Steroid-Induced Rosacea - A Rosacea Variant What to do if you have been diagnosed with this variant? an editorial by Brady Barrows
Please note: In my book, Rosacea 101, (published in October 2007) in Chapter 8, Steroid-induced Rosacea, page 35, you can read an updated version of what I wrote below which is the basis for this chapter. My new book is a comprehensive basic rosacea 101 knowledge for rosacea newbies who want to learn about the conventional and alternative treatments for rosacea. Anecdotal reports on the internet show that this basic rosacea knowledge about steroids is needed and you should read my book about this subject.
While some rosaceans have mixed the two, steroids and rosacea, it is not a good idea. And if you want some good advice, never mix the two. Do not use topical steroids on rosacea, period! Why is this such a problem that it is listed as a variant? Because rosaceans continue to use steroids or allow their physicians to treat them with steroids. An informed rosacean can decide whether the benefit of using steroids for rosacea is worth the risks, and your physician should explain the benefit/risk ratio to you. You have the choice to either accept the treatment or decline it.
Dermatologists have been using topical corticosteroids since the 1950s treating intractable dermatoses. However, a report in 1988 says, "Disadvantages of corticosteroid activity include the possibility of adrenal suppression, epidermal and dermal thinning, and local effects such as purpura, striae, and steroid-induced rosacea and perioral dermatitis." source
"...Corticosteroids were first introduced for topical use in dermatology in 1951. Since then uncontrolled use (abuse) has caused many different reactions, often with manifestations resembling those of rosacea..." source
"...Dermocorticosteroids can be indicated in numerous inflammatory skin diseases (psoriasis, eczema ...). They are formally contraindicated in case of skin infections, diaper rash, acne and rosacea..." source
Dr. Nase lists 'Topical Steroids' as the fifth main trigger for rosacea in his book on page 285. source > Beating Rosacea...
The NRS lists topical steroids as one of the tripwires on their list. source > Coping with Rosacea, National Rosacea Society, page 9 - http://www.rosacea.org
Ironically, uninformed physicians sometimes prescribe steroids for rosacea or rosaceans may use over the counter non-prescription steroid topicals for rosacea and initially the rosacea may improve but after continuous use the rosacea gets worse. Hence the term, steroid-induced rosacea has developed due to uninformed rosaceans using long term topical steroids to treat rosacea. This indicates that it is up to rosaceans to be informed and ask their physicians if they are keeping up with current treatment for rosacea. Reports still show that physicians prescribe steroids for acne rosacea, for example:
1998
"The first patient was treated with oral steroids, as well as doxycycline, to control his acne rosacea." source
What is difficult to understand is that two variants of rosacea, Rosacea Fulminans, and Perioral Dermatitits are treated with Accutane and steroids. One report says that Corticosteroids and isotretinoin are regarded as the two main therapeutic agents for treating RF. source
Periorol Dermatitis, a variant of rosacea, is sometimes the result of steroid use so rosaceans wonder what should they do if the physician prescribes steroids with all this conflicting data?
Demodicosis may develop after the use of steroids according to the following two reports:
"...the highest density of mites was found on the cheeks. A statistically significant increase in mites was found in all subgroups of rosacea, being most marked in those with steroid-induced rosacea...CONCLUSION: Increased mites may play a part in the pathogenesis of rosacea by provoking inflammatory or allergic reactions, by mechanical blockage of follicles, or by acting as vectors for microorganisms." (1993) source
"...Demodex folliculorum were also more frequently detected in patients who had previously been treated with topical corticosteroids (even in 91.9%), what was often followed by epitheloid granulomas..." (1992) source
However, one report in 2002 says the following:
"...Recently, steroid components have been synthesized that aim to have adequate anti-inflammatory effects and minimal adverse effects. The newest topical corticosteroids used for the treatment of different dermatoses and allergic reactions of the respiratory tract (in particular asthma) are budesonide, mometasone furoate, prednicarbate, the di-esters 17,21-hydrocortisone aceponate and hydrocortisone-17-butyrate-21-propionate, methylprednisolone aceponate, alclometasone dipropionate, and carbothioates such as fluticasone propionate..." source
As these new synthesized steroids are used, no doubt we will hear reports later of the long term effects for treating rosacea with these drugs. You as a rosacean have the right to ask questions about what treatment your doctor recommends.
"...54% developed the steroid rosacea while being treated with the lowest-strength (class 7) topical corticosteroids. Even over-the-counter hydrocortisone preparations induced steroid rosacea in susceptible children. Susceptibility may be genetic as 20% of children had a first-degree relative with rosacea." source
"...Initially, the mass was thought to be rhinophyma, but biopsy of the mass revealed noncaseating granulomata consistent with sarcoidosis. The mass resolved following several steroid injections..." source
FK506 (tacrolimus) may control the increase in IL-1alpha with glucocorticoid in KCs, suggesting FK506 to suppress harmful effects of glucocorticoids such as steroid rosacea. source | More on Tacrolimus
Combination therapy of tetracyline and tacrolimus source
However, one report of using Tacrolimus resulted in a "proliferation of Demodex due to local immunosuppression." source
Rosacea: where are we now?
Bikowski JB, Goldman MP.
Bikowski Skin Care Center, 500 Chadwick St, Sewickley, PA 15143, USA
Topical tacrolimus Protopic.
Lazarous MC, Kerdel FA.
Department of Dermatology and Cutaneous Medicine, University of Miami School of Medicine, Miami, FL 33136, USA.
Rosacea fulminans in pregnancy.
Lewis VJ, Holme SA, Wright A, Anstey AV.
Department of Dermatology, Royal Gwent Hospital, Cardiff Road, Newport, NP20 2UB, UK.
