Treating Steroid Induced Rosacea

Written by on December 4, 2007 in research, steroids with 1,090 Comments

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:

  1. Apply cool water compress on your face 3-4 times a day for 5 to 10 minutes.
  2. Follow immediately with lubrication. If skin gets tight during the day, keep applying your lubricant as often as necessary.
  3. Take an antihistamine to help contain the itching.
  4. Use a lubricating foundation to camouflage the erythema (for emotional support).
  5. Keep up with your oral antibiotics if you are on this for your rosacea. This is not the time to phase out on this.
  6. 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

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

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1,090 Reader Comments

  1. Patricia says:

    Hi breakout12,
    I have completely recovered from my steroid induced rosacea. It took a very long 2 years to finally have my normal skin back. I did as little as possible, no drugs, no make up, no harsh creams. Just coconut ghee or coconut oil and plain water.
    This forum was the biggest help in my days of rash’ and hurt.
    Hope everyone gets better day by day. Hugs Patricia.

  2. Jason says:

    Uh oh, think I am dealing with this same problem. I’ve been increasing use of topical steroids on face, neck, arms, behind knees to treat unknown itching, rashes, hives, redness. Could not figure out the cause. I have noticed that there is a rebound effect when used on the face that has shrunk now to about a 2 to 3 day cycle. Skin on face appears to have changed permanently to thicker, redder, itchy, bumpy, blotchy with a strange dry soapy or waxy feel.
    Stopped using everything about five days ago and life is not good. Glad to hear there is high probability of healed skin somewhere out there 4 months to 2 years away. Going to be miserable getting there.
    Enjoyed reading some of these forum posts going back a couple years. Very helpful – thanks.

  3. Patricia says:

    Dear Jason,
    It sounds like you are right unfortunately. You will suffer the most in this initial flare. Make sure you have faith and trust that you will get better.
    People are not as bad in judging, as one thinks, so explain your situation and they will understand.
    Make sure you eat right, exercise and get enough sleep. Use as little moisturizer in the beginning. You will feel very dry for a while.
    I am sorry you will have to go through this, but there is light at the end of the tunnel.
    Sincerely, Patricia.

  4. Rhonda says:

    I want to thank every single one of the people who have posted here. I thought I was going crazy. I’ve been using dr prescribed steroid cream for 2 yrs on the area around my mouth. I lost my job and haven’t had insurance for a very long time and haven’t been able to consult a derm. My family physician
    has just diagnosed me with rosacea and put me on clindamycin phosphate 1% gel. I’ve been using it for 2 months now and after an initial *wonderful* cleared-up period, I’m now facing worse symptoms than ever. Red, thick, chemical burned, heart beat throbbing, crawling, rip your face off itching skin over my entire face, from my bottom eyelashes to 2 inches under my chin. I’ts been going on for about 2 wks straight now and I sometimes just sit and cry. I found solace here….knowing that no matter how long it takes, there is an end to this and that there are others going thru the same thing.

    I saw a post in another area (my face is the worst ever?) about a 72 hr detox. Although my face now looks like I’m recovering from a severe burn, i.e. red swollen flaky unhealthy looking skin. It is an amazing improvement.

    I have copied it below. *Please Note This Was An Answer To A Specific Poster With Specific Dr Prescribed Medicines*

    72 hour detox:
    *Take a deep breath, try to calm down. You are experiencing a trigger induced facial flare up. Most likely a combination
    of foods and emotional stress. You are not alone, this is the most common side effect of Rosacea.
    *Continue to follow doctor instructions with antibiotic and metronziodaze. These are reasonable prescriptions.
    *Do not use any other products on your face besides metronziodaze.. Stop using a facial cleanser, facial moisturizers or acne creams.
    *Gentle cold water wash in the AM and PM only. Gently massage fingertips over face with cold water. Pat dry. Nothing more for 72 hours.
    *Take a no-drowsy antihistamine in the AM and PM (I recommend Clariton) for 3-4 days.
    *Replace coffee, tea, fruit juices, soda with water. Water will help flush the toxins out.
    *Reserve 20 minutes per day for the next three days for some low impact exercise such as walking. A 20 minute ‘brisk’ walk is excellent. This
    will help release serotonin in the brain. This is a natural anti depressant which should calm your nerves.

    Continue this routine for 3-4 days. You will notice a calming of the skin as the triggers are flushed out.

