Over the Counter Steroids can cause Steroid Induced Rosacea

Written by on June 6, 2006 in Over The Counter Treatments, steroids with 9 Comments

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 rosacea 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.

How To Treat Steroid Rosacea

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).

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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9 Reader Comments

  1. Bryan says:

    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:)

  2. 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 !

  3. Nicole Kaminski says:

    I’ve just recently been diagnosed with Rosacea, so I am still trying to gather as much info as I can and would really appreciate anybody’s advice regarding this disease. In trying to understand this frustrating illness, I came across this article, which I was naturally drawn to because of my life long steroid use.

    When I was 7, I was diagnosed with JRA, consequently, I have spent the majority of my life (not to mention 10+ years in a row) on HUGE amounts of Prednisone. My dermatologist couldn’t tell me why I have recently developed Rosacea, so I was just wondering, is it possible that the steroid Prednisone, could be the culprit?

    Thanks in advance for all the helpful opinions/intelligent comments/and friendly advice!

  4. Bumps says:

    I also wonder if steroids are the cause of my Rosacea. I had always had very nice skin. Then a doctor prescribed a strong inhaled steroid for an unrelated condition. Soon thereafter, I became afflicted with papular Rosacea. For more than a year I have tried everything my dermatologist suggests, with little or no relief. So, those of you who suspect that your Rosacea is steroid induced, how have you treated it? How long does it last after you cease taking steroids? Does it seem to spike and then recede? Is there any hope of it ever going away?

  5. Nicole Kaminski says:

    Well, I sure hope that it eventually goes away! LOL! My experience with Rosacea does seem to flare up and then go away.

    And as for how long it takes to clear up and go away, once stopping steroids, I dont know. I havent been on Predinsone on a daily basis since like ’03 or ’04, only going on it for brief periods of time through out the years, and not nearly the huge amounts that I was on before. So, from my own personal experience, once you go off the steroids, the face doesn’t necessarily clear up, unfortunately. I think it has to do with the steroids just screwing up your whole system. I mean once you take steroids for an extended period of time, you will experience negative side effects. Now, I also know that I am pre-disposed to auto-immune diseases, so it comes as no shock to me, that after suffering from inflammation of the joints for almost 2 decades, that in the past few years I have started to suffer from inflammation of the skin as well!

    I have recently been on a medicine for roughly the past year that has seemed to make my rosacea worse and thankfully my rheumatologist has agreed to put me on another medicine, so my face has been clearing up since I had my last dose about 2 months ago! Ive also found some all-natural products that are strong enough, yet gentle too, so they seem to be helping my face clear up and not irritating and agitating it like most products usually do!

  6. Eileen says:

    Nicole, I’d be interested in knowing what all-natural products you’re taking to help your face clear up. Thanks!

    Does anyone out there have rosacea AND eczema? Yup, I’m one of the lucky ones!

  7. Nicole Kaminski says:

    Hi Eileen,

    I don’t know if there all-natural products, but I love them becuase they have natural botanicals and vitamins and a bunch of other non-chemical crap, but I have been using TriDerma. Ive been using their Facial Redness Cleanser and Facial Redness Repair, twice day. I also think they’re great cause they have tons of lines of facial products for every skin problem like eczema, rosacea, psorasis. I would give them a try. I think their website is triderma.com.

  8. Jennifer Kennison says:

    I was being treated for acne about 20 years ago with the Obagi system, which was prescribed by my dermatologist. This involved using retin-a and hydrocortisone cream. My skin became very red and after several months of use, my dermatologist told me I had rosacea. I had never heard of it before. No one in my family has it. I have long suspected it was caused by that treatment. I will say that it has gotten better through the years, though it will flare up sometimes. I avoid the sun, wear sun screen, have tried all the prescriptions. I have to be careful what I put on it, no scrubbing or harsh cleansers. A beta hydroxy lotion from Paula’s choice seems to help.

  9. Bob says:

    Did any one with steroid rosacea eventually have it calm down?

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