chart at the end of the paper, that was kind of interesting about these cases. That there seems to be, at least for me, no rhyme or reason between how long somebody actually used steroids, versus how long the topical steroid withdrawal treatment in the TCM model was then required. So for example, you might have somebody that used steroids for like a year or maybe less, and then they needed like 13 months, versus somebody who used steroids for like decades and you worked with them for five months.
So just out of curiosity, I mean, obviously this is five case studies. And I think sometimes one problem, which is, I hate to say it but it's ubiquitous in the TSW skin community, is they like to take really small sample sizes and go, this is everything. So I wanted to ask you, yes, this paper is about five case studies, but because you have worked with so many cases, is there a perspective that you can add to this that this paper just doesn't have the capacity to illustrate?
Olivia Friedman (15:18.881)
Yeah, so that's a really great point Jennifer, and I'm glad you brought that up because I think any paper that is produced can only say so much, right? I think that we tried to keep it very tight with this particular paper since it was the first one, and we didn't want to lose an audience by putting in too much information. I think that there's a couple things going on here. So one, I definitely have seen that patients can be on steroids for 25 years, and then all of sudden this happens. Patients can also be on steroids once and this can happen. And I've seen everything in between. So there does not appear to be a specific type of steroid or a specific duration that is required to get TSW symptoms. And I actually change all of my notes, my intake notes, to actually get data for that. So I actually have every single person write out how long they've been on steroids, when did they start, when did they stop, why did they start taking it, why did they end? And so I've been trying to collect data to really say, is there a duration?
And then the other thing is, I know that there's been some papers that say it's the higher levels. And that has not been my experience either, because I actually document on my intakes too, that all my patients have to fill out, what steroids did you actually use. And so I have all of them listed, and they check off the ones that they've used, and what was the last one they used, and whatnot. And there doesn't seem to be a correlation for that either.
Jennifer Fugo (16:54.68)
Can I just ask one quick question? So is it just topical steroids that you track, or is it other forms like oral prednisone or oral nasal inhalers, those kind of steroids?
Olivia Friedman (17:10.921)
I ask for everything, yeah. So that's a good question too, because that's another question I had for myself is that, it only topical, or is it all steroids? So I've been collecting that data too. I've had some patients who have actually had responses, or reactions, to oral steroids. I haven't seen it in every case, but again, we haven't seen it in every case of TSW either. So to answer your other question about duration of treatment, that's also an interesting thing too, because some patients are able to afford to go the whole nine yards and finish up their treatment and completely resolve all the issues. Other patients, they can find themselves in a financial bind and unable to finish. So some of these patients may not have finished for that reason.
And so that's another thing that oftentimes comes into play with TCM, is that it's not covered by insurance and therefore it's out of pocket. And for a lot of these people, they oftentimes find themselves not being able to work anymore, and it's very, very difficult to continue this treatment if they don't have a source that can continuously fund the treatment. So I would say that's probably more what happened in some of these cases than not, and I see this all the time. And unfortunately, until there's a time when insurance recognizes herbal medicine, this is going to be the case. So, unfortunately, that's how it goes.
Jennifer Fugo (18:40.696)
Yeah, it is what it is. I wanted to clarify something you just said, because I think most people think of traditional Chinese medicine as going and getting the needles put in different spots, right? I know that there's meridians and all sorts of things, but you specifically mentioned herbs. So as part of this type of process that you provide and have created, what exactly does the topical steroid withdrawal treatment look like? Is it also using the needles and whatnot, or cupping, or what have you? Because I mean, I've gone to an acupuncturist and there's different things that she has done for me that have been vastly helpful. Obviously I've never had TSW symptoms, so I've never sought treatment for it. But what is this that you're specifically referring to that you do?
Olivia Friedman (19:30.071)
Yeah, so traditional Chinese medicine incorporates a lot of different treatment. And in this country, in order to become an herbalist or traditional Chinese medicine herbalist, you have to train as an acupuncturist first. So I do have a degree in acupuncture as well, but I went on to do herbal medicine, and then that was a few more years of schooling. And then on top of that, I specialized in dermatology, which was another program after that. So what I do is 100% herbal medicine, and because I treat people all over the world, it's impossible to do acupuncture. So I opted to just do herbal medicine, and I find that it's actually quite effective. It's really nice to have the adjunct of acupuncture if you can afford to do that, but oftentimes people who have TSW are really uncomfortable in their skin, and it's really difficult for them to lie still for 20 minutes with needles in them. Also, their skin is so incredibly sensitive that oftentimes inserting needles into various areas can cause them to have a little more discomfort and bring on some reactions sometimes. That's not the case all the time, but it can be.
