Hello,

I have posted this before in the past, but with this new case, I
thought it was pertinent to post it again.


Steroid-induced rosacea is still quite common because well-meaning
physicians routinely use topical steroids to treat rosacea redness
and inflammation. Topical steroids of any concentration should never
be used to treat rosacea sufferers or patients who show pre-rosacea
symptoms (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 anti-inflammatory medications being used
to decrease 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 Kligman 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 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). Start using Elidel twice daily.


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.


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 or metrogel. 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.


Regards,

Geoffrey
______________________________

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