Steroid advice needed

[boo2facialredness]

I was so happy that my face was clearing up from whatever flare I had last week (see photos posted in photo section). Then, of course, today I wake up and a new area is breaking out in these weird, itchy red bumps. I went to my allergist today and she is calling it "dermatits"- shocker! I told her that Protopic helps, but irritates my skin, and Elidel works, but not as well. She gave me a prescription for Westcort (sp?). She said it's "one step up" from 1% hydrocortisone.

So, steroid experts---J-Mill!!!--- Do I dare try this, or maybe just go one step "down" and try the 1% hydrocortisone, first? She, like my derm, thinks I need the steroid to calm things down quickly and then try to find a good maintenance schedule with the Elidel. But, yet again, no guesses as to what it IS or what is CAUSING it! (She is having more ANA testing done to see if it's autoimmune, but I doub it.)

I was hoping for a scratch test, but she said she's already done all testing possible. Yeah right! I think you could do a scratch test every time and get different/new results.

Oh well! Keep on keepin' on, right?! I've gotten it under control before, just have to try to do it again.

Thanks!
~J

[J-Mill]

Originally Posted by boo2facialredness

I was so happy that my face was clearing up from whatever flare I had last week (see photos posted in photo section). Then, of course, today I wake up and a new area is breaking out in these weird, itchy red bumps. I went to my allergist today and she is calling it "dermatits"- shocker! I told her that Protopic helps, but irritates my skin, and Elidel works, but not as well. She gave me a prescription for Westcort (sp?). She said it's "one step up" from 1% hydrocortisone.

So, steroid experts---J-Mill!!!--- Do I dare try this, or maybe just go one step "down" and try the 1% hydrocortisone, first? She, like my derm, thinks I need the steroid to calm things down quickly and then try to find a good maintenance schedule with the Elidel. But, yet again, no guesses as to what it IS or what is CAUSING it! (She is having more ANA testing done to see if it's autoimmune, but I doub it.)

I was hoping for a scratch test, but she said she's already done all testing possible. Yeah right! I think you could do a scratch test every time and get different/new results.

Oh well! Keep on keepin' on, right?! I've gotten it under control before, just have to try to do it again.

Thanks!
~J

Corticosteroid Potency Chart

Class 1--superpotent
Diprolene gel/ointment, 0.05%
Psorcon ointment, 0.05%
Temovate cream/ointment, 0.05%
Ultravate cream/ointment, 0.05%

Class 2--potent
Cyclocort ointment, 0.1%
Diprosone ointment, 0.05%
Topicort cream/ointment, 0.25%; gel 0.05%
Florone ointment, 0.05%; Maxiflor
ointment, 0.05%
Lidex cream/ointment, 0.05%
Halog cream, 0.1%

Class 3--upper mid-strength
Diprosone cream, 0.05%
Valisone ointment, 0.1%
Florone, Maxiflor creams, 0.05%
Elocon ointment, 0.1%
Aristocort cream, 0.5%

Class 4--mid-strength
Topicort LP cream, 0.05%
Synalar-HP cream, 0.2%; Synalar
ointment, 0.025%
Cordran ointment, 0.05%
Aristocort, Kenalog ointments, 0.1%

Class 5--lower mid-strength
Diprosone lotion, 0.05%
Valisone cream/lotion, 0.1%
Synalar cream, 0.025%
Cordran cream, 0.05%
Locoid cream, 0.1%
Westcort cream, 0.2%
Dermatop emollient cream, 0.1%
Kenalog cream/lotion, 0.1%

Class 6--mild
Aclovate cream/ointment, 0.05%
Aristocort cream, 0.1%
DesOwen cream, 0.05%
Synalar cream/solution, 0.01%
Tridesilon cream, 0.05%
Valisone lotion, 0.1%

Class 7--least potent
Topicals with hydrocortisone,
dexamethasone, flumethasone,
methyprednisolone and prednisolone

Hydorcortisone valerate is more like 3-4 steps up but this equates to using a steroid that is several hundred times stronger than hydrocortisone 1%. It is at least non-florinated, the florinated steroids are very strong and normally the culprits when steroid induced rosacea rears its head. Short term it is unlikely to cause any damage. I was given dermatop by a walk-in GP when I first flared (he thought, wrongly, that it was eczema) and used it for 4 days before I even knew what topical steroids were, no damage done (I cleared quite nicely actually...but it doesn't last...sigh). Sometimes using a stronger steroid lowers your exposure to it, using 4-5 days of hydrosortisone valerate may bring it under control which can indeed be maintenaced with Elidel, whereas you may apply hydrocortisone 1% for a year and never get full control.