But herbal medicine is something that typically every patient can do, and it's also something they can do every day. So you're working on the body, and moving it towards normal function, every single day. Versus acupuncture, most people can typically afford once a week, which can be very, very helpful, and I actually was treated with acupuncture for my skin condition in addition to herbal medicine. So I do feel like it's a great adjunct. But if you can only do one, I would say herbal medicine is the way to go.
Jennifer Fugo (21:18.958)
Well, I want to ask you as well, because the first time you were ever on the Healthy Skin Show was back in 2020, so five years ago, and we talked about TSW at that time. So between 2020 and now, especially you're doing so much research, you're digging into these cases, you're doing so much heavy lifting. And I want to just take a moment to appreciate you for that, because this is your time that you are dedicating to help people get answers, and to help change the current system and the way we view this. And that's a big deal. So is there anything that, like your opinions about TSW, has any of that changed as you've gained more knowledge and perspective on it with the multitude of cases that you've worked on?
Olivia Friedman (22:09.783)
Yeah, I think the thing that really hits me hardest is how much this impedes people from living their normal life, and also probably all the surrounding people who are trying to support them. It's really something that is so detrimental to someone's life in so many different ways that I think I feel even more compelled to do something to help because of it. You know, my appointment times with people are much longer than the typical dermatologist. My first intake is usually an hour and then my subsequent checkups are half an hour. And so I really get to know patients very well because they really open up to me during that time. It's not unusual for someone to spend a lot of their appointment crying, because this is the first time they've been able to be honest about how they truly feel about this condition. A lot of people don't have the opportunity to see a psychologist at the same time, but a lot of people have a lot of difficulty navigating this from an emotional and psychological level. And I am oftentimes the one person that they can talk to that gets it, because lots of times they've got parents or family members who are trying their best to support them and be there for them, but they oftentimes say things that are not helpful or somehow make people feel not so great.
I know a lot of friends don't understand the situation, don't understand the lassitude, the inability to get up and do things. Sometimes they end up kind of disappearing as people are going through this journey. So I think the thing that really strikes me is that this is just such a, I'll just come out and say it, it's a horrendous condition that really needs the best awareness, and it needs legislation, and it needs so many different things to make this come to a point where people are taking this very seriously. I think the more people that I meet, the more lives that I've been brought into, the more journeys I've been part of, the more I feel so strongly that this work has to be done.
Jennifer Fugo (24:35.384)
And Dr. Olivia, this is not just adults, this is also, you work with kids too. So you're watching children who aren't able to just be a kid, you know?
Olivia Friedman (24:48.066)
Yeah. That's probably one of the most heartbreaking things. I mean, it's hard to see anybody not be able to live a life. I always say that the worst thing that can happen to you is to be given a life, but not to be able to live it. And that's another thing that I really feel strongly about, and that's probably where I want to go with another paper, is that there's somewhat of a narrative out there that this only happens to women, and it only happens to women who put steroids on their face, and that is so not true. I can tell you, thousands of men that I've worked with, and lots and lots of children that I've worked with as well. And TSW knows no boundaries. It's not selective, it can happen to anybody at any time.
Jennifer Fugo (25:33.772)
Yeah. Another question for you. There's not a whole lot of great options right now in terms of the Western or conventional medicine route for the physicians who do actually believe that TSW is an issue. A lot of times, the options are biologic drugs, JAK inhibitors. And everybody who watches the show knows that I don't have any judgment against the topical steroid withdrawal treatment option you choose, I think that your path should look like what's most appropriate for you. So my question to you is, if someone is really, truly suffering and they're potentially considering some of these more systemic drugs, or they're already on one and they're not comfortable right now getting off because they're afraid of what's going to happen to their quality of life, could they still do this option, the TCM option, at the same time, or do you not recommend that?
Olivia Friedman (26:30.881)
Yeah, I'm really open to doing what's best for the patient. I mean, I don't really have a, I think it's really, what does that patient feel comfortable doing and let's meet them wherever they are. So I have a number of patients who will come to me who have been on a number of different pharmaceuticals, and maybe they're seeing some things resolving but not everything. And so they come to me and they say, hey, can you help me with the remaining symptoms that this particular drug is not helping me with? So that's one way people come in. Another way people come in is, they've been on a pharmaceutical for a while and they realize it's not their forever drug, and they think to themselves, I eventually want to get off of this, can you help me do that? And then we treat it that way. And then I have some people who have side effects from the pharmaceuticals and they know that it's helping them, but they're not ready to come off of them, but they are having side effects and they wonder if I can help them with that.
So those are the three main ways, I think, people come to see me when they're using pharmaceuticals. And I'll be completely honest, I mean some people come to me because they're afraid to go on pharmaceuticals, and maybe the herbs are just not enough for them. And I say to them, you know, we need to have a talk because if you're not feeling good and your quality of life is really suffering, and the herbs are not doing enough for you, maybe it's time for you to go back and try those other options.
