Liverty talking heads · round 2 (2026-11-03)

Primary text:

I don't give a f*ck if this upsets you. I am going to say something that nobody with eczema wants to hear.

I wrote my 1,412th prescription for a high-potency steroid on February 6th last winter.

Eleven days later, at 6:40 PM on February 17th, I was smearing my own first tube of clobetasol onto my own cracked hands.

I was 54 years old, I am a board-certified dermatologist.

Nineteen years of practice, fellowship trained in atopic dermatitis. The script was written by a colleague I had trained four years earlier.

I have had eczema for thirteen years and I refused to go up a potency class for eleven of them.

Because every flare I ever had cleared the same way. Steroid on, redness down, patch quiet, controlled.

Nine days before I opened that tube, the skin on both hands split open at once outside my own clinic and I could not close my fist without it bleeding.

The emollient regimen was $310 a month. The Dupixent quote was $3,800 a month — $45,000 a year, a needle every two weeks. The dermatology has billed my insurance for eleven straight months of steroid and biologic since.

They let me keep practicing, and nothing was taken from me. But I will never write the word controlled on another eczema chart without remembering that mine said controlled every year for thirteen years while the skin on my hands thinned down to nothing.

I am writing this because I know exactly what my colleagues will say when they see it. I do not care.

If you have eczema, or someone you love does, please read the entire thing.

I know it is long, I know you are scrolling. I know you have things to do.

Eleven months ago I would have given anything for someone who had already walked this to sit me down and tell me what I am about to tell you, nobody did.

I was diagnosed with atopic dermatitis thirteen years ago at 41. It started with a patch behind my right knee on a Tuesday, and it cracked and wept for nine days. I diagnosed myself in my own office before I ever saw a colleague about it.

My mother had eczema. She was called controlled for nine years. The steroids thinned her skin so far that at 61 it tore open across her back, got infected, and turned into eczema herpeticum. She spent the last four years of her life afraid of her own skin. She passed in a hospital at 67. The last note in her chart said her flares were well managed. I had watched the pattern in my own family, and I had built my entire practice on treating people who looked like my mother.

I did what any dermatologist would prescribe.

I started on hydrocortisone at diagnosis. I moved to triamcinolone four years later after two bad flares. I have not had an uncontrolled flare since, and that is exactly why I would not go stronger. Every year the redness came down and every year I told myself the steroid was working.

I did everything else too.

I moisturized three times a day for thirteen years with every ceramide cream on the market. I stripped every fragrance and dye out of the house. I did wet-wrap therapy, I bought the silk gloves. I read every elimination-diet book there is and ate that way for two years, no dairy, no gluten, nine cups of vegetables a day. I lost 22 pounds and kept it off.

I checked every box on my own protocol. I checked boxes most of my patients cannot afford to check.

And every year, the flare came back the same.

Redness down, patch quiet, skin a little thinner, controlled, controlled, and that word again.

Last September I did something I had never done in thirteen years of having this disease. I looked at what the steroid was hiding instead of what it was quieting.

The first thing I looked at was whether my skin could hold a flare down on its own. Not the redness the steroid brings down, but what my own body does once the cream wears off. Your skin makes its own calm against a flare and is supposed to keep it working. Mine brought a flare down only while the cream was on it, and the hour it wore off the flare climbed back. That is the thing you can watch even when the flare looks controlled.

Five years ago a flare the cream calmed would stay calm for weeks.

That autumn it came back within days of the tube going down.

For context, I have sat across from patients whose flares came back faster every year and used the sentence, we need to change course today while there is still time.

The redness over those same five years had looked controlled the entire time.

The second thing I looked at was how long a split took to close. It is the crudest measure there is and it is the one that predicts what your skin will look like in ten years. Five years ago a crack on my knuckle healed over in about a day. That autumn, the same crack stayed open and weeping for nine days.

I had not had an uncontrolled flare in nine years.

There was nothing the steroid was failing to control that could explain either thing.

I scheduled a full skin workup for myself, and then I cancelled it.

I want to tell you why.

Because sitting in my office at 7 PM staring at my own thinning hands under the exam lamp, I recognized something. I was doing exactly what my mother had done. She had been called controlled for nine years before the infection that put her in a hospital bed. She had been on a steroid and an antihistamine. Her charts had read managed, her flares had been controlled.

And she had died at 67 in a hospital ninety minutes from where I did my dermatology residency.

I cancelled my own workup because I already knew what it would show. I did not want it in writing. I told myself I had time.

Five months later both hands split open in the corridor outside exam room four.

My skin gave out at 3:20 in the afternoon. I remember the time because I had just finished a new patient consult and I looked at the clock to see how far behind I was running.

I thought I had just dried them out, I had not.

It was the breakdown I had described to four hundred patients in follow-up appointments, the knuckles first, then the whole back of the hand. Eleven steps down the hall and I could not close my hand without it splitting, and I leaned against the wall and stood in the middle of my own clinic, badge on, blood on the sleeve.

A fellow I had trained through her dermatology rotation in 2021 came around the corner. She is not a specialist yet but she has heard me describe this exact presentation in that clinic for four years.

She saw my hands and her face did the thing.

She cleaned me up, sat me down, and pulled my whole chart herself.

She pulled every flare note I have logged the way I have logged four hundred others. I already knew what they were going to say, forty flares.

The same story I have told four hundred people in follow-up appointments as nothing to be frightened of.

We were looking for the uncontrolled flare that would explain the hands, there wasn't one.

The notes read the way my notes have always read, controlled, redness resolved, well managed.

I went home that night with my husband, a box of gloves, hands that split when I closed them, and a chart that said there was nothing wrong with me.

After that day, my colleagues wanted me to have a full workup of my whole skin, and I did not want one.

I looked at every part of my own skin anyway.

Because I knew that if I did not, in three years I would be looking at somebody else's skin and seeing my mother's in it, and then my own.

I looked at how a flare behaved once I stopped the cream. Every time, within days, it came back in the same spot. There is a name for skin that only stays calm while the cream is on it, borrowed calm, and mine had been running on borrowed calm for years. Nobody had flagged it in thirteen years because nobody measures whether your own calm is holding at a standard eczema follow-up, including the practice I built.

The skin on my arms had started reacting to water alone. A barrier so breached that plain tap water stung. I had been dreading washing my hands for two years. I had blamed the soap, my sleep was gone.

I had been waking at 3 AM digging at my own skin for eight months. I had blamed stress, my grip had failed.

My right hand could not open a jar without a knuckle splitting, because the skin had no give left in it. I had stopped doing my own fine procedures the previous spring. I had told my partner the fellows needed the practice.

Every one of these was progressing while my flares looked controlled, and not one of them was an uncontrolled flare, same disease.

Same calm getting switched off, damage on my arms. Damage in my sleep. Damage in the skin that met water. Damage in my hands. And finally, skin that split when I closed a fist.

I sat in my office on March 2nd with all of it in front of me and I understood something I had never let myself understand in thirteen years of treating this disease.

Every drug I had ever been on was working on the immune flare.

Hydrocortisone was working on the flare.

Triamcinolone was working on the flare.

Clobetasol was working on the flare.

All three did it well. Nine years without an uncontrolled flare is those drugs doing exactly what they were built to do.

Not one of them had kept my own cortisol working underneath.

I am a dermatologist. I am supposed to be the person who knows how to stop this. I had put hundreds of patients on the exact protocol I was on, every one of those prescriptions was correct, every one followed the guidelines. Every one was the standard of care, and I would defend every one of them in front of any board in this country, and it had failed me at 54.

I sat at my desk that night at 11 PM after my husband had gone to bed and I did something I had not done since medical school.

I opened PubMed and I searched for the actual mechanism, and not the steroid trials, and not the management guidelines, the mechanism, the root cause.

I read for five hours.

I found what my training had covered lightly and never in the depth it deserved. My own cortisol, switched off early. A calm the skin makes and then loses. The reason my flares always looked controlled, the reason I had not had an uncontrolled one in nine years, and the reason my skin needed the cream again every time it wore off.

Your body already makes its own version of the medicine in that tube. It is a steroid, and it is called cortisol. Your adrenal glands make it, it travels to your skin, and it is the thing that actually brings a flare down on its own. The steroid cream is a man-made copy of it, which is why it works so fast. But your own cortisol does not get to work for long. There is an enzyme in your skin that turns it off into an inactive form almost as soon as it starts working, and on eczema skin that enzyme runs fast, shutting your own calm off early, hour after hour.

