From: “Linda Sy MD”
Date: Thu Dec 7, 2000 4:55 am
Subject: Re: [rosacea] the cortisone story continues
Hi Patricia,
Yes, what a bummer. There is no easy way to manage steroid induced dermatitis. Your skin has become addicted. How does one treat addiction? You either go cold turkey (in which case, you will undergo dramatic flares not just once but perhaps multiple times); or you can go easy on yourself and withdraw gradually (in which case, you may be delaying the eventual total withdrawal).
The latter method of course, is probably more practical, especially if you are working. One way of doing this, is to decrease potency & frequency of use (ex. from daily use to 3X per week, 2X, 1X etc. etc.) and keep stretching the duration. Then start diluting the concentration with a moisturizer. Skin is resilient and can adjust. Either way, you will get flare ups, sometimes even in other parts of your body (sort of metastatic rebound phenomenon).
So, do not be discouraged or surprised when you have a flare – it is not a set-back. Just keep on your program. Meanwhile, when you do get a flare, here are some ancillary suggestions:
- Apply cool water compress on your face 3-4 times a day for 5 to 10 minutes.
- Follow immediately with lubrication. If skin gets tight during the day, keep applying your lubricant as often as necessary.
- Take an antihistamine to help contain the itching.
- Use a lubricating foundation to camouflage the erythema (for emotional support).
- Keep up with your oral antibiotics if you are on this for your rosacea. This is not the time to phase out on this.
- Last but not the least, patience and give it time.
Some good news: There is a topical medication called Tacrolimus ointment. I read that it will be available in the near future. From published reports, Tacrolimus has been impressively effective in treating the “red face syndrome” induced by long-term continuous use of steroids in atopics. So,
you may not have too long to wait…
Linda Sy M.D.
Linda Sy Skin Care
http://www.lindasy.com
Voice:Toll-free 877-Lindasy (546-3279)
Outside US: 925-256-0178
FAX: 925-939-5207
See Also
Rosacea News Articles: moisturizers, cleansers and steroids,
13 comments ↓
I have been struggling with a very red face for the last year and a half. In the beginning I went to the doctor and he diagnosed me with contact dermatitis and prescribed mometasone cream along with Zyrtec. I put this on, and my symptoms lessened but the next day it was worse. I stopped taking it. I went to a dermatologist and he gave me Elacon Cream and Hydroxyzine. Same thing happened. Then my doctor prescribed predinisone 10 mg. As guessed same thing happened. In the beginning I was told that I had tested positive for EBV and that could be contributing to my symptoms. But after a year and a half??? I have heard of chronic mono but I dont have the symptoms such as fever,severe fatigue etc.
MY QUESTION IS THIS: How do I know if I have rosacea, steroid induced rosacea, or is it just an atypical presentation of the EBV(mononucleosis virus)?
Hello, everyone:
I suffered with acne for 15 years. 10 of those 15 years it was severe. I finally found a dermatologist who prescribed me two courses of Accutane. For the first time since I was 9 years of age, my skin began looking incredible. I was very happy. There was just one problem: the small, flat, red spots my previous acne had left behind were taking an abnormally long period of time to heal. For most people they normally take 3-4 months to completely fade away, but a year came and went and mine were still clearly visible. So I decided to ask my dermatologist if there was anything she could give me that would help quicken the pace they were fading and make them heal faster. She gave me a small tube of Tri-Luma and told me it would help.
HUGE MISTAKE!
I used it the night before Christmas Eve ‘07 and put it on in an upside down triangular shape on the side of my right cheek (because that’s where most of the flat, red spots are located). The next morning I woke up and everywhere I put the Tri-Luma was a dark purplish/reddish color and it felt like my face was on fire! And the flat, red spots were an even deeper color red! I obviously had some type of allergic dermatitis reaction to it.
HOWEVER, the story doesn’t end there….the first 3 or 4 days after the intense flare-up, the color faded to a light pink, but the pink upside down triangle was still clearly apparent. Keep in mind, that was THREE MONTHS ago and the pinkness still has not faded away. Now all the surface area of my skin that I put the Tri-Luma on acts like Rosacea. So imagine a large, pink, upside down triangle on the right side of my cheek that constantly flares up whenever I get hot, or anytime I’m near sunlight, or anytime I do strenuous activity, etc. It’s a nightmare.
I am scared to death that permanent damage has been done. By the way, Tri-Luma has a steroid in it as one of its ingredients (which I didn’t find out until after the fact).
*Tri-Luma ingredients:
– fluocinolone acetonide 0.01%
– hydroquinone 4%
– tretinoin 0.05%
I have heard of people who use steroid creams long-term and end up suffering with permanent damage to their skin, but I have never heard of permanent, intense damage being done to a person’s skin after only ONE use. The thought alone blows my mind and makes absolutely no sense whatsoever. I even called the makers of Tri-Luma and spoke to their “medical liaison representative.” He said he had never heard of anyone experiencing permanent damage to their skin after only one use of their product either. He kept telling me not to worry and that he didn’t believe it was permanent (even though I don’t see how he can make that evaluation when he’s never even seen the current condition of my skin.)