    I have been following this regimen for 3 days now and have seen a dramatic improvement. As long as I continue to see my skin healing I plan to continue with this plan. I will gradually reduce my use of antihistamine, but none of the other things on this list can do anything but help.

    So, again…I thank every single one of you, as I have read all your posts. This disease is life altering in every negative way possible. I have never felt so alone and ugly and miserable in my life, due to this disease. But! Thanks to you all, I do not feel so alone any more. 🙂 Good health to us all.

  5. Reba says:

    Hi Rhonda, sorry to hear you are going through hell.

    It is my feelings that you are experiencing TOPICAL STEROID WITHDRAW…check this site out http://www.itsan.org read Dr. Rappaports article and check out the forum. I am 3 years into my withdraw and experiencing wonderful skin at the moment.

    Hang in there…

  6. Patricia says:

    Dear Rhonda,
    I am sorry that you are suffering so much. I remember when I first learned that I had steroid induced rosacea and also found solace in this blog. Finally there were other people who had experienced what I was going through, helping with good advice and healing compassion.
    Know that you are in my prayers and heart. Big Kiss Patricia.

  7. Louise says:

    Hi. Just found this fantastic forum. Patricia, you sound lovely and i am glad you are finally through this.

    I am 13 months off the steroids and getting there slowly. I have a photo blog of my progress at http://topicalsteroidwithdrawal.blogspot.co.uk

    I am doing so much better now. I wish more doctors would accept the reality of steroid addiction.

    I wish you all well and speedy healing. If any of you have blogs, please let me know and i will happily add you to my blogroll. We all need to support each other. Itsan.org is a great resource.

  8. jazzman says:

    @Louise
    Hello, i see you have the classic symptoms of rosacea . i am still dealing with this nightmare, but each ‘flare’ gets a little bit easier. i dont rub my face as much as i use to , but the urge is still quite strong to rub as it is quite itchy (feels good temporarily like a mosquito bite)

    the skin is very reactive, i wish i could stop touching my face , but now its a habit. probably prolongs the healing.
    the problem is that when i rub the skin, sometimes i get rewarded by old dead skin that accumulates and it feels ‘clean’ to brush it off or remove it. But i should probably just leave it be , since if i touch it , red dots start erupting.

  9. jazzman says:

    correction, classic symptoms of **sterod induced** rosacea

  10. louise says:

    I would like some advice from “veterans” of the condition. I know Patricia said she was finally healed, but has anyone else on here experienced full healing? Do you think it is possible?

    I almost healed at 7 months, but then started flaring badly again at 12 months. I heard it can take 3 years on average. ANy thoughts on this?

  11. jazzman says:

    yes, its pretty slow to heal. its been more than 3 years for me and im not fully healed.

    But i think it depends on how long you used the steroid cream and what strength. Streroid creams come in 3 strengths, (or 4). i used a strength 2-3 steroid cream, and i applied the cream under a tight fitting face mask during winter, so i think it absorbed much greater. i thought it was a good moisturizer at the time, and my skin seemed not to get red , most moisturizers made my skin irritable . i thought i found a magic cream (boy was i wrong). i stopped when i realized i was getting spider veins, and much to my shock it turned out the cream had steroid in it.

    probably the worst aspect of healing is how unpredictable it is . but the good news is that youre healing (time is the cure). at times you will find it hard to believe you are getting better, (it isnt permanent).
    and i dont think you should rub it , because that causes it to erupt in more of those red pustules.
    for me, when i get in a flare, my face gets hot and then dots emerge. at first during flares i felt like i was going crazy, but ive gotten use to it . you will get use to it, adapt to it.
    i also think i may have another health problem, like my flares are accompanied by panic and adrenaline, palm sweating. but it hasnt been so bad lately .
    the worst flushing was the 1-2 years after i stopped it,

  12. Leslie says:

    Louise, Hi. It is Leslie here. I do not post any more on the Itsan forum but I still get emails from this one. I was on here a long time ago as I searched for what was causing my issues with my skin, it was a long time before ITsan ever existed, as a matter of fact, I met Reba on here long ago. re: your face, it will take forever to go away, I do not want to be negative, but my face is not 100 percent yet and I have been off steroids for 2.5 plus years. I was just now, getting flakes off my face again, as I do every single day of my life, and I hardly used any steroids on my face. for a long time, I had flare after flare over and over like clockwork. you may be like me, and if you are, it takes sooooo long to go away. the best thing to do is find a way to deal with it and do not get any hopes up when your face looks good.. now I am like a pro, I no longer stress when it comes back and it usually does. the problem areas are getting smaller now and my neck is very good just a few patches, my arms on the inner area are still a problem and so is my right nipple for some reason and behind my right knee.. so wierd. I too sometimes thing it will never go away but a lot is totally better now and I am mostly totally fine. If you ever want to communicate with me directly on email let me know… I stay away from the forum on Itsan now.. I still read it but no longer post. Noone ever took my advice anyhow on there….keep on going you can do it…