Keeping that calm working takes something that slows the enzyme, and it has to get into the body where the enzyme runs, and that is all it is.

It is not that your body stopped responding. It is your own calm getting switched off before it ever catches up to the flare, hour after hour, and the steroid never kept it working.

And this is why your flare can look controlled while your own calm keeps getting switched off underneath it.

None of this was hidden. It sat in journals I have had access to for nineteen years. The Journal of Investigative Dermatology, JAMA Dermatology. The British Journal of Dermatology. Teelucksingh and his team published it in the Lancet in 1990, that the compound in licorice root slowed that enzyme, 11-beta-hydroxysteroid dehydrogenase, in human skin, so the cortisol the skin already made stayed working longer.

I had read those journals every month. I had read them for the steroid and biologic trials. I had never read them for the cortisol papers, because my training had never told me anything about the root cause.

My training was wrong.

I closed my laptop at 4 AM and I sat at my kitchen table and I could not sleep.

I understood at that moment that I had told hundreds of people they were doing well while their own calm was being switched off underneath. I had said the words your skin looks great to people whose flare was about to come back the moment the cream wore off.

Two weeks later I saw a patient in follow-up whose skin should not have looked the way it did.

Her name was Emi, diagnosed fourteen years. She had transferred to me four years earlier after a hospital-grade flare. At intake the skin on her hands had been cracked and weeping. Her itch score was one of the worst I had on file.

I pulled her chart before she came in expecting to talk about starting Dupixent.

Her hands were clear.

Her itch scale had dropped from 61 to 22.

She had come off her steroid fourteen months earlier at her own insistence, and her skin only got better after she did.

I looked at her across the exam room and asked her what she was doing.

She was quiet for a moment. Then she said, Doctor, my grandmother Michiko ran a pharmacy back home for decades. She has been telling all of us for years. I did not bring it up because I did not think you would take it seriously.

I asked her what her grandmother had told her.

She wrote a name and a town on the back of my prescription pad.

The name was Michiko Tanaka. The town was one in central Pennsylvania I had never heard of.

I drove there the following Saturday.

I did not tell my husband where I was going.

I did not tell my colleagues.

I did not tell anyone in my department that a board-certified dermatologist was driving two and a half hours to meet a 76-year-old Japanese grandmother because everything I had been taught in nineteen years of practice had not saved me.

I pulled into the driveway of a small house at 11:20 AM.

She was in the garden along the front walkway, shiso, ginger, perilla. A persimmon tree by the door, she was 76, small woman, thin.

Gray hair pinned back.

She stood up out of that garden without putting a hand down to push herself up.

I introduced myself to her as Maya and nothing more, and she looked at me with sharp clear eyes and asked me why I had come, I told her.

I told her I was a dermatologist. Nineteen years in practice. That my own hands had split open in my clinic six weeks earlier. That my flares had looked controlled for thirteen years. That four separate things in my own skin were showing the pattern I had watched in hundreds of my own patients. That one of my patients had told me about her, she listened.

She did not interrupt.

When I finished she said, Come inside, doctor.

Her kitchen smelled like ginger.

She poured me tea without asking.

She had been a hospital pharmacist in Osaka for twenty-eight years before she came here. Her sister in Japan was diagnosed with severe eczema thirty-one years ago. Her sister is 72 now and has skin you would never guess had eczema.

She sat across from me and said, You are here because your flares look controlled and your skin is getting worse, I said yes.

She said, Then you already know your medicine is fighting the wrong battle, you know this. Nobody has ever given you anything for the root cause.

I did know it.

She said, In Japan we keep your own calm working. Here they quiet the flare and they wait, both are necessary. Your doctors gave you one.

She got up and set a small amber bottle on the table in front of me.

She tapped the first, cortisol.

The calm your body already makes against a flare. You know it even if you think you don't, it is the steroid in that tube, only yours and made inside you. The tube only ever puts it on from the outside.

She tapped the second, the enzyme.

The thing in your skin that turns that calm off too soon. On eczema skin it runs fast, so the calm you make never gets to hold. The tube does nothing to slow it, and neither does almost anything on that shelf.

She tapped the third, the plant.

The compound in licorice root, what gets called a plant steroid because it works on the cortisol your body already makes and not because it is one. It slows that enzyme, so the calm you already make keeps working longer.

She pushed the three of them together until they were touching.

Together, she said, they are your own calm, kept working, and it is what works underneath the cream. The tube gave you the calm from outside for a day and left the enzyme running, and it never gave you the one thing that keeps your own calm working.

I told her I understood the biochemistry. I told her I had read the papers.

She said, Then you understand it on paper. You do not yet understand it in your own skin.

Now here is what nobody taught you in medical school, she said.

For as long as anyone in my family can remember, this is what we have reached for when the skin flares, my mother. Her mother before her. I am seventy-six and my skin has never cracked in my life. My sister has taken it every day since the month she was diagnosed.

She said, There is a cheap version of this and a real one. The cheap ones use one herb and call it a remedy, and they leave out the compound that slows the enzyme entirely, which is a long way of saying your own calm still gets switched off. Almost everything on an American shelf is the cheap one.

And the cheap creams are not only useless. Loaded with fragrance and preservatives, they can drive the very flares you bought them to calm. There are creams on your pharmacy shelf with a dozen sensitizers in them, sold for sensitive skin, she is right, and it is well documented.

I have diagnosed contact allergy to a moisturizer twice in my own clinic, and both times the patient had bought the product to help their eczema.

I asked her if how it was made mattered, she nodded.

A cream that sits on the surface is not doing what you think it is doing, she said. It floods the top with a borrowed calm for a day, and it never reaches the enzyme shutting your own calm off. Those are two different things and your creams only ever do one of them.

I argued for a second, then I stopped, because she was right.

She said, A drop that only carries one herb never slows the enzyme. It might taste fine and change nothing underneath. That is a token, it is not the thing that keeps your own calm working.

The real one carries the compound from licorice root in a base thin enough to slip into the body under your tongue instead of sitting on the surface. Because it reaches the enzyme the cream never touched, the calm you already make keeps working.

In Japan they prescribe this compound for eczema at the pharmacy counter because they know a cream alone does not keep your own calm working. The right drop does the same job at home, she paused.

There is a company my niece in Boston told me about. The compound from licorice root in one formula, with the other calming plants beside it, every plant named and nothing hidden. Thin enough, under the tongue, to reach the enzyme that matters.

She wrote a name on the back of an envelope and slid it across the table, Phoilex, Liverty Dynamic Drops.

I read it in her driveway before I started the car.

Licorice root for the enzyme, named right on the label, with milk thistle, turmeric, nettle leaf, lemon balm and chaga beside it. A lemon-tasting oil you hold under your tongue, every plant printed, nothing hidden, steroid-free.

I ordered three bottles from her kitchen table before I left.

I drove two and a half hours home.

I did not tell my husband where I had been, they arrived that Wednesday.

I put the first dropper under my tongue that night, week one.

Since the hands went, I had been shutting my office door between 3 and 4 every day to reglove and re-cream. On day six the itch quieted enough that I forgot to, week two.

I had been sleeping with my hands outside the covers since the summer because of the burning, and that week I pulled the covers up, week three.

The cracks on my knuckles closed. Nine days to heal in September; that week, closed in two. I checked them four times because I did not believe it. All of them held, week four.

I did my own fine procedure for the first time in over a year, hand steady, skin holding. I opened a jar without a knuckle splitting for the first time in months, week six.

I slept through the night without waking to scratch. Twice that week, four times the next, week eight.

A flare I used to fight for weeks settled in days, and this time it stayed settled after I stopped the cream, week twelve.

The same full look I had taken at myself in the fall.

Cracks, closing in a day again, down from nine.

Grip, normal in both hands.

Skin met water without stinging, and it had stung for two years, itch scale, 24, and it was 58 the week I started.

A flare, when one comes, settles on its own now and stays settled. After five years of the calm never holding, that is the thing I care about most on this entire list.

And a flare, if I ever get one now, quiets the way it always did, controlled, same word.

Completely different skin underneath it.

I brought the photos to my practice partner, another dermatologist. Twelve years in practice.