But my question is this: If the pinkness and the flare-ups are not signs of permanent damage, then wouldn’t they have been gone a long time ago? How could I still be having a problem with pinkness and flare-ups, THREE months after the initial flare-up, if the current condition of my skin is not permanent?
Right after it happened (back in late December), I panicked and made an appointment with my derm. She told me not to worry and that it should fade within a few weeks. When I went back to see her about a month ago and told her I was worried that the pinkness still had not faded away, she got very defensive (a side of her I had never seen) and told me my face was just pink because it was still sensitive from the Accutane. BULL. I told her it obviously was due to the Tri-Luma because the discoloration and the flare-ups were/are in the exact same pattern I put the Tri-Luma on my skin. She tried to blame it all on me and said: “Well, YOU’RE the one who asked me to give you something to fade your red spots…..” Then she just rolled her eyes and said to come back and see her in June. She acted very rude and unprofessional. She was not helpful at all and the entire appointment with her was a complete waste of my time.
That said, I want to issue a warning to anyone thinking about using Tri-Luma to be careful! Try it on a pacth of skin on your arm or something first to make sure you don’t have a negative reaction to it. My derm told me to do that, too, AFTER I had already experienced the massive flare-up. By then, her suggestion was way too late.
Can anyone PLEASE help me or give me any advice on what you think might have caused such a severe reaction? Has anything like this every happened to anyone else? Do you think the damage is permanent? Do you have any suggestions on how I should treat it to help it go away?
I would be very grateful for any opinions or advice.
Thank you.
Hi Christian,
Do you think it could have caused vascular damage on your face, thus, you now have broken capillaries under your skin, which are causing the redness? That is what I currently have, on one particular spot on my right cheek. My dermatologist is suggesting that I do IPL therapy. Thinking about it… I would def. go to a dermatologist that you feel you can trust and respect, and respects you back. It made a huge difference for me. Good luck, keep your chin up.
I was afflicted with sterioid induced rosacea for close to a year before I finally found a dermatologist who knew what she was doing…Thank god! I had been applying steroid cream to my face for a year, on the advice of a derm, who I’m pretty sure went to the same medical school as Dr. Nick from the Simpsons. Anyway, the only solution is to discontinue using the steroids. This is awful because as the steroids are causing the problem, they are also keeping it in check. Discontinuing their use causes a rebound effect that for me was unbelievably painful, and encompassed most of my face. Tacrolimus is absolutely essential for speeding up the process, along with an antibiotic. Sorry you have to go through this mess I feel for you.
Thanks for the note Dan. Great to hear that you are on the other side of getting better. Do you have any more tips for stuff that helped you cope with the rebound ?
I am suffering from steriod induced rosacea. I am having a flare up right now and trying to slowly get off of the steroids. The issue I am having that is slightly different is that I am pregnant. I can’t take anything orally. Has anyone else experienced this withdrawl while pregnant? I am just miserable and depressed. My 2 year old son has also going through the same thing. We were mis diagnosed with eczema and have been using the steroids for about 18 months. What do you do with a 2 year old that has rosacea? I am really scared to treat him like I am treating myself. We have been using Finacea cream for 2 days. Does this work as effectively as the anitbiotics? If someone could answer some of my questions, maybe my mind can be put at ease. Thanks, Worried Mom
i am suffering from steroid induced rosacea.i have using the steroid cream since 14 years old because of my eczema problem and now im 19. At first i tried to stop but my face become much more worse. Than i continue with hydrocortisone 1% which is mild than elomet the one that i used before. And now i find out the side effect of hydrocortisone to my face which is it makes my skin become thinner, very sensitive to sunlight and my face become red and difficult to go away. then i discontinue from using this steroid cream but i find out the rebound effect and it fill worse ever.i fill very uncomfortable to go outside to hang out with my friends.futhermore there are some pimple come out from my face which is it never come before as i had very clean face. now im using herbal cream from hope relief product.i find out it cure a little bit but now im using for 1 week but the improvement is verryyy slow n i dont know is it worth it to use it and to wait the result or should i try another ceram.now im confused. before this i’ve met dermatologist and she gave me elidel but it make my face sunburn and my skin felt very tight and i find out that it has a very bad side effect which is skin cancer so i stop.now i dunno what to do because my skin are becoming red, very dry even i’ve put moisturizer on it 3-4 times a day. and the pimple is strt to coming out even my skin is dry.pelase please give some comment about it. and one more how long does it take to recover from rebound rosacea effect? im very woried about it!!
sorry about my english is very bad.=(
i hope u will understand
Hi
I’m currently trying to work out what on earth is wrong with my skin and the doctors aren’t helping much at all. I discovered I have an allergy to nickel which caused eczema on my face – I was given Euvomate (moderate strength steroid cream) to put on which worked brilliantly for the first 3 weeks then came the rollercoaster of trying to come off it, as well as avoiding all contact with nickel and weird horribly itchy tender spots started to erupt. They can come up anywhere on my face but the dermatologist told me that she thinks I have rosacea and it’s not caused by the steroid cream – how does she know that? I didn’t have it before and I don’t have what could even begin to be called typical rosacea pattern of spots – they appear wherever I have put steroid cream at some point but nowhere else.