So I really try to talk to my patients, to really understand what are their goals, what have they tried, what are they willing to do, what can they afford, right? Because insurance will cover those, but they will not cover herbal medicine. And we try to look at all of those things and figure out what is gonna be the best thing for you today. And maybe that's not gonna be forever, but let's think about it for today, and then if you're at a point of stability later, maybe you can reconsider and look at other options then. So at the end of the day, it's always about what is the best thing for the patient at that moment.
Jennifer Fugo (28:43.64)
I love that because everybody's journey looks different, and I love that you're able to meet them where they are and help them attain their goals. Because I agree with you, if you can't be, I know we mentioned it's not all women, right? We have men too. If you can't be the dad that you need to be, if you can't be the mom that you need to be for your family, you can't go to work, you are constantly in deep, deep suffering. I'm like, listen, you're not going to get the time back. Nobody's going to like give you a prize or a cookie for suffering, we don't get that. So the goal here is to help somebody get their quality of life back, on the journey, as quickly as possible because we don't exactly know how long the journey is going to be.
And so I love the fact that you meet people where they are. It's so interesting, and I'll just share this, because when we have clients that are interested in working with my practice who have TSW, or we'd assess them and we're like, I think you might actually have TSW, we usually send them to your clinic. I'm always like, go talk to Dr. Olivia, go talk to her first, because that may be the better route for you right now. Because I want someone to really, I think that we should have that shared desire to help someone find their way forward, not to just say, oh, they came to me and this is the best way. Everybody has, their journey is going to look different and that's okay.
Olivia Friedman (30:17.687)
Absolutely.
Jennifer Fugo (30:22.986)
And so I just know from the number of clients we've sent to you, they have had some really, really substantial, wonderful improvements in usually a number of months. Where a lot of times with TSW, because I view TSW as a secondary problem on top of whatever the original skin issue you had and the root causes to those skin issues are still there, that it just takes so much longer doing the more integrative functional route. Whereas my perspective has been that your process really helps get them to a more comfortable state. And then they can decide like, hey, do I still have some root causes, right? Because there could be underlying parasites, there could be underlying other inflammatory factors, dietary needs, that need to be addressed, all that kind of stuff. But I think sometimes this to me is like, that's why I know how much your work means to people because I've seen it in action. And it makes me so happy to help those individuals, at least get them to the right person, usually you, to really get them out of that crucial state where just they're not well, their health is really, really bad.
Olivia Friedman (31:25.933)
Thanks. Yeah. Well, I think it goes back to knowing what your own medicine's limitations are, and strengths, right? And I think for acute symptoms like we were talking about, the thermoregulation, the inability to sleep, the severe discomfort because of itchiness and things like that. I mean, those are the kinds of things that keep people from living their lives. And so if we can get that down, then people would be so much more comfortable. So it's really trying to find that right treatment that does that, and TCM is great at handling that if you respond to herbs.
Now, I'll be completely honest, not everybody responds to herbs. I would say 99% of the time I can help people, but every once in a while I find somebody who can't, and that's true of every single medicine there is out there. If there was one medicine that worked for everybody, no one would be going to anything else, right? So it's a trial by error, but I do think that when people become a little bit more stable and they're still having some issues, then I look at other people too and say, you know, you might want to try a nutritionist. You might want to go to these different types of people because I can do so much, but there's other people who can do other things too. And so I think that's what's nice about understanding where your lane is and staying in it, and not trying to be all things to all people.
Jennifer Fugo (32:59.308)
Yeah. And I wanted to ask you too, one last point. It seems to me like you just have such a huge level of experience because you've been doing this and, I don't remember when it was in the last five years, but you just started to have tons and tons of TSW clients coming into your practice. You have probably more experience than I think most, I would assume, most folks in the TCM space. Is what you're doing with the herbs and the assessments, is this what every TCM practitioner does, or do you feel at this point that you've utilized data points, and so many data points, to kind of refine what you're doing so it is a bit more of a unique method?
Olivia Friedman (33:45.245)
Absolutely, I mean when I first started I was general dermatology. And it just so happened that I happened to treat, and I can say her name because she wrote a book about it and uses my name in it, but I treated Kelly Barta. She was one of the first patients I ever had who had TSW, and at the time, I don't know that I knew that she was the president of ITSAN. And so I just did what I thought I could do for her, and I ended up helping her. And so, lo and behold, because she was the president of ITSAN, she started to tell other people. And then one thing led to another and another, and before I knew it, a lot of people with TSW were coming to me. So I would say because a lot of people started coming, I started seeing a lot of patterns, and I started seeing a lot of interesting things coming up and I had a lot of questions. Like I said before, I was kind of like, is it the duration? Is it the type of steroid? You know, all these different questions. So I started changing the way that I practice to see if I could collect better data. And when COVID happened, I actually started asking a lot of questions about that. Like, did you get COVID? Did you get the vaccine? Did that make it worse?