I put the September hands next to the twelve-week hands on her desk and I did not say anything.

She looked at them.

She looked at me, she said, Maya.

What did you do, I told her, the 76-year-old pharmacist, the kitchen table.

The cortisol, the enzyme, the plant pushed together. My own calm, kept working, all of it.

She listened for an hour without interrupting.

Then she asked the only question that mattered. Whether the steroid could account for it, and it cannot. The steroid quiets a flare from the outside. It does nothing to keep your own cortisol working, and no trial of it has ever shown it does. I had been on clobetasol five weeks before I drove out there and the flare still came back the hour I stopped.

Then she said, I was not trained on any of this. But I want to see it in my own patients. Give me the name, I gave it to her.

She has been running it with sixteen of her eczema patients for four months. She called me two weeks ago. Eleven have skin that stopped cracking. Nine have dropped their itch score by more than fifteen points. Two have come off the steroid they had leaned on for over a year.

I still keep a steroid in the drawer for a true emergency. The drops are something else entirely.

They are the other half, the half nobody gave either of us.

In June I shook every hand at my daughter's graduation. Ninety minutes of it, outside, in the heat. I have not been able to let anyone see my hands since 2019.

My hands, two weeks ago, were clear.

My skin split open in the hallway of my own clinic at 54 with a chart that said controlled.

I am writing this because I still have my practice. I can still do my own procedures. And I have watched a flare settle and stay settled for twelve weeks, after thirteen years of watching it come back the hour the cream wore off.

I have watched a colleague look at my hands and say the word I had waited eleven months to hear, healing, and not controlled, healing.

I am also writing this because I know the truth about what my profession is doing, and I am the profession.

I have written 9,187 steroid scripts. Every single time I wrote controlled, flare resolved, I believed I was delivering good news. I watched the relief on people's faces. I said the words your skin looks great to a woman who told me in the same visit that she had stopped shaking hands, and I did not connect the two.

I do not know how many of those people are hiding their hands now.

I do not know how many of them ended up where my mother did.

I know that the standard of care I was trained in, and that I taught to fellows, is built on the assumption that quieting the flare is all you need to do, and it is not. I have my own skin that proves it is not, and my mother's chart proves it was not for her either. Nine years of controlled flares, and her skin tore open at 61.

My hands split in that hallway at 54. Seven years ahead of her. The difference is that somebody's grandmother told me what my medical school did not.

If you have eczema, or your wife, your husband, your mother, or your daughter does, and you have been told your flare is controlled while your skin keeps getting worse, please listen to what I am telling you.

The flare looking calm cannot show you your own calm being switched off, and it never could. Controlled means the redness is down, and it does not mean your own cortisol is being kept working, because nothing you have been given keeps it working.

Your steroid does not keep your own cortisol working. It is not designed to and it never claimed to.

Dupixent does not keep your own cortisol working. It quiets the immune signal and does nothing about the enzyme switching your own calm off.

Moisturizer does not keep your own cortisol working. It softens the surface you already have, and you should still use it.

Elimination diets do not keep your own cortisol working. I cut everything for two years and the flare came back the entire time.

Cutting gluten does not keep your own cortisol working. I did two years of it and my hands cracked the entire time.

Keeping your own cortisol working takes one specific thing, and it has to get into the body where the enzyme runs.

The compound in licorice root, the one that slows the enzyme that turns your own cortisol off, in a base thin enough to slip under the tongue and reach it, instead of sitting on the surface where a cream can look busy and your own calm gets switched off anyway.

Phoilex Liverty Dynamic Drops.

The compound from licorice root in one formula, with milk thistle, turmeric, nettle leaf, lemon balm and chaga beside it. Every plant named on the label, nothing hidden, while the best-known rivals won't even say what is in their blend. Steroid-free, and a lemon-tasting oil you hold under your tongue.

One dropper under the tongue at night, and that is the whole protocol.

It is recognised by the National Psoriasis Foundation, which almost nothing on that shelf is.

The system that trained me did not give this to me when I needed it, and it is reaching you now, P.S.

My mother was called controlled for nine years. Her skin tore open at 61 and she passed in a hospital at 67, and her final chart says her flares were well managed, and I have a copy of it in my desk. I built my entire practice on the belief that I would prevent for my patients what nobody prevented for her. Instead I walked the same road in my own skin, under the same word, and I got there seven years earlier than she did. The difference is that I caught mine and she did not get a second chance to. Please do not wait for a calm-looking flare to give you permission to take this seriously, and it will not. That is the entire point of what I have just told you, P.P.S.

I do not work for Phoilex. I do not receive a penny from this. I am writing this at 11:40 PM on a Sunday, alone in my office, because a patient came in on Friday whose hands had gone from cracked to clear in seven weeks and I recognized my own skin on her chart. She had found it herself after reading something a woman had written about her husband. She told me it had been going around an eczema group she is in. I read it that night. It was the second time in four months that I have recognized my own patient in something written by a stranger, and not in anything written by my own field. Please send this to anyone you love who has eczema. Even if they are doing well. Especially if they have just been told their flare is controlled.

~ Dr. Maya Ellison, MD, board-certified dermatologist, atopic dermatitis subspecialty, age 55

Edit: Several people have asked for the link so here it is - https://phoilex.com/pages/liverty-drops

• I don't give a f*ck if this upsets you. I am going to say something that nobody with eczema wants to hear.
• My skin split open in the hallway of my own clinic at 54 with a chart that said controlled.
• Not one of them had kept my own cortisol working underneath.

Primary text:

I don't give a f*ck if this upsets you. I am going to say something that nobody with eczema wants to hear. The steroid cream I prescribed for thirteen years was quietly thinning the skin underneath the whole time, mine included.

I wrote my 1,412th prescription for a high-potency steroid on February 6th last winter.

Eleven days later, at 6:40 PM on February 17th, I was smearing my own first tube of clobetasol onto my own cracked hands.

I was 54 years old, I am a board-certified dermatologist.

Nineteen years of practice, fellowship trained in atopic dermatitis. The script was written by a colleague I had trained four years earlier.

I have had eczema for thirteen years and I refused to go up a potency class for eleven of them.

Because every flare I ever had cleared the same way. Steroid on, redness down, patch quiet, controlled.

Nine days before I opened that tube, the skin on both hands split open at once outside my own clinic and I could not close my fist without it bleeding.

The emollient regimen was $310 a month. The Dupixent quote was $3,800 a month — $45,000 a year, a needle every two weeks. The dermatology has billed my insurance for eleven straight months of steroid and biologic since.

They let me keep practicing, and nothing was taken from me. But I will never write the word controlled on another eczema chart without remembering that mine said controlled every year for thirteen years while the skin on my hands thinned down to nothing.

I am writing this because I know exactly what my colleagues will say when they see it. I do not care.

If you have eczema, or someone you love does, please read the entire thing.

I know it is long, I know you are scrolling. I know you have things to do.

Eleven months ago I would have given anything for someone who had already walked this to sit me down and tell me what I am about to tell you, nobody did.

I was diagnosed with atopic dermatitis thirteen years ago at 41. It started with a patch behind my right knee on a Tuesday, and it cracked and wept for nine days. I diagnosed myself in my own office before I ever saw a colleague about it.

My mother had eczema. She was called controlled for nine years. The steroids thinned her skin so far that at 61 it tore open across her back, got infected, and turned into eczema herpeticum. She spent the last four years of her life afraid of her own skin. She passed in a hospital at 67. The last note in her chart said her flares were well managed. I had watched the pattern in my own family, and I had built my entire practice on treating people who looked like my mother.

I did what any dermatologist would prescribe.

I started on hydrocortisone at diagnosis. I moved to triamcinolone four years later after two bad flares. I have not had an uncontrolled flare since, and that is exactly why I would not go stronger. Every year the redness came down and every year I told myself the steroid was working.

I did everything else too.

I moisturized three times a day for thirteen years with every ceramide cream on the market. I stripped every fragrance and dye out of the house. I did wet-wrap therapy, I bought the silk gloves. I read every elimination-diet book there is and ate that way for two years, no dairy, no gluten, nine cups of vegetables a day. I lost 22 pounds and kept it off.

I checked every box on my own protocol. I checked boxes most of my patients cannot afford to check.

And every year, the flare came back the same.

