Geoffrey,

You know me well enough to know that I am not easily impressed, but
I continue to be amazed with your ability to communicate key issues
so effectively and responsably (and often ...).

If there is one aspect of the performance of derms that continues to
astonish me, it is their insistence on throwing topical steroids at
people with obvious rosacea symptoms. All they need to do is type
in "steroid induced rosacea" into medline (like a lot of us amateurs
do ...) and up come a number of hits, like the abstract below.
Don't these guys bother to read anything?

Hell, give me the this guy's email address and I can assure you I
will be much less diplomatic ...

I think it is great that you are about to be approved to consult on
rosacea cases. The mean level of rosacea care in Indiana is above
to improve signficantly.

Rick


---------------------------
1: Am Fam Physician. 1993 Jul;48(1):67-71. Related Articles, Links


Steroid-induced rosacea.

Litt JZ.

Case Western Reserve University School of Medicine, Cleveland, Ohio.

The excessive, regular use of topical fluorinated corticosteroids on
the face often produces an array of skin complications, including an
eruption clinically indistinguishable from rosacea ("iatrosacea").
Treatment involves discontinuation of the steroid and administration
of oral tetracycline and nonsteroidal topical preparations. Once
therapy is begun, clearing of the lesions may take several months.

Publication Types:
Case Reports
Review
Review, Tutorial

PMID: 8322645 [PubMed - indexed for MEDLINE]
-------------------------


--- In rosacea-support@yahoogroups.com, "drnase2000"
<drnase1000@h...> 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@h... 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
> ______________________________