Steroid induced rosacea

[trixp]

I was diagnosed with dermatitis about 3 yrs. ago, a small area on my chin. I was given hydrocortisone cream 2.5% for it. I continued to get small red patches, and was advised to continue the use of the HC. I now have steroid induced rosacea because of this and have recently stopped using the HC about 6 days ago. As expected, I have flared terribly and my face is red, slightly swollen, and feels very tight. I have been given erythromycin pads (applied 2X daily) and also azelaic acid cream (20% azelex, 1 X daily). My question is does anyone know when I can expect the flare to reach it's peak and start to heal. I know it may take 6-8 weeks for it to heal, but when can I expect it to stop the horrible flare. I don't even want to leave my house.

TrixP.

[phlika29]

Trixp

Hi and welcome to the forum. There are a number of members here who have steroid induced rosacea and so I am sure you will find people in similar situations as you.

With regards you specific question about the post hydrocortisone flair I am afraid I am not the best to advise. J-Mill has talked on occasions about how best to limit this issue and I would advise either searching out his posts or generally searching the similar/co-existing section.

This link may help a little.

A few threads to get you started:
http://www.rosaceagroup.org/The_Rosa...ad.php?t=15770
http://www.rosaceagroup.org/The_Rosa...ad.php?t=15760

best wishes

Sarah

[bam85]

HI Trixp.

I went through the same thing. I used a steroid cream for about 4 months on my upper lip area. I finally got tired of having to use it everyday and seeing that my face would still get bumps and what looked like small lesions. I got off the steroid cream, and my face after about 2-3 days flared and looked really bad. I was so scared my face would stay like that forever!! I went to a new derm. and he gave me doxycycline for 4 weeks and then some other antibiotic for another 10 days. It now has been 4 months since I used the steroid cream and although my face is not back to normal it is a lot better. I have good days and then I have really bad days where I feel really down and tired of dealing with it. I know exactly what it feels like to not want to leave your house. Everyday I find myself on the computer trying to find what I can do to reverse my skin back to its normal state, but I guess the only thing we can do is be patient and never use steroid creams again. I hope you get better and if you have any question feel free to contact me.

[dryeyeday]

Sometimes, in order to avoid a full blown steroid flare the doctor will give you a steroid shot. This is suppose to help wean you off the steroid slowly. It is worth asking about.

I am so scared of steroids of any kind now...I avoid them at all cost. I had to have my wisdow teeth out last year, and when they told me the sedation IV had antibiotics, and steroids in it to prevent swelling...I refused it. They then agreed to just give me only sedation, and antibiotics.

[J-Mill]

Originally Posted by trixp

I was diagnosed with dermatitis about 3 yrs. ago, a small area on my chin. I was given hydrocortisone cream 2.5% for it. I continued to get small red patches, and was advised to continue the use of the HC. I now have steroid induced rosacea because of this and have recently stopped using the HC about 6 days ago. As expected, I have flared terribly and my face is red, slightly swollen, and feels very tight. I have been given erythromycin pads (applied 2X daily) and also azelaic acid cream (20% azelex, 1 X daily). My question is does anyone know when I can expect the flare to reach it's peak and start to heal. I know it may take 6-8 weeks for it to heal, but when can I expect it to stop the horrible flare. I don't even want to leave my house.

TrixP.

I may be able to give you some advice but a few questions:

1. When you say dermatitis I take it you mean atopic dermatitis (also known as eczema), is this correct? What is the status of this skin problem.

2. Were you diagnosed with steroid Rosacea and if so what did you face look like BEFORE going off the steroid. That is prior to stopping the steroid, did you flare, and if so where and what did it look/feel like?

3. Are you getting pustules and papules, and if so, did this pre-exist the "steroid rosacea"?

4. What is the name of the erythromycin pads you were given?

The good news is if it is steroid rosacea, unlike common rosacea, it is curable.

[bam85]

Hey J-Miller
I'm still dealing with the healing process of using a steroid cream on my face. I was wondering if you have any advice.
I used a steroid cream on my upper lip for 4 months, that was back in March. 4 months later my skin is a lot better, but I have tiny tiny red bumps in some areas, kinda rash-like. It looks like my pores are swollen in some areas. Do you think my skin is just healing?
I think initially what I had were two bumps on the side of my nose due to stress, thats what led me to see the derm. He thought maybe it was seb. dermatitis and gave me the steroid cream. I knew I didn't have what he thought, since there was no flaking or dryness just to bumps that wouldn't go away. I believe that it probably was just the beginning of perioral dermatitis, or who knows. I would tell him that I was still having problems with my skin and he'd say to continue using the cream. If I only knew then what I know now!
My skin doesn't itch and the upper lip area (where I put the steroid cream on) only seems to blush after I wake up when I start to talk or have something to eat. I've been using products by california baby which don't seem to irritate the area. I just want my skin back to normal so I can get on with my life. It has been so hard dealing with this and I know others can relate.
I know you've been on the forums longer and I was hoping you could give us hope. Thanx.