Redness down, patch quiet, skin a little thinner, controlled, controlled, and that word again.

Last September I did something I had never done in thirteen years of having this disease. I looked at what the steroid was hiding instead of what it was quieting.

The first thing I looked at was the skin itself, under the flare. Not the redness the steroid brings down, the skin underneath it. A potent steroid used twice a day for a single week has been shown to cut the skin's own collagen by about two thirds, and collagen is what keeps skin thick enough to hold. Every year of cream thins it further, and it shows even when the flare looks controlled.

Five years ago a flare the cream calmed would stay calm for weeks.

That autumn it came back within days of the tube going down.

For context, I have sat across from patients whose flares came back faster every year and used the sentence, we need to change course today while there is still time.

The redness over those same five years had looked controlled the entire time.

The second thing I looked at was how long a split took to close. It is the crudest measure there is and it is the one that predicts what your skin will look like in ten years. Five years ago a crack on my knuckle healed over in about a day. That autumn, the same crack stayed open and weeping for nine days.

I had not had an uncontrolled flare in nine years.

There was nothing the steroid was failing to control that could explain either thing.

I scheduled a full skin workup for myself, and then I cancelled it.

I want to tell you why.

Because sitting in my office at 7 PM staring at my own thinning hands under the exam lamp, I recognized something. I was doing exactly what my mother had done. She had been called controlled for nine years before the infection that put her in a hospital bed. She had been on a steroid and an antihistamine. Her charts had read managed, her flares had been controlled.

And she had died at 67 in a hospital ninety minutes from where I did my dermatology residency.

I cancelled my own workup because I already knew what it would show. I did not want it in writing. I told myself I had time.

Five months later both hands split open in the corridor outside exam room four.

My skin gave out at 3:20 in the afternoon. I remember the time because I had just finished a new patient consult and I looked at the clock to see how far behind I was running.

I thought I had just dried them out, I had not.

It was the breakdown I had described to four hundred patients in follow-up appointments, the knuckles first, then the whole back of the hand. Eleven steps down the hall and I could not close my hand without it splitting, and I leaned against the wall and stood in the middle of my own clinic, badge on, blood on the sleeve.

A fellow I had trained through her dermatology rotation in 2021 came around the corner. She is not a specialist yet but she has heard me describe this exact presentation in that clinic for four years.

She saw my hands and her face did the thing.

She cleaned me up, sat me down, and pulled my whole chart herself.

She pulled every flare note I have logged the way I have logged four hundred others. I already knew what they were going to say, forty flares.

The same story I have told four hundred people in follow-up appointments as nothing to be frightened of.

We were looking for the uncontrolled flare that would explain the hands, there wasn't one.

The notes read the way my notes have always read, controlled, redness resolved, well managed.

I went home that night with my husband, a box of gloves, hands that split when I closed them, and a chart that said there was nothing wrong with me.

After that day, my colleagues wanted me to have a full workup of my whole skin, and I did not want one.

I looked at every part of my own skin anyway.

Because I knew that if I did not, in three years I would be looking at somebody else's skin and seeing my mother's in it, and then my own.

I looked at the skin on both hands under magnification. Both had thinned to the point of translucency. There is a phrase for it, steroid atrophy, which is what is left behind after years of cortisone flattens the skin. Nobody had flagged it in thirteen years because nobody measures how thin the skin is getting at a standard eczema follow-up, including the practice I built.

The skin on my arms had started reacting to water alone. A barrier so breached that plain tap water stung. I had been dreading washing my hands for two years. I had blamed the soap, my sleep was gone.

I had been waking at 3 AM digging at my own skin for eight months. I had blamed stress, my grip had failed.

My right hand could not open a jar without a knuckle splitting, because the skin had no give left in it. I had stopped doing my own fine procedures the previous spring. I had told my partner the fellows needed the practice.

Every one of these was progressing while my flares looked controlled, and not one of them was an uncontrolled flare, same disease.

Same skin thinning under the cream. Damage on my arms, damage in my sleep. Damage in the skin that met water. Damage in my hands. And finally, skin that split when I closed a fist.

I sat in my office on March 2nd with all of it in front of me and I understood something I had never let myself understand in thirteen years of treating this disease.

Every drug I had ever been on was working on the immune flare.

Hydrocortisone was working on the flare.

Triamcinolone was working on the flare.

Clobetasol was working on the flare.

All three did it well. Nine years without an uncontrolled flare is those drugs doing exactly what they were built to do.

Not one of them had done anything but thin the skin further and leave my own cortisol switched off underneath.

I am a dermatologist. I am supposed to be the person who knows how to stop this. I had put hundreds of patients on the exact protocol I was on, every one of those prescriptions was correct, every one followed the guidelines. Every one was the standard of care, and I would defend every one of them in front of any board in this country, and it had failed me at 54.

I sat at my desk that night at 11 PM after my husband had gone to bed and I did something I had not done since medical school.

I opened PubMed and I searched for the actual mechanism, and not the steroid trials, and not the management guidelines, the mechanism, the root cause.

I read for five hours.

I found what my training had covered lightly and never in the depth it deserved. My own cortisol, switched off early. A calm the skin makes and then loses. The reason my flares always looked controlled, the reason I had not had an uncontrolled one in nine years, and the reason my skin needed the cream again every time it wore off.

Your body already makes its own version of the medicine in that tube. It is a steroid, and it is called cortisol. Your adrenal glands make it, it travels to your skin, and it is the thing that actually brings a flare down on its own. The steroid cream is a man-made copy of it, which is why it works so fast. But your own cortisol does not get to work for long. There is an enzyme in your skin that turns it off into an inactive form almost as soon as it starts working, and on eczema skin that enzyme runs fast, shutting your own calm off early, hour after hour.

Keeping that calm working takes something that slows the enzyme, and it has to get into the body where the enzyme runs, and that is all it is.

It is not that your body stopped responding. It is your own calm getting switched off before it ever catches up to the flare, hour after hour, and the steroid never kept it working.

And this is why your flare can look controlled while your own calm keeps getting switched off underneath it.

None of this was hidden. It sat in journals I have had access to for nineteen years. The Journal of Investigative Dermatology, JAMA Dermatology. The British Journal of Dermatology. Teelucksingh and his team published it in the Lancet in 1990, that the compound in licorice root slowed that enzyme, 11-beta-hydroxysteroid dehydrogenase, in human skin, so the cortisol the skin already made stayed working longer.

I had read those journals every month. I had read them for the steroid and biologic trials. I had never read them for the cortisol papers, because my training had never told me anything about the root cause.

My training was wrong.

I closed my laptop at 4 AM and I sat at my kitchen table and I could not sleep.

I understood at that moment that I had told hundreds of people they were doing well while their own calm was being switched off underneath. I had said the words your skin looks great to people whose flare was about to come back the moment the cream wore off.

Two weeks later I saw a patient in follow-up whose skin should not have looked the way it did.

Her name was Emi, diagnosed fourteen years. She had transferred to me four years earlier after a hospital-grade flare. At intake the skin on her hands had been cracked and weeping. Her itch score was one of the worst I had on file.

I pulled her chart before she came in expecting to talk about starting Dupixent.

Her hands were clear.

Her itch scale had dropped from 61 to 22.

She had come off her steroid fourteen months earlier at her own insistence, and her skin only got better after she did.

I looked at her across the exam room and asked her what she was doing.

She was quiet for a moment. Then she said, Doctor, my grandmother Michiko ran a pharmacy back home for decades. She has been telling all of us for years. I did not bring it up because I did not think you would take it seriously.

I asked her what her grandmother had told her.

She wrote a name and a town on the back of my prescription pad.

The name was Michiko Tanaka. The town was one in central Pennsylvania I had never heard of.

I drove there the following Saturday.

I did not tell my husband where I was going.

I did not tell my colleagues.

I did not tell anyone in my department that a board-certified dermatologist was driving two and a half hours to meet a 76-year-old Japanese grandmother because everything I had been taught in nineteen years of practice had not saved me.

I pulled into the driveway of a small house at 11:20 AM.

She was in the garden along the front walkway, shiso, ginger, perilla. A persimmon tree by the door, she was 76, small woman, thin.

Gray hair pinned back.

She stood up out of that garden without putting a hand down to push herself up.

I introduced myself to her as Maya and nothing more, and she looked at me with sharp clear eyes and asked me why I had come, I told her.