I have now been off the steroid cream for 3 weeks and have had a lot of nightmare days and red flushing (particularly on my nose) and a general feeling of tenderness but (hope I’m not saying this too soon!) the reactions are not as severe as they were so I am hopeful that it is the steroid cream that has induced the rosacea and it wasn’t there all along.
Anyway – what some of you might like to know is that I have to find something to calm everything down as my derm refuses to prescribe tacrolimus (she won’t accept the steroids could have caused this new problem – duh!) so I have been making a very strong cup of green tea each morning – once cool I put some in a pot and apply it liberally throughout the day wherever and whenever I get inflamation. My face remains horribly dry but the inflammation is less and the dryness is not as bad. It’s not a miracle cure but it is helping me to just about keep sane through this unpredictable ride. Hope that helps someone and if anyone has any other tips I’d love to hear them.
Topical steriods do worsen flushing.
You have to wean off the steroid slowly, to lessen the rebound flushing.
Many drs recommend Elidel and Noritate during this.
Many drs will also put you on oral antibiotics like Clarithromycin.
Some drs will put you on accutane at 5 milligrams a day.
This approach hopefully lessens the rebound reaction. You can’t just stop the steroids cold turkey.
After the storm has passed you might want to consider getting IPL or V Beam treatments to lessen the redness and to rebuild the collagen in your skin.
I have been using a topical steriod for over a year. I went to the dermatologist because I got tired for the rash returning. She prescribed an antifungal cream. The rash only got worst. Then she suspected I might have a steriod dependency. I had red itchy bumps all over my face especially on my cheeks. My face felt like a carpet. All the makeup in the world couldn’t hide it. I was given some topical antibiotics but it did not work. Through my own research I asked my Derm about Doxycycline 100mg and Tacrolimus ointment. She agreed but prescribed Elidel instead of Tacrolimus ointment she said they were the same. Today is day four and I am happy to say 90% for the rash is gone. My face is finally feeling like mine again. Not too fund of the Elidel as per the side effects but I will use it for a short period of time.
I FIND ALOE VERA HELPS A LOT STINGS A LOT FIRST TIME BUT AFTER THAT IT CALMS DOWN A LOT NOW DAY THREE OF USING IT I FEEL GREAT STILL A FACE LIKE A BEETROOT BUT IT FEELS OK
MY STORY: I had acne when i was in grade 6. My mom took me to the doctor, BIG MISTAKE, and i was prescribed differen. Using this on my acne dryed my face out and made my face red. So we went back to the doctors, another BIG MISTAKE, and I was prescibed a Topical steriod moisturizer cream and it made my face look very nice but once I stopped using it my face got red in the location where I applied it, so a kept on using it….why you ask? I don’t know, i was a kid. It’s GRADE 9 now! I’ve stopped using acne meds but still have acne. It’s no longer a concern of mine. I go to the doctors because I find I’m having to use too much of the Topical steriod moisturizer cream multiple times a day to stop my face from looking red, blotchy, dry, peeling and flaking………….. I’m prescribed a NON-STERIOD moisturizer called ELIDEL, it helps at first but FOUR YEARS later, I’m 19 now, my ance is gone, no thx to any meds I’m sure, but i have to apply ELIDEL to my face too often to keep my face from blotching and drying JUST LIKE BEFORE. I stop using prescription creams cold turkey because i feel betrayed by a system that supposed to look after my health, not make things worse. I have lost all faith in the medical care system as far as prescription medications go. It’s horrible, i use normal moisturizers sparingly but not much helps. I tryed Skin Zinc for a few months but it barely helped and in the end it made things worse. I’m 22 YEARS OLD NOW, and this is where the time-line stops. I’ve stopped using prescription meds for 3, almost 4, years now and my face still has big red blotches where i used to apply the creams. They flare up 75% of the time and flake and peel 20% of the time. I wash and scrub my face daily because it keeps the flaking down but it makes the redness worse. ALOE VERA GEL makes my skin feel really nice. i recommend it too. its the only moisturizer i use. does anyone have any advise other NON-MEDICATED moisturizers that may help with redness and smoothness of skin? Has anyone ever tryed sueing there doctor or the prescription company? Because I am sure no one here knew the consequences of using these drugs.
pst. if anyone wants to contact me to chat about this or other things, message me over facebook.com. my name is Jonathan Dahmer(no relation *wink*). I’m the guy holding a gray kitten……. idk why i desided to google skin damage from steriod moisturizers today but im glad i did because i really thought i was the only.
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