An interesting exchange in recent editions of the Journal of the American Academy of Dermatology. A paper in July 2005 suggested that the population in general was safely using over the counter hydrocortison (steroids). This conclusion was then challenged by a letter published in Jan 2006 pointing out the abuse of OTC steroids can lead to steroid induced rosacea.
The letter sounds an excellent warning against using even even low-dose corticosteroids ;
This preliminary study demonstrates that tacrolimus 0.075% ointment may be effective for patients with steroid-induced rosacea, when combined with avoidance of topical steroid use, as well as avoidance of other agents known to aggravate rosacea (caffeine, spicy foods, alcohol, hot fluids, and fluoride).
Firstly the original paper:
Consumers appropriately self-treat based on labeling for over-the-counter hydrocortisone. Journal of the American Academy of Dermatology, 2005 Jul;53(1):41-51.
Ellis CN, Pillitteri JL, Kyle TK, Ertischek MD, Burton SL, Shiffman S. Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan 48109-0314, USA.
BACKGROUND: Over-the-counter (OTC) topical corticosteroids, such as hydrocortisone cream (HC), are commonly used for the treatment of minor dermatological conditions. The safety and efficacy of such products are well documented, but details on patterns of use and self-treatment with HC in the OTC environment remain scarce.
OBJECTIVE: We sought to determine compliance with label directions of OTC HCs by examining self-reported patterns of OTC HC use in adults and children.
METHODS: A random digit-dialed telephone survey was conducted with 2000 US adults. Following identification of users of OTC HC in the last 6 months, respondents were asked questions about the conditions being treated with OTC HC and the frequency and duration of use in both adults and children.
RESULTS: Of adults completing the survey, 20% (n = 396) had used OTC HC. In 83% of cases, the conditions treated were consistent with the OTC label. Use was limited; HC was applied < or =4 times daily in 98% of adult users and lasted < or =7 days in 92%. Patterns of pediatric use were similar and almost always consistent with the labeling. Of households with children, 25% (n = 168) had used OTC HC to treat pediatric dermatological conditions. Of child users, 93% were 2 years of age or older, treatment was limited (97% applied HC < or =4 times daily and 94% of treatments lasted < or =7 days), and the conditions treated were appropriate in 86% of cases.
LIMITATIONS: This telephone survey relied on respondents’ recall and self-reporting. Our data on pediatric use of OTC HC are skewed toward treatment of younger children.
CONCLUSION: The data suggest that OTC HC products are used for self-treatment in a limited and appropriate fashion that is likely to be safe in both adults and children.
Supported by GlaxoSmithKline Consumer Healthcare.Disclosure: Drs Ellis, Pillitteri, and Shiffman and Ms. Ertischek serve as consultants to GlaxoSmithKline Consumer Healthcare; Dr Ellis also serves as a consultant to other manufacturers of topical corticosteroids. Mr. Burton and Mr. Kyle are employed by GlaxoSmithKline Consumer Healthcare.
The follow up letter ;
Morbidity of over-the-counter topical steroids. (PDF).
Journal of the American Academy of Dermatology, 2006 Jan;54(1):182, Tackett BN, Smith MC, Nedorost ST.
This article emphasizes that over-the-counter usage of hydrocortison is generally safe and appropriate. However, we are greatly concerned with the potential for topical steroid use on facial skin, which may result in steroid-induced rosacea and topical steroid addiction. After observation of long-term facial application of even low-dose corticosteroids, we have see many adults and children with a rosacea diathesis in whom severe burning and itching develop, along with bright red papules and nodules.This may occur after long-term application of even low-potency topical corticosteroids.
Steroid-induced rosace clearly occurs after the use of topical corticosteroid that have never been associated with adrenal suppression.
Application of topical corticosteroids causes immediate vasoconstriction and reduces the redness seen in rosacea and many other skin conditions. However, when patients discontinue usage of the topical corticosteroid, symptoms immediately reappear, and the symptoms are often much worse than those seen in the original condition.
One promising treatment for steroid induced rosacea is tacrolimus. Tacrolimus ointment for the treatment of steroid-induced rosacea: a preliminary report. This preliminary study demonstrates that tacrolimus 0.075% ointment may be effective for patients with steroid-induced rosacea, when combined with avoidance of topical steroid use, as well as avoidance of other agents known to aggravate rosacea (caffeine, spicy foods, alcohol, hot fluids, and fluoride).
2 comments ↓
Hydrocortizone lotion 2.5% (Nutracort) long term use caused steriod induced rosacea for me…I went to Protopic and it cleared me up within 2 weeks. I still use protopic every 3rd day or so when my regualr rosacea starts to flare up. Protopic seems to work well for me. I also take very low dosage isotroin 10MG every 3rd day. This helps me have more good days:) Unfortunately I don’ t think I will ever be a clear face confident person like I was when I was younger. Those days are gone for good. It is tough to deal with. But take extra care and pay extra attention to your condition and eventually you will find a method that works for you to give you more good days:)
Great to hear that Protopic was helpful for you Bryan. It is sad that some people don’t realise the risks that over the counter steroids can pose – let alone the prescription strength ones. Be careful out there !
Leave a Comment