I told her I was a dermatologist. Nineteen years in practice. That my own hands had split open in my clinic six weeks earlier. That my flares had looked controlled for thirteen years. That four separate things in my own skin were showing the pattern I had watched in hundreds of my own patients. That one of my patients had told me about her, she listened.

She did not interrupt.

When I finished she said, Come inside, doctor.

Her kitchen smelled like ginger.

She poured me tea without asking.

She had been a hospital pharmacist in Osaka for twenty-eight years before she came here. Her sister in Japan was diagnosed with severe eczema thirty-one years ago. Her sister is 72 now and has skin you would never guess had eczema.

She sat across from me and said, You are here because your flares look controlled and your skin is getting worse, I said yes.

She said, Then you already know your medicine is fighting the wrong battle, you know this. Nobody has ever given you anything for the root cause.

I did know it.

She said, In Japan we keep your own calm working. Here they quiet the flare and they wait, both are necessary. Your doctors gave you one.

She got up and set a small amber bottle on the table in front of me.

She tapped the first, cortisol.

The calm your body already makes against a flare. You know it even if you think you don't, it is the steroid in that tube, only yours and made inside you. The tube only ever puts it on from the outside.

She tapped the second, the enzyme.

The thing in your skin that turns that calm off too soon. On eczema skin it runs fast, so the calm you make never gets to hold. The tube does nothing to slow it, and neither does almost anything on that shelf.

She tapped the third, the plant.

The compound in licorice root, what gets called a plant steroid because it works on the cortisol your body already makes and not because it is one. It slows that enzyme, so the calm you already make keeps working longer.

She pushed the three of them together until they were touching.

Together, she said, they are your own calm, kept working, and it is what works underneath the cream. The tube gave you the calm from outside for a day and left the enzyme running, and it never gave you the one thing that keeps your own calm working.

I told her I understood the biochemistry. I told her I had read the papers.

She said, Then you understand it on paper. You do not yet understand it in your own skin.

Now here is what nobody taught you in medical school, she said.

For as long as anyone in my family can remember, this is what we have reached for when the skin flares, my mother. Her mother before her. I am seventy-six and my skin has never cracked in my life. My sister has taken it every day since the month she was diagnosed.

She said, There is a cheap version of this and a real one. The cheap ones use one herb and call it a remedy, and they leave out the compound that slows the enzyme entirely, which is a long way of saying your own calm still gets switched off. Almost everything on an American shelf is the cheap one.

And the cheap creams are not only useless. Loaded with fragrance and preservatives, they can drive the very flares you bought them to calm. There are creams on your pharmacy shelf with a dozen sensitizers in them, sold for sensitive skin, she is right, and it is well documented.

I have diagnosed contact allergy to a moisturizer twice in my own clinic, and both times the patient had bought the product to help their eczema.

I asked her if how it was made mattered, she nodded.

A cream that sits on the surface is not doing what you think it is doing, she said. It floods the top with a borrowed calm for a day, and it never reaches the enzyme shutting your own calm off. Those are two different things and your creams only ever do one of them.

I argued for a second, then I stopped, because she was right.

She said, A drop that only carries one herb never slows the enzyme. It might taste fine and change nothing underneath. That is a token, it is not the thing that keeps your own calm working.

The real one carries the compound from licorice root in a base thin enough to slip into the body under your tongue instead of sitting on the surface. Because it reaches the enzyme the cream never touched, the calm you already make keeps working.

In Japan they prescribe this compound for eczema at the pharmacy counter because they know a cream alone does not keep your own calm working. The right drop does the same job at home, she paused.

There is a company my niece in Boston told me about. The compound from licorice root in one formula, with the other calming plants beside it, every plant named and nothing hidden. Thin enough, under the tongue, to reach the enzyme that matters.

She wrote a name on the back of an envelope and slid it across the table, Phoilex, Liverty Dynamic Drops.

I read it in her driveway before I started the car.

Licorice root for the enzyme, named right on the label, with milk thistle, turmeric, nettle leaf, lemon balm and chaga beside it. A lemon-tasting oil you hold under your tongue, every plant printed, nothing hidden, steroid-free.

I ordered three bottles from her kitchen table before I left.

I drove two and a half hours home.

I did not tell my husband where I had been, they arrived that Wednesday.

I put the first dropper under my tongue that night, week one.

Since the hands went, I had been shutting my office door between 3 and 4 every day to reglove and re-cream. On day six the itch quieted enough that I forgot to, week two.

I had been sleeping with my hands outside the covers since the summer because of the burning, and that week I pulled the covers up, week three.

The cracks on my knuckles closed. Nine days to heal in September; that week, closed in two. I checked them four times because I did not believe it. All of them held, week four.

I did my own fine procedure for the first time in over a year, hand steady, skin holding. I opened a jar without a knuckle splitting for the first time in months, week six.

I slept through the night without waking to scratch. Twice that week, four times the next, week eight.

The skin on the back of my hands had thickened enough that I could not read a watch through it any more, week twelve.

The same full look I had taken at myself in the fall.

Cracks, closing in a day again, down from nine.

Grip, normal in both hands.

Skin met water without stinging, and it had stung for two years, itch scale, 24, and it was 58 the week I started, skin thickness, holding.

After five years of thinning under the cream, that is the number I care about most on this entire list.

And a flare, if I ever get one now, quiets the way it always did, controlled, same word.

Completely different skin underneath it.

I brought the photos to my practice partner, another dermatologist. Twelve years in practice.

I put the September hands next to the twelve-week hands on her desk and I did not say anything.

She looked at them.

She looked at me, she said, Maya.

What did you do, I told her, the 76-year-old pharmacist, the kitchen table.

The cortisol, the enzyme, the plant pushed together. My own calm, kept working, all of it.

She listened for an hour without interrupting.

Then she asked the only question that mattered. Whether the steroid could account for it, and it cannot. The steroid quiets a flare from the outside. It does nothing to keep your own cortisol working, and no trial of it has ever shown it does. I had been on clobetasol five weeks before I drove out there and the flare still came back the hour I stopped.

Then she said, I was not trained on any of this. But I want to see it in my own patients. Give me the name, I gave it to her.

She has been running it with sixteen of her eczema patients for four months. She called me two weeks ago. Eleven have skin that stopped cracking. Nine have dropped their itch score by more than fifteen points. Two have come off the steroid they had leaned on for over a year.

I still keep a steroid in the drawer for a true emergency. The drops are something else entirely.

They are the other half, the half nobody gave either of us.

In June I shook every hand at my daughter's graduation. Ninety minutes of it, outside, in the heat. I have not been able to let anyone see my hands since 2019.

My hands, two weeks ago, were clear.

My skin split open in the hallway of my own clinic at 54 with a chart that said controlled.

I am writing this because I still have my practice. I can still do my own procedures. And I have watched a flare settle and stay settled for twelve weeks, after thirteen years of watching it come back the hour the cream wore off.

I have watched a colleague look at my hands and say the word I had waited eleven months to hear, healing, and not controlled, healing.

I am also writing this because I know the truth about what my profession is doing, and I am the profession.

I have written 9,187 steroid scripts. Every single time I wrote controlled, flare resolved, I believed I was delivering good news. I watched the relief on people's faces. I said the words your skin looks great to a woman who told me in the same visit that she had stopped shaking hands, and I did not connect the two.

I do not know how many of those people are hiding their hands now.

I do not know how many of them ended up where my mother did.

I know that the standard of care I was trained in, and that I taught to fellows, is built on the assumption that quieting the flare is all you need to do, and it is not. I have my own skin that proves it is not, and my mother's chart proves it was not for her either. Nine years of controlled flares, and her skin tore open at 61.

My hands split in that hallway at 54. Seven years ahead of her. The difference is that somebody's grandmother told me what my medical school did not.

If you have eczema, or your wife, your husband, your mother, or your daughter does, and you have been told your flare is controlled while your skin keeps getting worse, please listen to what I am telling you.

The flare looking calm cannot show you the skin thinning under the cream, and it never could. Controlled means the redness is down, and it does not mean the skin is being kept whole, because the cream that calmed each flare was thinning it the whole time.

Your steroid brought each flare down. But every tube was thinning the skin underneath, and when people stop after years the skin can turn raw and red in a way the regulators now warn about. In 2024 the MHRA put a withdrawal warning on topical steroid packs after 267 reports.