When stepping up from hydrocortisone 1% I would think desonide is your next logical step in part due to its well studied safety profile for facial use, but I can understand a doctor wanting to stay in the hydrocortisone family for someone with allergy issues who has responded well to hydrocortisone (you can actually be allergic to certain steroids so changing from one to another is not always a wise move).

I think doctors all too often reach for stronger steroids but I don't know your doctor. You have to decide if you trust them. Over a short period of time (no more then 2 weeks max) use of a steroid like hydrocortisone valerate is unlikely to cause you any harm. The real danger IMO is you get used to the control is establishes and want to use it everytime you flare. You can either try 1% hydrocortiosne and see if that works to regain control and if not switch to the stronger one or just use the stronger one off the bat. I wouldn't give the 1% any longer then 1-2 weeks, and if you have not cleared in that time it is likely not strong enough.

[boo2facialredness]

Thanks for all that info! I do have Desonide in my arsenal and had to use it back in March to get a nasty contact dermatitis under control. I just don't know if I want to go there again!

I guess I could call my derm and see what she thinks of the prescription choice the allergist recommended. I just don't want to do any more damage!

Ugh...so frustrating!

[boc]

Originally Posted by boo2facialredness

I was so happy that my face was clearing up from whatever flare I had last week (see photos posted in photo section). Then, of course, today I wake up and a new area is breaking out in these weird, itchy red bumps. I went to my allergist today and she is calling it "dermatits"- shocker! I told her that Protopic helps, but irritates my skin, and Elidel works, but not as well. She gave me a prescription for Westcort (sp?). She said it's "one step up" from 1% hydrocortisone.

So, steroid experts---J-Mill!!!--- Do I dare try this, or maybe just go one step "down" and try the 1% hydrocortisone, first? She, like my derm, thinks I need the steroid to calm things down quickly and then try to find a good maintenance schedule with the Elidel. But, yet again, no guesses as to what it IS or what is CAUSING it! (She is having more ANA testing done to see if it's autoimmune, but I doub it.)

I was hoping for a scratch test, but she said she's already done all testing possible. Yeah right! I think you could do a scratch test every time and get different/new results.

Oh well! Keep on keepin' on, right?! I've gotten it under control before, just have to try to do it again.

Thanks!
~J

Hi:

First of all, ¡Stay away from steroids!

Protopic has been linked with cancer and Elidel, too. I don't know whether it is or not viral guerrilla , but if you do a search in Google you will get information about it.

I used Elidel without good results. I used steroid (high power) for seven year with very bad consecuence in my health (never again).

If you are talking about seb derm, use Nizoral (Ketoconazole):


Cream, for 30 days

Shampoo, two or three days a week

Oral, for ten days (if your case is strong, only if necessary)

Use in your shower Head & Shoulder, in your first wash, then use any shampoo with 2% of Zinc piritione.

*Shampooes with Selenium (2.5%), Salicilic acid and coaltar are good too.

*I'm a seb derm and rosacea patient.

Sorry for my bad English.

Boc

[boo2facialredness]

Originally Posted by boc

Hi:

First of all, ¡Stay away from steroids!

Protopic has been linked with cancer and Elidel, too. I don't know whether it is or not viral guerrilla , but if you do a search in Google you will get information about it.

I used Elidel without good results. I used steroid (high power) for seven year with very bad consecuence in my health (never again).

