Steroid-induced rosacea is an

iatrogenic Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. "Iatrogenic", ''Merriam-Webster.com'', Merriam-Webster, Inc., accessed 2 ...

condition (induced by the physician or patient) from the use of either systemic

steroid A steroid is a biologically active organic compound with four rings arranged in a specific molecular configuration. Steroids have two principal biological functions: as important components of cell membranes that alter membrane fluidity; and a ...

or topical steroids. It is nearly identical to steroid induced

acne Acne, also known as ''acne vulgaris'', is a long-term Cutaneous condition, skin condition that occurs when Keratinocyte, dead skin cells and Sebum, oil from the skin clog hair follicles. Typical features of the condition include comedo, black ...

from the standpoint of etiology. Steroid Rosacea

Cause

Steroid-induced rosacea can be caused by the prolonged used of a topical steroid on the face. Topical steroid comes in 7 different strengths (Some countries use 4 categories). Class I is super potent, and class VII is very weak. Usually, any categories of steroids over class VI can induce rosacea with prolonged use. The typical presentation is inflammatory acne lesions consisting of

pustule A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this sy ...

papule A papule is a small, well-defined bump in the skin. It may have a rounded, pointed or flat top, and may have a dip. It can appear with a stalk, be thread-like or look warty. It can be soft or firm and its surface may be rough or smooth. Some h ...

s, and

cyst A cyst is a closed sac, having a distinct envelope and cell division, division compared with the nearby Biological tissue, tissue. Hence, it is a cluster of Cell (biology), cells that have grouped together to form a sac (like the manner in which ...

s. The patient often admits to the daily use of a topical steroid, often being under the advisement of a

physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

. Examination of the pustules often revealed inflammatory cells, and in many cases, numerous motile

demodex mite ''Demodex'' is a genus of tiny mites that live in or near hair follicles of mammals. Around 65 species of ''Demodex'' are known. Two species live on humans: ''Demodex folliculorum'' and ''Demodex brevis'', both frequently referred to as eyela ...

Prevention

Physicians need to be aware of the danger of topical steroids. Only mild steroids should be applied to the face. The use of the topical steroid should be limited to the condition. Alternate week therapy or 3 consecutive days a week therapy is better than continuous therapy in preventing steroid-induced rosacea. Only the mildest topical steroid should be used on the face if a condition warrants such use. The use of

nonsteroidal anti-inflammatory drug Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of ...

s (NSAIDs) does not necessary prevent steroid induced rosacea. Similar conditions have been seen with both Elidel and Protopic, possibly from

immunosuppression Immunosuppression is a reduction of the activation or efficacy of the immune system. Some portions of the immune system itself have immunosuppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse react ...

and

Demodex ''Demodex'' is a genus of tiny mites that live in or near hair follicles of mammals. Around 65 species of ''Demodex'' are known. Two species live on humans: ''Demodex folliculorum'' and ''Demodex brevis'', both frequently referred to as eyelash ...

or bacterial growth.

Treatment

Treatment often involves the gradual weaning off the topical steroid, and the use of a systemic anti-inflammatory antibiotic. If the patient is using a strong topical steroid, he or she is weaned to a weaker class VI or VII steroid. Usually, they are to use the substitute steroid daily, then only on weekends, then stop completely. The facial

dermatitis Dermatitis is inflammation of the skin, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved can v ...

and discomfort often worsen when they stop the offending steroid. The oral antibiotic will decrease the inflammatory nature of the lesions. The antibiotic of choice is usually a

tetracycline antibiotic Tetracyclines are a group of broad-spectrum antibiotic compounds that have a common basic structure and are either isolated directly from several species of '' Streptomyces'' bacteria or produced semi-synthetically from those isolated compounds. ...

. Additionally,

tacrolimus Tacrolimus, sold under the brand name Prograf among others, is an immunosuppressive drug. After allogeneic organ transplant, the risk of organ rejection is moderate. To lower the risk of organ rejection, tacrolimus is given. The drug can also ...

combined with oral antibiotics has proven to speed up the recovery process.

References

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External links

Steroid Rosacea
Acneiform eruptions

Cause

Prevention

Treatment

See also

References

External links