In a severe situation, a two week maximum course of a topical steroid may be beneficial. Steroid Induced Redness and Flushingĭespite all the evidence that such a practice does more harm than good, there are still some physicians and dermatologists who will prescribe topical steroids for facial treatment of rosacea, or in a more complex situation for the treatment of eczema, psoriasis or acne when they have no idea how else to treat it. The proteins of most fruits and vegetables provide the body and brain with many nutrients with a high pH that are needed to repair the body and facial tissue for the best “rosacea diet” while carbohydrates are needed for energy and is most often stored as fat. High fiber foods provide a slow energy burn and do not result in vascular flushing or facial redness. This gives us the sensation of feeling fuller after the meal. The more complex carbohydrates including root vegetables, meats and some fruits create a slower released energy burn providing the body with more sustained energy, less physical fatigue and reduced facial flushing.įiber based foods have a higher pH, a slower digestion and burn rate. On the facial skin this relates to faster, high impact flushing event. These foods would include such things as alcohol, candies, cookies, donuts and foods containing high sugar content. Avoiding spikes from high energy burns and heavy meals through the consumption of balanced meals with small healthy snacks in between can help to regulate the sugar/carb spikes and control facial redness and flushing.įoods with a high acidic pH are identified on the pH scale in the 1 to 3 range are digested and dispersed quickly into the blood stream causing high glucose spikes. Periorificial dermatitis is a less severe steroid-induced rash, in which small papules develop around the lips, around the nose and around the eyelids.The vascular induced flushing resulting from heavy carb and sugar spikes causes the digestive system to react to the increase in vascular dilation with its increased blood flow, visually this is seen as facial redness or a flushed appearance. Occasionally steroid rosacea is confused with tinea faciei and tinea incognita (often spelled incognito), fungal infections masked by topical steroids. Many adverse effects have been described from the use of topical steroids. What other effects do topical steroids have on facial skin? A similar rash has been reported from prolonged application of calcineurin inhibitors ( tacrolimus ointment, pimecrolimus cream). Conversely it is less likely to occur with mild steroids, particularly when applied infrequently. Steroid rosacea tends to be more likely to occur and more severe when strong steroids have been applied to facial skin. Innate immune reaction with inflammatory cytokine release.New blood vessel formation and rebound vasodilation.Proliferation of other micro- organisms in the skin.Proliferaton of hair follicle mites, demodex ( demodicosis).It is not known why topical steroids cause steroid rosacea. Why do topical steroids cause steroid rosacea? Steroid rosacea may become especially severe when the topical steroid cream is discontinued. The skin becomes sensitive to anything applied to it.In time, telangiectasia (enlarged blood vessels) may develop.The reddened areas feel burning hot and itchy.Small bumps ( papules) and pustules appear.What are the clinical features of steroid rosacea?Īfter several weeks of applying a topical steroid to the mid-forehead, eyelids, cheeks or chin, the affected area becomes red. However, it can affect males and children. Steroid rosacea is most often seen in adult women. It is considered distinct from steroid acne, which is caused by oral corticosteroids. It is a variant of perioificial dermatitis (also known as perioral dermatitis) or may be the same condition (note that periorificial dermatitis may occur in the absence of topical steroid). Steroid rosacea is the name given to a rosacea-like condition on the mid-face caused by potent topical steroids or their withdrawal.
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