    Leslie

    P.s. Hi to Patricia, Jazzman, Ali and Reba.. you guys were my original skin friends.. Patricia, so glad you are doing great now… Yeah…..

  13. jazzman says:

    Hi leslie, its good to hear youre recovery is coming along

    What ive learned from all this, it helps to keep positive, to be appreciative of life, and even staying busy. Reading a book , watching a movie, get your mind off your face. and skip looking in the mirror, because it can be depressing waiting to see healing. ive had to lay down during these heat flares (and then i get shivers). so try to make yourself comfortable, avoid stress.
    i also think it may be a lot of people are dealing with side effects of steroids , not just those who apply it their skin (but take it orally)

  14. leslie says:

    Hi Jazzman,

    I am doing very well most of the time, I do not have too many issues any more. but I do think this takes a long time to go away for some people, myself included. I hope that it will be finally gone one day totally but I still have a few issues. I did not use very many steroids either compared to others and hardly at all on my face, so it can happen to anyone, even people like me who hardly use them. my main usage was a period of time about 11 years ago where I totally overused them for about a month for topicals and some steroid shots in my hands. then I did not use any steroids for years, minimally for another rash that I got about 4-5 years ago. I hardly used any of them, and still I had an absolute hellish reaction. and on my face, I barely used any at all, only a few times, and the weakest one… so strange.. but yes, I am doing very well now.. thanks,
    Leslie

  15. Chris says:

    So nice to hear I am not alone in all of this. My story is so very similar…. I was prescribed a compound for a small dry patch on my chin 2 years ago. What I wouldn’t give to have that dry spot back. I experience a horrible flare when I ran out of his “magic” compound and began educating myself. His compound was full of steroids. On top of the topical steroids, I had a bad case of poison ivy and received a steroid injection x2 and a dose pack x2…..which I believe made this all come to an ugly head.
    I am currently 3 month off topical steroids and although my skin doesn’t look awful,it feels horrible. Crazy burning. I wake up everyday and try to put on a positive, happy face for my family’s sake, somedays I want to die. I wish someone could tell me how long this will go on…..

  16. Swati says:

    Hi Chris,

    I was also suffering from this condition(Steroid Induced Rosacea) one year back. It went on for 8-9 months then I got control over it, I am all fine now. You can email me and I can help you the best I could. My email id is swati.shrma@gmail.com.

  17. Patricia says:

    Hi Guys,
    It’s been a long time since I have posted here too. I got really touched reading your post Leslie, and it is so good to hear that everyone has gotten a lot better, although not completely healed.
    My skin has recovered mostly, but not to the degree it was before my ordeal, and I also get mini flares here and there. It never bothers me anymore, though.
    I also had a lot of help having you fellow sufferers out there to talk to, and to went my anger at all the pain we all had to go through, because of incompetent doctors and greedy medicine companies.

    To all of you new sufferers, I am sorry it happened to you too, hang in there, use each other to went on this forum and get better soon!
    Peace and healing energy. Patricia.

  18. Patricia says:

    Sorry, soon is not the right word, but it will pass, thank God!

  19. priya says:

    Hi everyone,
    I have been having steroid created rosecea for a year or so and have been doing strict
    pitta pacifying diet and am off steroid creams also i have never taken any oral medication for it

    few tips that helped me a little that i can share are:
    put some fennel seeds,coriander seeds and cumin seeds in boiling water and drink it daily at least 3 cups it helps in digestion.
    Also i drink one cup of green tea and eat aloevera chunk fresh from aloevera plant on empty stomach
    milk with ghee in it and a pinch of cardamom
    u get everything from Indian grocery store.
    i also apply ghee on my face as a moisturizer every time just a bit of it to keep skin hydrated. Also you get Triphala tablets from banyan botanical site which helps in digestion as it has been known that rosecea is connected with ppor diet and digestion problems which needs to be taken car of

    will keep you posted once my condition gets better am still struggling with pimples and red rash all over my face:( i guess i really took it far with the steroids:(

    Priya

  20. Patricia says:

    Hi Privia,
    Good advice, I used ghee as a moisturizer as well, it was the only thing my face didn’t reject.