Dupixent does not keep your own cortisol working. It quiets the immune signal and does nothing about the enzyme switching your own calm off.

Moisturizer does not keep your own cortisol working. It softens the surface you already have, and you should still use it.

Elimination diets do not stop the thinning. I cut everything for two years and the cream kept thinning my skin the entire time.

Cutting gluten does not stop the thinning. I did two years of it and the tube thinned my skin the entire time.

Keeping your own cortisol working takes one specific thing, and it has to get into the body where the enzyme runs.

The compound in licorice root, the one that slows the enzyme that turns your own cortisol off, in a base thin enough to slip under the tongue and reach it, instead of sitting on the surface where a cream can look busy and your own calm gets switched off anyway.

Phoilex Liverty Dynamic Drops.

The compound from licorice root in one formula, with milk thistle, turmeric, nettle leaf, lemon balm and chaga beside it. Every plant named on the label, nothing hidden, while the best-known rivals won't even say what is in their blend. Steroid-free, and a lemon-tasting oil you hold under your tongue.

One dropper under the tongue at night, and that is the whole protocol.

It is recognised by the National Psoriasis Foundation, which almost nothing on that shelf is.

The system that trained me did not give this to me when I needed it, and it is reaching you now, P.S.

My mother was called controlled for nine years. Her skin tore open at 61 and she passed in a hospital at 67, and her final chart says her flares were well managed, and I have a copy of it in my desk. I built my entire practice on the belief that I would prevent for my patients what nobody prevented for her. Instead I walked the same road in my own skin, under the same word, and I got there seven years earlier than she did. The difference is that I caught mine and she did not get a second chance to. Please do not wait for a calm-looking flare to give you permission to take this seriously, and it will not. That is the entire point of what I have just told you, P.P.S.

I do not work for Phoilex. I do not receive a penny from this. I am writing this at 11:40 PM on a Sunday, alone in my office, because a patient came in on Friday whose hands had gone from cracked to clear in seven weeks and I recognized my own skin on her chart. She had found it herself after reading something a woman had written about her husband. She told me it had been going around an eczema group she is in. I read it that night. It was the second time in four months that I have recognized my own patient in something written by a stranger, and not in anything written by my own field. Please send this to anyone you love who has eczema. Even if they are doing well. Especially if they have just been told their flare is controlled.

~ Dr. Maya Ellison, MD, board-certified dermatologist, atopic dermatitis subspecialty, age 55

Edit: Several people have asked for the link so here it is - https://phoilex.com/pages/liverty-drops

• I don't give a f*ck if this upsets you. I am going to say something that nobody with eczema wants to hear. The steroid cream I prescribed for thirteen years was quietly thinning the skin underneath the whole time, mine included.
• My skin split open in the hallway of my own clinic at 54 with a chart that said controlled.
• Not one of them had done anything but thin the skin further and leave my own cortisol switched off underneath.

Primary text:

I don't give a f*ck if this upsets you. I am going to say something that nobody with eczema wants to hear. For thirteen years I told patients their skin would settle if they handled their stress better, and my own skin proved me wrong.

I wrote my 1,412th prescription for a high-potency steroid on February 6th last winter.

Eleven days later, at 6:40 PM on February 17th, I was smearing my own first tube of clobetasol onto my own cracked hands.

I was 54 years old, I am a board-certified dermatologist.

Nineteen years of practice, fellowship trained in atopic dermatitis. The script was written by a colleague I had trained four years earlier.

I have had eczema for thirteen years and I refused to go up a potency class for eleven of them.

Because every flare I ever had cleared the same way. Steroid on, redness down, patch quiet, controlled.

Nine days before I opened that tube, the skin on both hands split open at once outside my own clinic and I could not close my fist without it bleeding.

The emollient regimen was $310 a month. The Dupixent quote was $3,800 a month — $45,000 a year, a needle every two weeks. The dermatology has billed my insurance for eleven straight months of steroid and biologic since.

They let me keep practicing, and nothing was taken from me. But I will never write the word controlled on another eczema chart without remembering that mine said controlled every year for thirteen years while the skin on my hands thinned down to nothing.

I am writing this because I know exactly what my colleagues will say when they see it. I do not care.

If you have eczema, or someone you love does, please read the entire thing.

I know it is long, I know you are scrolling. I know you have things to do.

Eleven months ago I would have given anything for someone who had already walked this to sit me down and tell me what I am about to tell you, nobody did.

I was diagnosed with atopic dermatitis thirteen years ago at 41. It started with a patch behind my right knee on a Tuesday, and it cracked and wept for nine days. I diagnosed myself in my own office before I ever saw a colleague about it.

My mother had eczema. She was called controlled for nine years. The steroids thinned her skin so far that at 61 it tore open across her back, got infected, and turned into eczema herpeticum. She spent the last four years of her life afraid of her own skin. She passed in a hospital at 67. The last note in her chart said her flares were well managed. I had watched the pattern in my own family, and I had built my entire practice on treating people who looked like my mother.

I did what any dermatologist would prescribe.

I started on hydrocortisone at diagnosis. I moved to triamcinolone four years later after two bad flares. I have not had an uncontrolled flare since, and that is exactly why I would not go stronger. Every year the redness came down and every year I told myself the steroid was working.

I did everything else too.

I moisturized three times a day for thirteen years with every ceramide cream on the market. I stripped every fragrance and dye out of the house. I did wet-wrap therapy, I bought the silk gloves. I read every elimination-diet book there is and ate that way for two years, no dairy, no gluten, nine cups of vegetables a day. I lost 22 pounds and kept it off.

I checked every box on my own protocol. I checked boxes most of my patients cannot afford to check.

And every year, the flare came back the same.

Redness down, patch quiet, skin a little thinner, controlled, controlled, and that word again.

Last September I did something I had never done in thirteen years of having this disease. I looked at what the steroid was hiding instead of what it was quieting.

The first thing I looked at was whether my skin could hold a flare down on its own. Not the redness the steroid brings down, but what my own body does once the cream wears off. Your skin makes its own calm against a flare and is supposed to keep it working. Mine brought a flare down only while the cream was on it, and the hour it wore off the flare climbed back. That is the thing you can watch even when the flare looks controlled.

Five years ago a flare the cream calmed would stay calm for weeks.

That autumn it came back within days of the tube going down.

For context, I have sat across from patients whose flares came back faster every year and used the sentence, we need to change course today while there is still time.

The redness over those same five years had looked controlled the entire time.

The second thing I looked at was how long a split took to close. It is the crudest measure there is and it is the one that predicts what your skin will look like in ten years. Five years ago a crack on my knuckle healed over in about a day. That autumn, the same crack stayed open and weeping for nine days.

I had not had an uncontrolled flare in nine years.

There was nothing the steroid was failing to control that could explain either thing.

I scheduled a full skin workup for myself, and then I cancelled it.

I want to tell you why.

Because sitting in my office at 7 PM staring at my own thinning hands under the exam lamp, I recognized something. I was doing exactly what my mother had done. She had been called controlled for nine years before the infection that put her in a hospital bed. She had been on a steroid and an antihistamine. Her charts had read managed, her flares had been controlled.

And she had died at 67 in a hospital ninety minutes from where I did my dermatology residency.

I cancelled my own workup because I already knew what it would show. I did not want it in writing. I told myself I had time.

Five months later both hands split open in the corridor outside exam room four.

My skin gave out at 3:20 in the afternoon. I remember the time because I had just finished a new patient consult and I looked at the clock to see how far behind I was running.

I thought I had just dried them out, I had not.

It was the breakdown I had described to four hundred patients in follow-up appointments, the knuckles first, then the whole back of the hand. Eleven steps down the hall and I could not close my hand without it splitting, and I leaned against the wall and stood in the middle of my own clinic, badge on, blood on the sleeve.

A fellow I had trained through her dermatology rotation in 2021 came around the corner. She is not a specialist yet but she has heard me describe this exact presentation in that clinic for four years.

She saw my hands and her face did the thing.

She cleaned me up, sat me down, and pulled my whole chart herself.

She pulled every flare note I have logged the way I have logged four hundred others. I already knew what they were going to say, forty flares.

The same story I have told four hundred people in follow-up appointments as nothing to be frightened of.