[trixp]

J-Mill
Answers to your questions:

1. When you say dermatitis I take it you mean atopic dermatitis (also known as eczema), is this correct? What is the status of this skin problem. Initially it was just called atopic dermatitis/eczema. I went back after finding out that I was pregnant (with my second child, no skin conditions with the first pregnancy), and was told it was seborrheic dermatits, which after doing some research looking back, I really doubt it was, none of my symptoms matched the description of it. Anyway, the initial problem cleared quickly, within a week or so, but that's when I started to develop small red patches on my chin/cheeks sporadically.

2. Were you diagnosed with steroid Rosacea and if so what did you face look like BEFORE going off the steroid. That is prior to stopping the steroid, did you flare, and if so where and what did it look/feel like? Prior to stopping the steroid my skin was pretty clear, because I was constantly using the steroid to keep it that way. I stopped using it 3 days prior to my derm appointment to be able to show the derm what it looked like if I stopped. My skin became red, and slightly swollen on my chin, around my mouth, and up one of my cheeks. Basically all the places that I had used the steroid. It made my skin feel very tight, like I had a bad sunburn. The derm said it looked more like acne/rosacea than dermatitis.
3. Are you getting pustules and papules, and if so, did this pre-exist the "steroid rosacea"? No pustules, papules yes, I believe that's what they would be called. They are red slightly raised patches. They didn't really exist prior to the rosacea.

4. What is the name of the erythromycin pads you were given? Ery 2% Pads (Erythromycin Pledget USP, 2%)

I think I forgot to mention in my original post that I am 6 months pregnant with my 3rd child, so I guess treatment options are limited, I am praying for some type of improvement with this initial flare. Thanks for the comments.

TrixP

[J-Mill]

Originally Posted by bam85

Hey J-Miller
I'm still dealing with the healing process of using a steroid cream on my face. I was wondering if you have any advice.
I used a steroid cream on my upper lip for 4 months, that was back in March. 4 months later my skin is a lot better, but I have tiny tiny red bumps in some areas, kinda rash-like. It looks like my pores are swollen in some areas. Do you think my skin is just healing?
I think initially what I had were two bumps on the side of my nose due to stress, thats what led me to see the derm. He thought maybe it was seb. dermatitis and gave me the steroid cream. I knew I didn't have what he thought, since there was no flaking or dryness just to bumps that wouldn't go away. I believe that it probably was just the beginning of perioral dermatitis, or who knows. I would tell him that I was still having problems with my skin and he'd say to continue using the cream. If I only knew then what I know now!
My skin doesn't itch and the upper lip area (where I put the steroid cream on) only seems to blush after I wake up when I start to talk or have something to eat. I've been using products by california baby which don't seem to irritate the area. I just want my skin back to normal so I can get on with my life. It has been so hard dealing with this and I know others can relate.
I know you've been on the forums longer and I was hoping you could give us hope. Thanx.

What steroid were you using on your upper lip incidentally? Steroid rosacea from 4 months of use of a non-flourinated steroid in such a small area is highly unlikely IMO. Some derms are stupid though and hand out whatever sample they have in their office, I have heard of people being given potent steroids for facial skin despite the clear contraindication in the prescribing information. As such, steroids get a bad name. I read up extensively in this area before choosing to use hydrocortisone 1% on my face to keep my seb derm under control (seb derm and rosacea dx for me, both pre-exist any steroid use). I have used it for 2 years now without problems. Other users here have used it for decades, not sure why derms insist on handing out more powerful stuff before trying the mild stuff.

Anyway, I agree the initial diagnosis of seb derm makes no sense. I am also not sure how 2 bumps on the side of your nose resulted in use of the steroid on the upper lip, I am assuming the bumps spread there. The upper lip BTW is an extremely uncommon area for Rosacea, in fact, some textbooks suggest it is a reason to doubt the diagnosis. My upper lip is the only area I never have problems with Rosacea or Seb Derm. Periorial Dermatitis is a more likely culprit, but it normally involves a number of pustules.

Bottom line, I don't think you have steroid rosacea. Steroid Rosacea would be a likely diagnosis if while you were using the steroid you developed a scaly red pustular rash. You didn't develop anything until after you withdrew the steroid (abruptly). Sounds like you were developing some skin issue prior to ever using the steroid. The steroid suppressed this skin issue, you then abruptly stopped the steroid, this causes a well documented effect known as rebound where the initial skin condition comes racing back with a vengeance. The abrupt stopping of steroids is not recommended, you have to taper. I always tell people if you have been using steroids for a number of months you need to half your applications for at least 2 weeks and then half again for a week and then maybe 1 or 2 applications the next week and then come off. (For example, if you used is 2x a day for 4 months, use it 1x a day for 2 weeks, every second day - once a day for a week, and then once or twice - once a day the next week and then quit).