If you are talking about seb derm, use Nizoral (Ketoconazole):


Cream, for 30 days

Shampoo, two or three days a week

Oral, for ten days (if your case is strong, only if necessary)

Use in your shower Head & Shoulder, in your first wash, then use any shampoo with 2% of Zinc piritione.

*Shampooes with Selenium (2.5%), Salicilic acid and coaltar are good too.

*I'm a seb derm and rosacea patient.

Sorry for my bad English.

Boc

Thanks for the advice, but I'm allergic to ingredients in both Nizoral and H&S. I have a call into my derm, so I'll see what she says about topical ketokonazole or oral itraconazole when/if she calls back.

I've had many doctors tell me that the link of Elidel/Protopic to cancer is not true. Still, I'm not comfortable using it, but it does work, so I use it sparingly and only as needed.

Thanks again!

~J

**I should also add that I've never been told it's seb derm, and I have conflicting opinions on whether it's rosacea or not. I know I have atopic skin and I avoid my chemical irritants, but there might still be something out there that wasn't in the TRUE test I had that I'm allergic/sensitive to. Just not sure! Such a complete PITA!!!

[J-Mill]

Originally Posted by boo2facialredness

Thanks for the advice, but I'm allergic to ingredients in both Nizoral and H&S. I have a call into my derm, so I'll see what she says about topical ketokonazole or oral itraconazole when/if she calls back.

I've had many doctors tell me that the link of Elidel/Protopic to cancer is not true. Still, I'm not comfortable using it, but it does work, so I use it sparingly and only as needed.

Thanks again!

~J

**I should also add that I've never been told it's seb derm, and I have conflicting opinions on whether it's rosacea or not. I know I have atopic skin and I avoid my chemical irritants, but there might still be something out there that wasn't in the TRUE test I had that I'm allergic/sensitive to. Just not sure! Such a complete PITA!!!

I can tell you even if it is seb derm ketoconazole cream may do nothing (it did nothing for me but give me irritant contact dermatitis which caused my worst flare of seb demr to date...that's right ketoconazole cream made my seb derm worse) and oral anti-fungal meds may also do nothing, in fact this is likely, I used both oral ketoconazole and itraconazole with no effect (I in fact have never seen a single report here from someone who tried them for seb derm that they helped in any fashion whatsoever).

As for the cancer connection and Elidel/Protopic, my understanding is that there is no evidence of a casual relationship. Here is a good article explaining the debate: http://www.dermadoctor.com/pages/new...asp?AID=194313. It is interesting to note the stance of the American Academy of Dermatologists, they are an entity that is capable of being sued afterall and one would expect in the litigation conscious U.S. would be heistant about making declarations such as this without being fairly confident of its truth. It is also interesting to note the absence of skin cancer which one would expect to be the most frequent type contracted from use of a topical cream. I expect if I did a search for any medication and cancer I will find websites claiming a connection. We hopefully base our opinions on evidence and science and not alarmist theory and propoganda.

[boo2facialredness]

My derm's office called back and said that my derm is comfortable with me trying the Westcort if the allergiest thought it would be useful. They did say, however, if it doesn't appear to be working in 3-5 days to call them and they will try to get me in before my Aug. 8th appt. That's a nice change from my old derm who would basically tell me to use a terribly strong steroid on my face indefinitely and come back in a few months!!!

I'm still hesitant about using it, but I'd rather try a little over the next few days and get it under control instead of letting it get out of hand. If you looked at me from a few feet away you wouldn't notice. Even the allergist had to get up close to see it. So, it's annoying, but not so bad that I want to hide away in my dark closet. I don't even have makeup on it today and I've been out running a million errands with no problem! (That's how I judge my skin on a daily basis!)

I'll keep you posted!

Thanks for the article on Protopic/Elidel, J-Mill. I did a ton of research online before I started using it and found a lot of information saying it was safe. I use it so sparingly, though, that I've had my Protopic since March and I don't even think a 1/4 of the tube it gone, and my Elidel I've had since May, and it doesn't even look like any has been used! A little goes a long way and does work. My allergist today said it's not addictive, either, unlike steroids, but I don't know about that.

Thanks again!

~J