We were looking for the uncontrolled flare that would explain the hands, there wasn't one.

The notes read the way my notes have always read, controlled, redness resolved, well managed.

I went home that night with my husband, a box of gloves, hands that split when I closed them, and a chart that said there was nothing wrong with me.

After that day, my colleagues wanted me to have a full workup of my whole skin, and I did not want one.

I looked at every part of my own skin anyway.

Because I knew that if I did not, in three years I would be looking at somebody else's skin and seeing my mother's in it, and then my own.

I looked at how a flare behaved once I stopped the cream. Every time, within days, it came back in the same spot. There is a name for skin that only stays calm while the cream is on it, borrowed calm, and mine had been running on borrowed calm for years. Nobody had flagged it in thirteen years because nobody measures whether your own calm is holding at a standard eczema follow-up, including the practice I built.

The skin on my arms had started reacting to water alone. A barrier so breached that plain tap water stung. I had been dreading washing my hands for two years. I had blamed the soap, my sleep was gone.

I had been waking at 3 AM digging at my own skin for eight months. I had blamed stress, my grip had failed.

My right hand could not open a jar without a knuckle splitting, because the skin had no give left in it. I had stopped doing my own fine procedures the previous spring. I had told my partner the fellows needed the practice.

Every one of these was progressing while my flares looked controlled, and not one of them was an uncontrolled flare, same disease.

Same calm getting switched off, damage on my arms. Damage in my sleep. Damage in the skin that met water. Damage in my hands. And finally, skin that split when I closed a fist.

I sat in my office on March 2nd with all of it in front of me and I understood something I had never let myself understand in thirteen years of treating this disease.

Every drug I had ever been on was working on the immune flare.

Hydrocortisone was working on the flare.

Triamcinolone was working on the flare.

Clobetasol was working on the flare.

All three did it well. Nine years without an uncontrolled flare is those drugs doing exactly what they were built to do.

Not one of them had kept my own cortisol working underneath.

I am a dermatologist. I am supposed to be the person who knows how to stop this. I had put hundreds of patients on the exact protocol I was on, every one of those prescriptions was correct, every one followed the guidelines. Every one was the standard of care, and I would defend every one of them in front of any board in this country, and it had failed me at 54.

I sat at my desk that night at 11 PM after my husband had gone to bed and I did something I had not done since medical school.

I opened PubMed and I searched for the actual mechanism, and not the steroid trials, and not the management guidelines, the mechanism, the root cause.

I read for five hours.

I found what my training had covered lightly and never in the depth it deserved. Eczema skin makes less of its own calm when the pressure is on. The reason being told to just relax never settled anyone, the reason a hard week undoes a good month, and the reason my skin climbed every year no matter how carefully I lived.

Your body already makes its own calm against a flare. It is a steroid called cortisol, your adrenal glands make it, it travels to your skin, and it is the thing that actually settles the redness and the itch. But eczema skin was built making less of it when the pressure is on. The calming response that should arrive on a hard day arrives late and small, so the flare climbs while the brake that should stop it is still catching up. You were never short on willpower. Your skin was born short on the brake.

Giving that brake something to work with takes the compound that keeps your own cortisol working, and it has to get into the body, and that is all it is, and it is not a failure of yours.

It is a brake your skin was born making less of, and no amount of managing your stress was ever going to build it back.

And this is why you can do everything right and still flare, while the calm your skin should make arrives late and small underneath it.

None of this was hidden. It sits in the research, that people with eczema make a weaker cortisol response to stress, which is why being told to just relax was never enough. Teelucksingh and his team even showed in the Lancet in 1990 that the compound in licorice root slowed the enzyme that turns cortisol off, 11-beta-hydroxysteroid dehydrogenase, in human skin, so the little cortisol you do make stays working longer.

I had read those journals every month. I had read them for the steroid and biologic trials. I had never read them for the cortisol papers, because my training had never told me anything about the root cause.

My training was wrong.

I closed my laptop at 4 AM and I sat at my kitchen table and I could not sleep.

I understood at that moment that I had told hundreds of people they were doing well while their own calm was being switched off underneath. I had said the words your skin looks great to people whose flare was about to come back the moment the cream wore off.

Two weeks later I saw a patient in follow-up whose skin should not have looked the way it did.

Her name was Emi, diagnosed fourteen years. She had transferred to me four years earlier after a hospital-grade flare. At intake the skin on her hands had been cracked and weeping. Her itch score was one of the worst I had on file.

I pulled her chart before she came in expecting to talk about starting Dupixent.

Her hands were clear.

Her itch scale had dropped from 61 to 22.

She had come off her steroid fourteen months earlier at her own insistence, and her skin only got better after she did.

I looked at her across the exam room and asked her what she was doing.

She was quiet for a moment. Then she said, Doctor, my grandmother Michiko ran a pharmacy back home for decades. She has been telling all of us for years. I did not bring it up because I did not think you would take it seriously.

I asked her what her grandmother had told her.

She wrote a name and a town on the back of my prescription pad.

The name was Michiko Tanaka. The town was one in central Pennsylvania I had never heard of.

I drove there the following Saturday.

I did not tell my husband where I was going.

I did not tell my colleagues.

I did not tell anyone in my department that a board-certified dermatologist was driving two and a half hours to meet a 76-year-old Japanese grandmother because everything I had been taught in nineteen years of practice had not saved me.

I pulled into the driveway of a small house at 11:20 AM.

She was in the garden along the front walkway, shiso, ginger, perilla. A persimmon tree by the door, she was 76, small woman, thin.

Gray hair pinned back.

She stood up out of that garden without putting a hand down to push herself up.

I introduced myself to her as Maya and nothing more, and she looked at me with sharp clear eyes and asked me why I had come, I told her.

I told her I was a dermatologist. Nineteen years in practice. That my own hands had split open in my clinic six weeks earlier. That my flares had looked controlled for thirteen years. That four separate things in my own skin were showing the pattern I had watched in hundreds of my own patients. That one of my patients had told me about her, she listened.

She did not interrupt.

When I finished she said, Come inside, doctor.

Her kitchen smelled like ginger.

She poured me tea without asking.

She had been a hospital pharmacist in Osaka for twenty-eight years before she came here. Her sister in Japan was diagnosed with severe eczema thirty-one years ago. Her sister is 72 now and has skin you would never guess had eczema.

She sat across from me and said, You are here because your flares look controlled and your skin is getting worse, I said yes.

She said, Then you already know your medicine is fighting the wrong battle, you know this. Nobody has ever given you anything for the root cause.

I did know it.

She said, In Japan we help the calm your skin already makes keep working. Here they quiet the flare and they wait, and they tell you to manage your stress. Your doctors gave you the hardest half to do alone.

She got up and set a small amber bottle on the table in front of me.

She tapped the first, cortisol.

The calm your body already makes against a flare. Eczema skin just makes less of it when the pressure is on, which is not a thing you can try harder at.

She tapped the second, the brake.

The calming response that is supposed to arrive on a hard day. On eczema skin it arrives late and small, so the flare climbs before your own calm ever catches up.

She tapped the third, the plant.

The compound in licorice root, what gets called a plant steroid because it works on the cortisol your body already makes and not because it is one. It slows the enzyme that turns that calm off, so the little you make stays working longer.

She pushed the three of them together until they were touching.

Together, she said, they give the brake something to work with. Not a cream, and not one more lecture about your stress. The one thing nobody handed you while they blamed you for a flare you could not will calm.

I told her I understood the biochemistry. I told her I had read the papers.

She said, Then you understand it on paper. You do not yet understand it in your own skin.

Now here is what nobody taught you in medical school, she said.

For as long as anyone in my family can remember, this is what we have reached for when the skin flares, my mother. Her mother before her. I am seventy-six and my skin has never cracked in my life. My sister has taken it every day since the month she was diagnosed.

She said, There is a cheap version of this and a real one. The cheap ones use one herb and call it a remedy, and they leave out the compound that slows the enzyme entirely, which is a long way of saying your own calm still gets switched off. Almost everything on an American shelf is the cheap one.

And the cheap creams are not only useless. Loaded with fragrance and preservatives, they can drive the very flares you bought them to calm. There are creams on your pharmacy shelf with a dozen sensitizers in them, sold for sensitive skin, she is right, and it is well documented.