  21. lisa says:

    I think i have this but i didnt use steroids for too long. About 3 weeks straight with otc stuff.
    I am getting these yellow small blister pimples and some rrgular ones too. Is this normal?

  22. John says:

    I read somewhere that Gold Cosmetics had products to treat redness. So I bought their cleanser and creams. When I looked in the ingredients, it had steroids. Even the OTC products may have it.

    I also went through a steroid withdraw for approximately 6 to 7 months. In the beginning, I attempted to stay indoors, lost weight, and placed ice cold towels on my face every night to calm the redness and painful episodes.

    After the withdraw I still suffered from some redness. After years of trying different methods, I realized cutting back on alcohol, sugars and gluten products along with fatty foods helped with the redness. Also, during the withdraw symptoms, diet is also key along with taking vitamins such as oil of oregano and ksn skin care vitamins sold on Amazon. Mild aloa vera facial soaps and getting plenty of rest and relaxation help.

    Sometimes a doctor can prescribe a mild relaxant medication to assist with the emotional stress of the withdraw.

  23. lisa says:

    Ahhh thats nice to know. I just recently stopped moisturizing.
    Well see how it goes. John, did you get pimply blisters?

  24. John says:

    Lisa,
    I have a seborrhea type of rosacea so I get red, but no blisters. I was fortunate not to get blisters, but I suffered from acute acne with redness as a teenager and had to take Accutane. In small doses for the recommended period of time it will remove all the acne or blisters. I never had another issue with acne so I’m one who would recommend it for complete remission of pimples or acne. Accutane shrinks the sebaceous glands. Its a strong drug, but blood tests are taken to check your liver count. It worked wonders for me and I still don’t regret taking it. I took a steroid cream for a few years after the accutane for the seborrhea/rosacea and it took me 6 to 8 months to recover from it. As you can see, Accutane will only remove the pimples/acne but not the rosacea at least for my case.

  25. lisa says:

    I see. Thanks john. What were your symptoms while you were recovering from the steroids?

  26. John says:

    Lisa,
    Extreme redness around the front part of my face. Burning and itching. I found about steroid addiction through a physician in California. He said many of his patients were going through the addiction withdraws. Worst pictures I saw were the ones who used steroid eye drops. His patients appeared to have raccoon eyes. I had to attend class and it was psychologically difficult for a while. I also got several stares from people on the street. The good news it gets better with time. Ice cold towel applications at night helped with the swelling. Diet is key. I stopped drinking, smoking and any foods that could trigger a flare. Your skin will be very vulnerable. I noticed even with one cigarette, my skin would immediately flare. The withdraw flares are bad, but again it gets better with time. Don’t get back on the steroids. Unfortunately some of my doctor’s patients went back due to the severe withdraw side affects. I saw your previous post about not using moisturizers, but I use a little bit at night now to offset triggering the sebaceous glands or causing part of the redness. I use an oil free moisturizer, Alba Botanica Hawaiian oil free moisturizer that contains aloe and green tree. I realize I keep mentioning diet, but for us who suffer from skin disorders, its key. I avoid sodas and drink plenty of water. Now, once a week preferably on the last work day of the week I’ll drink alcohol and eat something greasy just to stay sane.

  27. John says:

    Just an added note, a 20mg of Pepcid prior to lunch and an aspirin helps with redness and flares. I also apply sunscreen twice a day, and wash my face three times a day with a mild soap and just a little bit of salyic acid (extra strength Dennorex). I suffer from seborrhea so I have to use Dennorex four times a week to remove the excess oil from the scalp that can add additional unwanted oil to my face. There’s a lot, but as everyone mentioned, keeping a diet helps. The steroid addiction will eventually subside depending on how long you used the steroids.

  28. lisa says:

    Thanks for the encouragement john.
    I hope it will subside. And didnt actually give myself real rosacea.
    And i hope the rashs start to go. Its so disheartening to see how badly your skin cn deteriate so fast. I resorted to just wash with water and let nature take its course. Hopefully things will be for the better.