So I was looking for anything to kind of better understand, what are the triggers, what are the things that exacerbate it, what are the things that can actually make it better? And so I started to actually look at people's supplements too. I asked so many different questions just trying to get at, what is it that's making this worse? What is it that's leading people to a place that one day they're doing okay, and then the next day they're triggered and things are going nuts again. So I have really changed the way I practice as a result. I also think that because I've had so many different patients come in, I've tried so many different herbs with people too. As we've already determined, TSW was not something that was around 4,000 years ago, there were no topical steroids, so herbal medicine came into being before this even existed. But there's an understanding of, like we were talking about, the four levels and various other diagnostic tools that we use in TCM that help me kind of understand, well, how does this translate in Chinese medicine?
So I've tried a lot of different kinds of herbs on people to see how they work, and now, because I've been doing this for so many years, I'm so much better at selecting the right herbs at the right time. And I think timing is also another thing too, or pacing. When you treat somebody with herbs, you really have to monitor them very closely to see how their symptoms are evolving. And there comes a point in time when you oftentimes have to change formulas, or least change ingredients, or even dosages of individual ingredients. And so you really have to watch that. And so I think people are kind of surprised when they find out they're going to be seeing me as often as they are. And the reason is because that's what I'm looking for, every single time I meet with you, I want to say, okay, is it time to take this herb out? Is it time to put in this other herb?
The other thing I've noticed is this is a step process. It's not like, one day you have TSW, you take herbs, and then you're fine. Usually what happens is certain symptoms start to abate, we start to see another layer of things come through. Then we have to make sure that we're treating that properly, and then the next layer of things come. And then sometimes maybe you revert a little bit because you had a flare. And so I'm constantly changing the formula to match where you are today and also thinking to myself, okay, this is where I want you to be the next time I see you, so I want to give you the herbs that will get you there. So it's a dynamic treatment, and it does require a lot more monitoring and a lot more partnership with myself and the patient. I mean, they have to answer all these questions, and they have to answer them in detail, so that I can really make good decisions for them.
Jennifer Fugo (37:58.882)
Yeah. And I think that underscores the idea that healing is not linear. We can take a step back. I always am sharing this with clients, I know sometimes when you're in it, it's hard to see progress because you see, oh, I did this, I got better, but then I kind of regressed, and then I got a little better, and then maybe it got worse. And they just see this back and forth. But if you were to step back from the entire picture, like from a 2,000-foot view, what you can see is progress because we're headed in the right direction. But what you're explaining is exactly that. You have to make adjustments, and they have to be done in a very calculated way in order to meet where the person is.
So this isn't some canned protocol that you can go on the internet and just buy a formula. It literally is tailored to your specific situation, your specific symptoms, the severity of the symptoms, all these different factors that you've shared, in order to meet you where you are, like you said, to get the person to the next goalpost.
Olivia Friedman (38:57.473)
Yeah.
Jennifer Fugo (39:10.102)
I really, really love that, and I'm so thrilled about all of the new research that you're working on. We'll have to have you come back sometime and talk about that once it's published. I will make sure to share your website, so for anybody listening to this, that they're able to reach out to you directly if this is something that they feel like would be a good fit for them and they're curious about it. Any final parting words that you would want to share with somebody listening to this who's maybe been struggling with TSW?
Olivia Friedman (39:29.389)
I would say I just really feel strongly that you need to do what you feel like is right for you. If this sounds like something that you might want to try, that's great, but I'm never gonna be the person who judges if you do anything else. I mean, at the end of the day, we all have to lead our lives in the way that we believe is the right way to go. I am trying my best to cull all the data that I can possibly do to help move this forward so that there's more awareness of the actual condition, and also a better understanding of all the different phases of it and presentations of it. I think that's another thing that we really need to do. Diagnostic criteria is nice, but I think people really need to understand that it's many phases, and you have to really know what they are to understand TSW. So hopefully we'll get more and more of that information out. The more people I see, the more data I can actually put together. So hopefully I can keep helping people understand what it is and provide some help for people.
Jennifer Fugo (40:39.5)
Well, thank you so much for joining us again.
Olivia Friedman (40:42.605)
Thank you, Jen. I really appreciate your show so much, that you bring so much quality information to people, and you ask such great questions so that people can really understand things to a much larger degree than they would ever on their own search. So thank you for everything you do for everybody as well.
Jennifer Fugo (41:00.3)
I appreciate that. I think this is why we all make a good team, is because we're all dedicated to seeing things improve, people that get better quality of life. I personally believe that the human body is created to heal. So, while our journeys may look slightly different, I love for people to know what options they have so they can make the best decisions for themselves. I so deeply appreciate your commitment to that. Thank you.
Olivia Friedman (41:24.951)
Thank you, Jen.