I have diagnosed contact allergy to a moisturizer twice in my own clinic, and both times the patient had bought the product to help their eczema.

I asked her if how it was made mattered, she nodded.

A cream that sits on the surface is not doing what you think it is doing, she said. It floods the top with a borrowed calm for a day, and it never reaches the enzyme shutting your own calm off. Those are two different things and your creams only ever do one of them.

I argued for a second, then I stopped, because she was right.

She said, A drop that only carries one herb never slows the enzyme. It might taste fine and change nothing underneath. That is a token, it is not the thing that keeps your own calm working.

The real one carries the compound from licorice root in a base thin enough to slip into the body under your tongue instead of sitting on the surface. Because it reaches the enzyme the cream never touched, the calm you already make keeps working.

In Japan they prescribe this compound for eczema at the pharmacy counter because they know a cream alone does not keep your own calm working. The right drop does the same job at home, she paused.

There is a company my niece in Boston told me about. The compound from licorice root in one formula, with the other calming plants beside it, every plant named and nothing hidden. Thin enough, under the tongue, to reach the enzyme that matters.

She wrote a name on the back of an envelope and slid it across the table, Phoilex, Liverty Dynamic Drops.

I read it in her driveway before I started the car.

Licorice root for the enzyme, named right on the label, with milk thistle, turmeric, nettle leaf, lemon balm and chaga beside it. A lemon-tasting oil you hold under your tongue, every plant printed, nothing hidden, steroid-free.

I ordered three bottles from her kitchen table before I left.

I drove two and a half hours home.

I did not tell my husband where I had been, they arrived that Wednesday.

I put the first dropper under my tongue that night, week one.

Since the hands went, I had been shutting my office door between 3 and 4 every day to reglove and re-cream. On day six the itch quieted enough that I forgot to, week two.

I had been sleeping with my hands outside the covers since the summer because of the burning, and that week I pulled the covers up, week three.

The cracks on my knuckles closed. Nine days to heal in September; that week, closed in two. I checked them four times because I did not believe it. All of them held, week four.

I did my own fine procedure for the first time in over a year, hand steady, skin holding. I opened a jar without a knuckle splitting for the first time in months, week six.

I slept through the night without waking to scratch. Twice that week, four times the next, week eight.

A flare I used to fight for weeks settled in days, and this time it stayed settled after I stopped the cream, week twelve.

The same full look I had taken at myself in the fall.

Cracks, closing in a day again, down from nine.

Grip, normal in both hands.

Skin met water without stinging, and it had stung for two years, itch scale, 24, and it was 58 the week I started.

A flare, when one comes, settles on its own now and stays settled. After five years of the calm never holding, that is the thing I care about most on this entire list.

And a flare, if I ever get one now, quiets the way it always did, controlled, same word.

Completely different skin underneath it.

I brought the photos to my practice partner, another dermatologist. Twelve years in practice.

I put the September hands next to the twelve-week hands on her desk and I did not say anything.

She looked at them.

She looked at me, she said, Maya.

What did you do, I told her, the 76-year-old pharmacist, the kitchen table.

The cortisol, the enzyme, the plant pushed together. My own calm, kept working, all of it.

She listened for an hour without interrupting.

Then she asked the only question that mattered. Whether the steroid could account for it, and it cannot. The steroid quiets a flare from the outside. It does nothing to keep your own cortisol working, and no trial of it has ever shown it does. I had been on clobetasol five weeks before I drove out there and the flare still came back the hour I stopped.

Then she said, I was not trained on any of this. But I want to see it in my own patients. Give me the name, I gave it to her.

She has been running it with sixteen of her eczema patients for four months. She called me two weeks ago. Eleven have skin that stopped cracking. Nine have dropped their itch score by more than fifteen points. Two have come off the steroid they had leaned on for over a year.

I still keep a steroid in the drawer for a true emergency. The drops are something else entirely.

They are the other half, the half nobody gave either of us.

In June I shook every hand at my daughter's graduation. Ninety minutes of it, outside, in the heat. I have not been able to let anyone see my hands since 2019.

My hands, two weeks ago, were clear.

My skin split open in the hallway of my own clinic at 54 with a chart that said controlled.

I am writing this because I still have my practice. I can still do my own procedures. And I have watched a flare settle and stay settled for twelve weeks, after thirteen years of watching it come back the hour the cream wore off.

I have watched a colleague look at my hands and say the word I had waited eleven months to hear, healing, and not controlled, healing.

I am also writing this because I know the truth about what my profession is doing, and I am the profession.

I have written 9,187 steroid scripts. Every single time I wrote controlled, flare resolved, I believed I was delivering good news. I watched the relief on people's faces. I said the words your skin looks great to a woman who told me in the same visit that she had stopped shaking hands, and I did not connect the two.

I do not know how many of those people are hiding their hands now.

I do not know how many of them ended up where my mother did.

I know that the standard of care I was trained in, and that I taught to fellows, is built on the assumption that quieting the flare is all you need to do, and it is not. I have my own skin that proves it is not, and my mother's chart proves it was not for her either. Nine years of controlled flares, and her skin tore open at 61.

My hands split in that hallway at 54. Seven years ahead of her. The difference is that somebody's grandmother told me what my medical school did not.

If you have eczema, or your wife, your husband, your mother, or your daughter does, and you have been told your flare is controlled while your skin keeps getting worse, please listen to what I am telling you.

The flare coming back on a hard week cannot show you a brake you were born short on, and it never could. Controlled means the redness is down, and it does not mean your skin can make its own calm when the pressure is on, because you were born making less of it.

Your steroid does not build the brake your skin was born short on. It is not designed to and it never claimed to.

Dupixent does not build the brake. It quiets the immune signal and does nothing about the weak calm your skin makes under stress.

Moisturizer does not keep your own cortisol working. It softens the surface you already have, and you should still use it.

Elimination diets do not build the brake. I cut everything for two years and a hard week flared me the entire time.

Managing your stress does not build the brake. I did it for years, and my skin was born making less of its own calm no matter how calm I stayed.

Giving that brake something to work with takes one specific thing, and it has to get into the body.

The compound in licorice root, the one that keeps the little cortisol you make working longer, in a base thin enough to slip under the tongue, instead of one more instruction to handle your stress better.

Phoilex Liverty Dynamic Drops.

The compound from licorice root in one formula, with milk thistle, turmeric, nettle leaf, lemon balm and chaga beside it. Every plant named on the label, nothing hidden, while the best-known rivals won't even say what is in their blend. Steroid-free, and a lemon-tasting oil you hold under your tongue.

One dropper under the tongue at night, and that is the whole protocol.

It is recognised by the National Psoriasis Foundation, which almost nothing on that shelf is.

The system that trained me did not give this to me when I needed it, and it is reaching you now, P.S.

My mother was called controlled for nine years. Her skin tore open at 61 and she passed in a hospital at 67, and her final chart says her flares were well managed, and I have a copy of it in my desk. I built my entire practice on the belief that I would prevent for my patients what nobody prevented for her. Instead I walked the same road in my own skin, under the same word, and I got there seven years earlier than she did. The difference is that I caught mine and she did not get a second chance to. Please do not wait for a calm-looking flare to give you permission to take this seriously, and it will not. That is the entire point of what I have just told you, P.P.S.

I do not work for Phoilex. I do not receive a penny from this. I am writing this at 11:40 PM on a Sunday, alone in my office, because a patient came in on Friday whose hands had gone from cracked to clear in seven weeks and I recognized my own skin on her chart. She had found it herself after reading something a woman had written about her husband. She told me it had been going around an eczema group she is in. I read it that night. It was the second time in four months that I have recognized my own patient in something written by a stranger, and not in anything written by my own field. Please send this to anyone you love who has eczema. Even if they are doing well. Especially if they have just been told their flare is controlled.

~ Dr. Maya Ellison, MD, board-certified dermatologist, atopic dermatitis subspecialty, age 55

Edit: Several people have asked for the link so here it is - https://phoilex.com/pages/liverty-drops

• I don't give a f*ck if this upsets you. I am going to say something that nobody with eczema wants to hear. For thirteen years I told patients their skin would settle if they handled their stress better, and my own skin proved me wrong.
• My skin split open in the hallway of my own clinic at 54 with a chart that said controlled.
• Not one of them had kept my own cortisol working underneath.