Here is the article that was quoted: in a nutshell, these Drs feel that
these two cases were caused by "backspray" where the liquid actually got on
the skin arond the nose and mouth. So maybe there is no need to freak out
about nasal steroids. There are some other options tho - the Clinical
Pharmocology article (i will try to post this later) on Singulair cites
that it not only acts like the antihistamines but it also has a mucous
thinning property and th at 40% of patients can go off the nasal steroids.
Sounds good to me, 1 med instead of 3!




Int J Dermatol. 1999 Feb;38(2):133-4.
Rosacea induced by beclomethasone dipropionate nasal
spray
Conleth A. Egan, MB, MRCPI, Tena M. Rallis, MD, Kappa P. Meadows, MD, and
Gerald G. Krueger, MD
From the Department of Dermatology, Case 1 A 46-year-old white woman
presented with a new-onset facial eruption that had
University of Utah School of developed soon after she had started to use a
beclomethasone dipropionate nasal spray
Medicine, Salt Lake City, Utah
for the treatment of allergic rhinitis. The patient did not complain of a
history of facial
flushing. On examination, she had inflammatory papules and pustules on a
background of Correspondence
Conleth A. Egan, MB, MRCPI erythema localized around the mouth and
paranasal area, extending onto both cheeks
Department of Dermatology with sparing of the vermilion of the lips (Fig.
1). The patient had no clinical evidence of
University of Utah School of Medicine conjunctivitis. She stopped the
steroid spray and started to use desonide cream topically
50 North Medical Drive
twice daily and minocycline 100 mg a day. After 8 weeks of therapy and
stopping the Salt Lake City, UT 84132
steroid spray, the patient’s eruption had resolved completely without
recurrence.
Drug name Case 2 A 42-year-old white woman presented with a history of
flushing, facial erythema,
beclomethasone dipropionate nasal
and perinasal inflammatory papules. These symptoms had worsened after she
had spray: Beconase, Vacenase
started to use a beclomethasone dipropionate nasal spray for the treatment
of allergic
rhinitis. On examination, she had facial erythema and telangiectasia with
inflammatory
papules on her nose. The patient stopped using the steroid spray and began
applying
metronidazole 0.75% cream twice a day with resolution of the inflammatory
lesions and
diminution of facial flushing.
© 1999 Blackwell Science Ltd International Journal of Dermatology 1999, 38,
131–141
Discussion
The association of halogenated topical steroids and rosacea
or perioral dermatitis is well documented in the literature.
Dermatologists and nondermatologists alike tend to be
aware of this complication of potent topical steroid
preparations.1,2 We feel, however, that these two cases of
steroid-induced rosacea occurred as a result of ‘‘backspray’’
from subsequent exhalation or nasal leakage of steroid
onto the face from the nasal spray device. Beclomethasone
dipropionate is a potent halogenated steroid,3 and in
this form represents a surreptitious means of causing or
worsening pre-existing rosacea.
The means by which halogenated corticosteroids
exacerbate rosacea is not well understood.4 Halogenated
topical steroids can cause cutaneous atrophy, leading to
erythema and increased telangiectasia.5 The method by
which they produce in.ammatory papules and pustules
cannot be explained so easily. They may permit the
proliferation of pilosebaceous bacterial .ora or demodex,
but these have not been shown to be prominent in the
in.ammatory lesions of rosacea.6,7 Leyden et al.,8 in their
Figure 1 Patient 1 with in.ammatory papules and pustules
localized around the nose and mouth
original description of steroid-induced rosacea, suggested
that these patients may be predisposed to the development
of rosacea and this is unmasked by the topical steroid.
Both of our patients .t the sex, age, and genetic background
of patients predisposed to the development of rosacea.
Another manifestation of steroid rosacea is acute .aring of
erythema and in.ammatory lesions upon stopping topical
application of the steroid in some patients. This effect can
be minimized in some patients by prescribing a low potency
corticosteroid.9 The reason for this is unknown. Neither
of our patients’ symptoms .ared when they stopped the
steroid spray.
Treatment for steroid-induced rosacea or perioral dermatitis
does not differ from the treatment of classical rosacea,
with the exception of stopping the steroid agent. Both of
our patients responded quickly to the therapies outlined.
Once clinical resolution was achieved, neither patient had
further exacerbations.
In summary, we wish to highlight the fact that halogenated
topical corticosteroids can cause or exacerbate
rosacea. In our patients, rosacea was an unwanted sideeffect
of therapy for allergic rhinitis. In patients predisposed
to the development of rosacea, it would be prudent to
avoid potent steroid nasal sprays or, if this is not possible,
the correct technique for administering the nasal spray is
vital to minimize aerosolized steroid contact with facial
skin.
References
1 Martin DL, Turner ML, Williams CM. Recent onset of
smooth, shiny, erythematous papules on the face. Steroid
rosacea secondary to topical .uorinated steroid therapy.
Arch Dermatol 1989; 125: 828.
2 Litt JZ. Steroid-induced rosacea. Am Fam Physician
1993; 48: 67–71.
3 Chervinsky P. Clinical review of once-daily
beclomethasone dipropionate for seasonal allergic
rhinitis. Clin Ther 1996; 18: 790–796.
4 Marks R. Rosacea, .ushing and perioral dermatitis. In:
Champion RH, Burton JL, Ebling FJG, eds. Textbook of
Dermatology, 5th edn. Oxford: Blackwell Scienti.c
Publications, 1992: 1851–1863.
5 Robertson DB, Maibach HI. Topical corticosteroids. Int
J Dermatol 1982; 21: 59–67.
6 Savin JA, Alexander S, Marks R. A rosacea like eruption
of children. Br J Dermatol 1972; 87: 425–429.
7 Marks R, Black MM. Perioral dermatitis: a
histopathologic study of 26 cases. Br J Dermatol 1971;
84: 242–247.
8 Leyden JJ, Thew M, Kligman AM. Steroid rosacea. Arch
Dermatol 1974; 110: 619–622.
9 Urabe H, Koda H. Perioral dermatitis and rosacea-like
dermatitis: clinical features and treatment.
Dermatologica 1976; 152(Suppl 1): 155–160.



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