Steroid withdrawal question
Joined: 26 Jun 2006
Location: BC
| Posted: Sun Feb 17, 2008 3:12 am Post subject: | |
| You may want to do a bit of research here and elsewhere before trying the protopic. I found it was hell on my face, an experience that is not unique. _________________ Do what you feel in your heart to be right, for you'll be criticized anyway. You'll be damned if you do, and damned if you don't. – Eleanor Roosevelt |
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Joined: 18 Oct 2007
| Posted: Sun Feb 17, 2008 8:09 am Post subject: Steroid Addiction vs. Steroid Rosacea | |
| I think it is important to note that Steroid addiction and Steroid Rosacea are not the same. Steroid Rosacea can be difficult to differentiate from other skin disorders such as regular Rosacea, bad seb derm, atopic eczema, etc. Steroid addiction syndrome (as described in Rapaport's article the burning red face which anyone can buy off pubmed for $5.00) is a specific dermatitis that has very specific characteristics: including constant red burning facial skin, save for and except the sparing of the nose and upper lip. The key here is the sparing of the nose, Rosacea (and steroid Rosacea) will of course give us the now well known butterfly flush across the cheeks and nose area. Steroid addicition also frequently sees eruptions of dermatitis at sites where no steroid was ever applied, such as the neck or arm when it was applied to the face whereas steroid rosacea is localized to the facial skin.
When I spoke of the time to clear I am speaking of steroid Rosacea. Steroid addiction is something altogether different and although Rapaport's article mentions that the time it takes to become addicted to steroids was in one case as little as 3 months, the norm is years of application of potent flourinated topicals and/or oral steroids. The chances that someone developed steroid addiction from 4 months of desonide and hydrocortisone butyrate use would be slim to none. Steroid rosacea...maybe some people are just sensitive to it. BTW Twickle, just to throw in my 2 cents I also couldn't stand protopic, lit me up like a bonfire, but it has helped a number of people, boo2fr is right there are actually 3 studies now showing it can be of great assistance in clearing steroid dermatitis, stubborn seb derm and recalcitrant atopic eczema. Patch testing it is a good idea though. |
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Joined: 07 Jan 2008
| Posted: Sun Feb 17, 2008 2:59 pm Post subject: Re: Steroid Addiction vs. Steroid Rosacea | |||
I have not had any patch testing. I'll ask my derm/allergist about it and see what they can do. What would I test for? Can they do things like various ingredients in moisturizers? I am even more confused about my condition now!!! I used the steroids for four or five months, twice a day. I flared when I stopped them (cold turkey) and then flared again when I finished a three week round of Pred. However, I have the butterfly rash on my face. It does not affect my nose, but I have noticed that my nose will flush from time to time, especially at night after I wash my face. It doesn't hurt or burn or anything, just kind of pink for a 1/2 hour or so, then goes away. I do have redness above my lip, though, but I had also put steroids there on a dry patch. I started out blotchy, but my forehead is now almost completely red, no longer blotchy, and my cheeks are much more symmetrical now, the spots a bit larger than when I first started this, and pretty red, too. Can I have a little of both, steroid withdrawal AND steroid rosacea? My derm the other day said it looked like a steroid "flare" most likely brought on my the use of steroids. I also tried 100mg of doxy last night and woke up with puffy eyes, which is exactly what happened when I tried Oracea for a few days. I don't think I can take doxy. Just another thing to cross off my list! So FRUSTRATING!!!! ~J |
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Joined: 26 Jun 2006
Location: BC
| Posted: Sun Feb 17, 2008 4:53 pm Post subject: | |||
Very interesting about steroid addiction, J-Mill. I also read your other informative posts and wonder if any one has considered steroid allergy?
source It is much more common than is generally understood. I believe it is now ranked the 7th highest med in terms of risk for allergic reaction. Because of the steroid response (reaction dampening) it becomes challenging to diagnose because it dampens its own reaction. I use Clobex (Clobetasol Propionate) only now, because I have developed this problem yet still require the steroid.  I am hoping there are some profound breakthroughs in my lifetime...