  29. John says:

    Most of us in this forum have to deal with serious skin issues. I looked back at my pictures as a teen and saw the redness. Now with the internet you can research on it. I’m disappointed with those who want you to buy their books on how to successfully treat skin disorders. I only found one real solution and that’s controlling my diet, using mild soaps and taking lots of vitamins.
    I guess the way I got through the bad episodes was to think there could be worst things in life. And as long as you smile and stay kind, people look past the skin problems you see as really frightening.

  30. lisa says:

    Thanks john.
    Ive never had any skin issues growing up. Just acne on the back and that was it really. So this is a big blow to me. Hopefully skin can recover itself. And quickly.

  31. Harold says:

    I stopped using a steroid creme on my face about a month ago, I used it for two weeks to fight a fungus/bacteria infection. I applied it to the cheek area next to the nose. My face now looks shiny, nose is red oily and itches at night, and I can see small capillaries. I’m traveling in South America and can’t go home for a few months, can someone give me advice? Right now I wash my face once a day with regular bath soap, then put some aloe vera gel on. I also stay out of the sun because I found that my face turns even more red. Will I heal in time?

  32. Dale says:

    Buy a better quality soap and use a good quality sunscreen. Two weeks is not a long time to be on a steroid cream. You shouldn’t have the same issues most of us had.
    An added comment, a forum mentioned hormonal imbalances may be the main cause of the redness. I think he/she is right.

  33. Caryn says:

    We all heal differently it seems and at different rates. I used an over the counter strength hydrocortisone cream on my chin to treat a rash. Used it for about ten days on my chin only. Then shortly after stopping it I had the same reaction that you are describing (Harold, from post earlier today ). My face became oily, red, shiny, hot and flushy. And also very itchy as you describe. It has now been 4 1/2 years. It is much improved and does not react as often as it used to. But it is not the same as it used to be. But defintiely better. I am very sensitive I suppose and really reacted very badly to the hydrocortisone. My thoughts are with you and I hope that your healing time is much more rapid.

  34. Harold says:

    Thank you Caryn and Dale for your comments
    I guess I just have to hope for the best and wait it out
    Do you have any tips or suggestions for covering the redness?
    I’m 34 and looks aren’t too important but I still don’t want people staring at me. Thanks

  35. Harold says:

    It has been 42 days and my skin is still very sensitive, red and oily. When I get back to the States I’m going to see a dermatologist just to be safe. Hopefully he or she will help me through this. I changed my face soap to dove and I’m still moisturizing with aloe. I read somewhere that steriod induced rosaeca does get better in time and that it isn’t permanent, if I’m lucky I’ll see some improvements before I go home. I’ll keep you posted.

  36. Disha says:

    Hi All
    I have been using Betnovate N from the past 10 years. I have been diagnosed with steroid dependent rosacea.
    I am tapering off the steroid cream slowly now coz in the starting it gave me terrible flare.
    Even now i have nasty rebound effect. My cheeks are burning hot, kindly guide. How long the burning will last. m So depressed

  37. ivan says:

    I’ve been using cortisone for 1 1/2 year how long you guys think it would take to SIR to go away?

  38. Eileen says:

    I am fully recovered!!!! I stopped ALL steroid use in March, I threw everything away in my house that had any steroid in it. Was it horrible, YES! But I finally have my face back. I started drinking green tea everyday and putting the tea bags on my skin, ibuprofen every day and coconut oil at night to moisturize. I didn’t think I would ever have a clear complexion ever again, but here I am 9 months later, and I am not embarrassed to show my face, thank you thank you thank you!!

    • ivan says:

      Eillen thats awesome news.. I hope I’ll get there one day this SIR is kicking my butt. I just have some questions to ask you. what kind of steroid did you use ? and for how long? did you get p&p or just facial redness and dryness?

    • ivan says:

      Eillen thats awesome news.. I hope I’ll get there one day this SIR is kicking my butt. I just have some questions to ask you. what kind of steroid did you use ? and for how long? did you get p&p or just facial redness and dryness?

  39. Disha says:

    Hi Ivan,
    Howz your recovery goin on?

  40. simminarula says:

    Hi,
    I have been diagonized with steroid induced rosacea and its been 25 days that I am on antibiotics and some other medicines for the treatment . I have been prescribed to used Fucidin H with cetaphil moisturizing cream to clear up the drying patches. I believe fucidin H is helping me in the treatment and it is suiting my skin texture too. Should I ask my dermatogolist before increasing the application of this cream on my skin? s

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