I can personally vouch for how terrible it is to completely stop topical
steriods immediately. Please don't do it, I wouldn't want anyone to experience
what I did. My PCP (I should say former PCP) had prescribed Lotrisone cream for
my rosacea. I did not know I had rosacea at the time, the doctor thought I had
some fungal infection on my face. I became unexpectedly pregnant and was
advised to stop taking it immediately. I was not put on anything at all since I
was/still am pregnant. It was a complete nightmare when I woke up one night,
about 2 nights after I discontinued the cream, with my face stinging and burning
so bad I found myself dunking my head in a cool sink of water. I then rubbed
ice on my face, stuck my head in the freezer, you name it I probably tried it
for relief. Nothing I found made it feel any better. I literally screamed at
one point I was so frustrated. It felt like ant stings all over my face. My
entire face turned bright red over the coarse of a few
days and completely covered in p&p, except at my temples and around my eyes. I
went to the doctor (the same one) again and he told me to lay out in the sun and
put egg white on my face. I followed his advise which made it even worse. I
had a family reunion that next weekend and I went anyway, but spent the entire
time trying to explain my facial condition. I then went to a dermatologist and
found out I had rosacea. That was about 2 months ago and things are slowly
looking..well, at least somewhat better. That doc should have known better, I'm
sure I could have diagnosed myself had I even known what rosacea was.

drnase2000 <drnase1000@...> wrote:



"A GP perscribed Elocon 0.1% and used that for the past 18
months. Last Friday, I quit using the Elocon "



Hello,


I am so sorry that you were treated with this moderate level
steroid. Please do not stop all of a sudden, especially after 18
straight months of use. This is a horrible mistake by the GP and
you should call in and speak to him in person and warn him to never
treat facial redness with topical steroids -- tell him that he/she
personally induced steroid rosacea in your case.

Steroid-induced rosacea is still quite common because well-meaning
physicians routinely use topical steroids to treat facial redness
and inflammation. Topical steroids of any concentration should never
be used to treat rosacea sufferers or patients who show pre-rosacea
symptoms (i.e., facial flushers and blushers). With continued use,
topical steroids thin the epidermis, weaken the blood vessels, and
worsen facial flushing. One of the most important first steps that
rosacea sufferers can take is to wean themselves off topical
steroids.

The major problem with discontinuing topical steroids is that
rosacea sufferers usually get worse before they get better. They
almost always experience rebound flares that cause their faces to
become more red, inflamed, and sensitive. (33) Under normal
conditions, this can take weeks to reverse, and months for the skin
to fully heal itself. (33) To decrease this rebound flare and speed
up the healing process, medical experts now recommend a very
effective four-step approach to weaning off topical steroids:

1. First Step – begin treatment with oral anti-inflammatory
medications: Physicians recommend that rosacea sufferers begin
treatment with oral anti-inflammatory medications one to four weeks
prior to weaning off topical steroids. This pre-treatment therapy
can help decrease inflammation, and reduce the intensity of steroid-
withdrawal flares. Popular oral anti-inflammatory medications being
used to decrease the rebound inflammation include:

• Clarithromycin – 250 milligrams twice a day. (56, 57)

• Minocycline – 100 milligrams twice a day. (58)

• Very-low-dose isotretinoin – Drs. Plewig and Klingman recommend
isotretinoin at 5 milligrams per day. (59)

2. Second Step – reduce the amount of topical steroid applied
to the facial skin: After the initial oral anti-inflammatory
therapy, rosacea sufferers are instructed to start weaning off
topical steroids. During the first week, rosacea sufferers should
simply reduce the amount of cream that they apply to their faces
(i.e., use less cream and less applications per day).

3. Third Step – decrease the strength of the topical steroid:
Over the next two to four weeks rosacea sufferers should decrease
the strength of the topical steroid in a stepwise fashion. Rosacea
sufferers should wean themselves down to 0.5% over-the-counter
hydrocortisone. Begin to use Elidel as this is FDA approved for
steroid rosacea.

4. Fourth Step – slowly replace the steroid with topical anti-
inflammatory creams: Eventually, rosacea sufferers will be able to
permanently replace the steroid with metronidazole-based creams such
as noritate#61652; or metrogel#61652;. Some physicians also recommend topical
zinc oxide for healing steroid-induced rosacea. (60)

Note: Most rosacea sufferers would be wise to stay on oral anti-
inflammatory medications throughout the entire withdrawal process
until the skin and blood vessels normalize.

I will not sugar coat this for you at all because that would not be
in your best interest. You will need to treat this very seriously
and follow the above list step by step or your face will literally
feel like it has a third degree sunburn and your epidermal skin will
slough off and bleed. Please be very careful. I would rather
someone warn me about what was about to happen if I was not careful
than sugar coat it pat you on the back and tell you everything is
going to be OK. As long as you have been using this steroid, that
is how long it will take your skin to recover.

BTW, do not have any vascular laser treatments performed for a while
because your dermis and epidermis are not physically prepared for
laser treatment.

If you want, give that GP my name and email address
drnase1000@.... I would like to help guide him and yell at
him at the same time.

You will get through this, but it will take a while.

Kind Regards,

Geoffrey
______________________________

Dr. Geoffrey Nase
Ph.D. Neurovascular Physiologist
http://www.drnase.com
______________________________











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