You have a few options but getting a better derm to have a look is the one that makes the most sense. If I am right and it is not steroid rosacea you need someone to look at it and tell you what it is. It may be that a derm would suggest that you clear the rash again with steroids and taper off this time. If I am wrong and it is steroid rosacea, you should be using oral antibiotics and perhaps a topical as well if you can tolerate any of them.

Within 6 months it should clear completely - if it does not the dx should be reconsidered (presuming abstinence from topical steroids). This treatment has the benefit of also being effective against periorial dermatitis. Doxycycline is the most commonly prescribed antibiotic for these disroders, if you cannot take tetracyclines I suggest a macorlide like azithromycin. Steroid rosacea is the only rosacea that is curable, if it doesn't go away in 6 months it is not steroid rosacea.

Good Luck.

p.s.

[J-Mill]

Originally Posted by trixp

J-Mill
Answers to your questions:

1. When you say dermatitis I take it you mean atopic dermatitis (also known as eczema), is this correct? What is the status of this skin problem. Initially it was just called atopic dermatitis/eczema. I went back after finding out that I was pregnant (with my second child, no skin conditions with the first pregnancy), and was told it was seborrheic dermatits, which after doing some research looking back, I really doubt it was, none of my symptoms matched the description of it. Anyway, the initial problem cleared quickly, within a week or so, but that's when I started to develop small red patches on my chin/cheeks sporadically.

2. Were you diagnosed with steroid Rosacea and if so what did you face look like BEFORE going off the steroid. That is prior to stopping the steroid, did you flare, and if so where and what did it look/feel like? Prior to stopping the steroid my skin was pretty clear, because I was constantly using the steroid to keep it that way. I stopped using it 3 days prior to my derm appointment to be able to show the derm what it looked like if I stopped. My skin became red, and slightly swollen on my chin, around my mouth, and up one of my cheeks. Basically all the places that I had used the steroid. It made my skin feel very tight, like I had a bad sunburn. The derm said it looked more like acne/rosacea than dermatitis.
3. Are you getting pustules and papules, and if so, did this pre-exist the "steroid rosacea"? No pustules, papules yes, I believe that's what they would be called. They are red slightly raised patches. They didn't really exist prior to the rosacea.

4. What is the name of the erythromycin pads you were given? Ery 2% Pads (Erythromycin Pledget USP, 2%)

I think I forgot to mention in my original post that I am 6 months pregnant with my 3rd child, so I guess treatment options are limited, I am praying for some type of improvement with this initial flare. Thanks for the comments.

TrixP

I will simply say I would be shocked if 1 week of hydrocortisone 2.5% use, even if you used it 4x a day on your entire face would cause steroid rosacea. It would be the first documented case in the history of dermatology. Steroid rosacea normally occurs when someone uses a potent flourinated steroid on their face for long periods of time (we are talking months and years here, not days).

I would see my reply post to bam85 just before this one and would say the same thing about your situation. Your choices of treatment are more limited (most oral antibiotics are class B drugs for pregnancy). The pledgets you are using though are a horrible option IMO, the base that the erythromycin is in is ethyl alcohol and propylyn glycol, no wonder your skin is red and sore, and you are using skinoren on top of it which could only be increasing the sensivity. It also makes no sense if it is steroid rosacea, which is curable with oral and/or topical antibiotics. In the short term I would get a better topical antibiotic, something in a gentler base - such as a cream or lotion. In the long term get tin to see a decent derm., I think you are being misdiagnosed and even if your diagnosis is right the treatment IMO is wrong.

Good Luck.

[bam85]

Thanx so much for your reply.
I'm so confused on what is going on. Maybe I was getting perioral dermatitis at the beginning of all this. The thing is, right after I stopped using the steroid cream the derm. gave me doxycycline to take for 4 weeks and then some other antibiotic for 10 days, i think it was called amoxcillin. I remember him scraping a bit of my skin when it was flared and told me that the results indicated normal flora bacteria, what does that mean? Everything seemed to get a lot better during that time. But after the 10 days I again started to get a few swollen pores pink in color (i guess thats how i can describe it cuz thats how small they were) I again began taking Doxycycline, I thought that maybe my skin was still reacting to the fact that I wasn't using the steroid cream, which by the way was Locoid for about the first month and then desonide for 3 months. Im still on doxy (10 weeks tomorrow). I thought by now those rash like bumps would stop popping up, but they haven't.
Could it be that Doxycycline is just not working?
I wish I could figure this out because sometimes I feel that a dermatologist doesn't know what it is and just makes you try stuff that could only make it worse.
Thanx again J-Miller for your interest in all this.