I have to add, in case someone else is offered Prednisone for a skin rash, that in my history of chronic skin inflammation, I have been hospitalized many times, studied at teaching hospitals (very dehumanizing) and seen more derms than I can recall, I RARELY was prescribed oral prednisone unless I had generalized (all over) severe inflammation that was not responding to everything else that was tried -- first. And also when my adrenals become suppressed due to load, at which point the course is tapering. The recent posts of folks who were prescribed oral prednisone surprises me a bit. The side effects are serious with this stuff, even short courses can have long term implications. Steroids are the true Jekyll and Hydes! A skin rash which has prednisone prescribed should, generally, mean there is an autoimmune disorder manifesting the rash, something that takes specific testing and accurate diagnosis. I am left wondering if derms are becoming irresponsible (and lazy) with this stuff. Of course, derms are one of the longest educated physician specialists we see, not to say they are perfect because many stories here illustrate they are not, but my point is that they are the best source of information and guidance. A facial rash can be a minor irritant or a sign of something serious. I hope to give anyone reading this pause before they accept this medication for a facial rash without a specific diagnosis for which it is called for. Prescribing this casually is as irresponsible as physicians dispensing antibiotics without first determining what, if any, infection they are fighting. _________________ Do what you feel in your heart to be right, for you'll be criticized anyway. You'll be damned if you do, and damned if you don't. – Eleanor Roosevelt |
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Joined: 18 Oct 2007
| Posted: Sun Feb 17, 2008 5:45 pm Post subject: patch testing and steroid allergy | |
| boo2fr / Twickle,
Yes, when they do patch testing they can and usually do test for allergies to the ingredients in moisturizers/cleansers, etc. It's not a comfortable test, they tape all of these little "samples" to your back and they have to stay there for 48 hours. With respect to steroid allergy the doctor that did my patch testing advised that although there are actual cases of steroid allergy they are extremely rare, often though the person turns out to be allergic to something in the steroid's base. Further she added that an actual allergy to one type of steroid (for instance desonide) rarely would involve an allergy to others, she has never seen anyone who is allergic to all steroids but has heard that such cases exist in the literature. I agree about oral prednisone as well, I think doctors turn to sledgehammers to treat a finess problem all to often. If your going to use steroids why not try 1% hydrocortisone first given the extremely safe profile. I was offered oral pred. by a derm (derm #3) that is when I stopped seeing them. Ora pred. has its place, as a last line treatment option. Clobex? Yikes, it is thought to be 1800 times more potent then 1% hydrocortisone, you are a brave soldier Twickle, you do what you have to do right? Boo2fr, I would think its unlikely you have steroid addiction, but steroid rosacea would likely be on any derms differential diagnosis for you. It is also not only possible but likely you are having rebound flares from the sudden withdrawl of steroids, what kind of derm doesn't suggest a tapering process? Not a good one obviously, it is "Steroid 101" that you have to taper it, skin doesn't like it when after months of suppressing its natural responses it all of a sudden is free to "run amok" again! Note a rebound effect is different from a diagnosis of true steroid addiction. Rebound can be solves by going back on proper topical steroids and tapering off. If you have steroid addiction, tapering won't do squat, only complete withdrawl would ultimately resolve the issue over time. Given the steroids you were on and the complete sudden withdrawl method your derm used, rebound would be very probable. Given your description of the original problem and your continuing issues there sounds like there may very well be an atopic/allergy issue involved. Is there any neck involvement? My patch testing allergist/derm did mention that as very common for atopic responses, one of those beacons doctors look for. |
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Joined: 07 Jan 2008
| Posted: Sun Feb 17, 2008 10:59 pm Post subject: Re: patch testing and steroid allergy | |
| I agree about oral prednisone as well, I think doctors turn to sledgehammers to treat a finess problem all to often. If your going to use steroids why not try 1% hydrocortisone first given the extremely safe profile. Ora pred. has its place, as a last line treatment option.
In my derm's defense (which I won't defend her much!) the first round of pred was a one week dose of 20 or 40 mg. It came after a couple months of trying topicals. I think she thought it would knock the rash our and then she would maintain it with topicals/moisturizers. It didn't work, though. When I came off it came right back, worse! Clobex? Yikes, it is thought to be 1800 times more potent then 1% hydrocortisone, you are a brave soldier Twickle, you do what you have to do right? Funny that that is such a strong one b/c it's the FIRST one derm 2 prescribed for the eczema on my hand! It works, really fast! I only use it once every couple months, if at all, and it clears it right up and I can maintain with moisturizers or less potent steroid cream. Given the steroids you were on and the complete sudden withdrawl method your derm used, rebound would be very probable. Can the rebound subside without going back on the topicals? I'm hoping that the Protopic won't burn and will give me the relief the steroids would if I went back on, but we'll just have to see! I think the derm, again, thought that the second round of pred would get it under control and then she could maintain it, but as soon as I started tapering it started getting even worse than when I started. I never went back on topicals, though. The derm, herself, was very confused! Given your description of the original problem and your continuing issues there sounds like there may very well be an atopic/allergy issue involved. Is there any neck involvement? My patch testing allergist/derm did mention that as very common for atopic responses, one of those beacons doctors look for. Yes, there is neck involvement. When I came off the three week round of pred, my neck got very blotchy, rashy, and itchy. A little on my chest, too. The derm saw it and thought it looked like an inflammatory response to something (um...my face!). I did use steroids on that and it calmed down and is fine now. I maintain with moisturizer, Aveeno Eczema care products and a little dab of Desonide when needed. ~J |
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Joined: 18 Oct 2007
| Posted: Mon Feb 18, 2008 5:27 am Post subject: Rebound | |
| Yes, rebound can subside without going back on steroid topicals, immunodulators like protopic are one option. Another is to "ride it out", but this can be frustrating and uncomfortable.
The neck involvement is very interesting and sounds atopic, remember like the poison ivy example, you can get rashes in areas the substance didn't even touch if you are allergic enough to it. I would at least rule out the possibility that you are allergic to something you are applying through patch testing. I had a colleague whose father-in-law started getting wide spread hives for no reason, after many doctors scratching their heads and trial and error they discovered that he was allergic to the fireproofing substance on a new mattress he had purchased. It can be like trying to find a needle in a haystack. |
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