Tapering topical steroids

Endocrinologists are specialists in hormonal diseases, including adrenal and pituitary conditions that cause secondary adrenal insufficiency. An endocrinologist will have more training and experience in properly diagnosing and treating secondary adrenal insufficiency than most physicians. Most cases of permanent secondary adrenal insufficiency should be managed by an endocrinologist.  In cases of steroid withdrawal for the treatment of medical conditions, endocrinologists often work with the primary physician or specialist in that disease to assess the recovery of pituitary-adrenal reserve and provide guidance about whether long term glucocorticoid therapy is needed.

Topical Steroid Withdrawal (TSW) is the lengthy withdrawal process that the body undergoes after stopping topical steroids. Primary symptoms of TSW include:   inflamed “Red Skin” with “red sleeves” on upper and/or lower extremities; increased itching; burning; stinging; oozing; swelling; flaking/shedding skin; hair loss; insomnia; and temperature dysregulation (being too hot/too cold). Other symptoms include, but are not limited to: HPA axis suppression, adrenal suppression, stunted growth in children, glaucoma. Often used interchangeably with RSS.

Many hemangiomas will leave behind a combination of redundant stretched skin and bulky subcutaneous fibrofatty tissue after the vessels have involuted. These patients are the safest candidates for surgical debulking because there are few if any residual vessels, and it is much easier to judge how much soft tissue to leave behind.  A smooth surgical scar is generally superior to a protruding mound or loose redundant skin.  In most cases, however, patients and their parents will be reluctant to wait until complete shrinkage because the waiting period will extend into the early school years.

There is no agreed treatment for topical corticosteroid withdrawal, apart from ceasing the topical corticosteroid. However whether this should be tapered or abrupt has not been determined. Japanese reports suggest there is minimal difference in the outcome, so recommend immediate cessation. A tapering course of oral steroids is helpful, as the addiction appears to relate only to the use of topical corticosteroids. Oral tetracyclines and low-dose isotretinoin have been used in steroid rosacea and perioral /periorificial dermatitis .

I have a rare auto-immune disease that requires high (160mg 2x day) dose prednisone to stop a severe blistering of mucosal tissue ., 2-3 degree burns of mouth, throat, sinus, eyes and even my heart. The possibility of this disease killing me without prednisone is real and my doctor explained that prior to prednisone a great majority of people with Erythema Multiforme – Major died.
So what’s the problem? Over many years and a dozen high dose treatments with prednisone I have been 302 committed and upon release my doctors where cautioned about this therapy.
During my most recent treatment, I went into a manic state or worse. I was PFA’d and removed from my home by police after scaring my wife and kids. I had to finish treatments at the hospital and I requested a psychological evaluation because I hadn’t slept in 5 days, almost lost my job, and was was manic or worse. After a discussion with a psychiatrist he added several different mood stabilizers and anti psychotic meds. I have come off the prednisone and the pshyc meds are taking effect. I cant wait until prednisone is out of my system.
My doctor now realizes after this last event a new protocol is being thought out with future treatments.
This I can tell you without a doubt in my mind that Prednisone is a miracle and a curse all rolled up into one medicine. If you are experiencing mental issues with prednisone tell your doctor immediately, insist on getting psychiatric support and PRAY.

Tapering topical steroids

tapering topical steroids

There is no agreed treatment for topical corticosteroid withdrawal, apart from ceasing the topical corticosteroid. However whether this should be tapered or abrupt has not been determined. Japanese reports suggest there is minimal difference in the outcome, so recommend immediate cessation. A tapering course of oral steroids is helpful, as the addiction appears to relate only to the use of topical corticosteroids. Oral tetracyclines and low-dose isotretinoin have been used in steroid rosacea and perioral /periorificial dermatitis .

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