.  "A GP perscribed Elocon 0.1% and used that for the past 18 months.  Last

Friday, I quit using the Elocon "

  Hi

Been plagued with rosacea since 1989. I am no expert but if I am not

mistaken, Elocon is a steroid which is not the best for rosacea. To me, it

seems as if you are experiencing withdrawal from the Elocon.

You may need to wean yourself off. It seems that I remember something about

either reducing its use and using something milder ( like a hydrocortisone )

until your skin can handle one of the topicals for rosacea.



I am sure that you'll get help with this one.

All the best

We're here for you. I don't know what I would have done without the support

of all the wonderful caring folks at this group.

Linda

   "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 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.



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

______________________________

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

______________________________























--

Please read the list highlights and FAQ before posting to the whole group

(http://rosacea.ii.net).

Yahoo! Groups Links



















---------------------------------

Do you Yahoo!?

  Check out the new Yahoo! Front Page. www.yahoo.com



[Non-text portions of this message have been removed]

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

> ______________________________