Red Skin Syndrome: Stages, Treatment, Healing, and More.The Rash That Wouldn't Quit - Kara Fitzgerald ND Naturopathic Doctor

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Understanding Topical Steroid Withdrawal (TSW) and Eczema

 

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Steroid Rebound - A Topical Issue.Off prednisone.. rash returned - localhost

 

Clinicians, if you read anything today, read this: A case of total body contact dermatitis of unknown etiology, hives and dermatographism. Ellen found my practice after listening to a podcast I did on allergic disease with Dr. Amy Meyers for her Autoimmune Summit. See baseline and follow-up photos below. Two baseline photos sent to me on Note that these pictures were taken while on prednisone. Ellen is a married 39 year old woman with two young kids. She called my office out of desperation, she said.

It was non-responsive to almost every medication except oral and topical prednisone and about mg of Benedryl per day. And even these big guns were limited in their efficacy, only taking the edge off and enabling her to survive her day.

Understandably, however, her dermatologist said that after 18 months, he had to permanently taper her off the steroids. What Ellen described as a rash was actually a collection of different skin problems, including contact dermatitis of unknown etiology, eczema atopic dermatitishives and dermatographism.

It turns out that what Ellen described as a rash was actually a collection of different problems, including contact dermatitis of unknown etiology, hives and dermatographism. Patch testing was positive for eugenol, nickel, fragrance, neosporin, bacitracin and UVB.

He suspected her reaction was caused by sun and sunscreen and advised avoidance. She did, to no avail. Nothing worked. Literally any item that Ellen came into contact with could leave its mark. Her back was a mirror imprint of her nightgown in the morning. Her purse left a band on her arm after she carried it.

Any item she came in contact with could leave its mark. Her hives were similar in sensitivity. Warmth from her car seat heater? Hives on her calves. That said, skin prick testing done after the start of the rash, showed positive reactions for almost everything environmental, but no foods. As I investigated for antecedent and triggering factorsthere were two clear smoking guns.

Indeed, Ellen herself knew these were big deals. InEllen developed food poisoning after eating sushi. She was hospitalized for a week. After developing C. Her gut function has been a problem ever since; she passes up to six loose BMs daily. The lasting damage to her microflora and gut wall had to be a piece of her extreme hypersensitivity response.

After six months of no sleep, lattes and straight sugar diet, Ellen suddenly developed the rash. Ellen herself got very little sleep through the night, and as a result of this, her food intake deteriorated. When Ellen came to our clinic, my overriding focus was getting her through the final leg of her steroid taper without the common, but devastating possibility, of rebound dermatitis.

When she came to my office, my overriding focus was getting her through the final leg of her steroid taper without the fairly common, but devastating possibility, of rebound dermatitis.

We had about two weeks to prepare her body. Not enough time for lots of labs, but we ordered them anyway. They would guide us later. Of course, I anticipated finding nutrient deficiencies after years-long chronic diarrhea; IgE food allergies yes, despite the skin prick testing being negative and IgG sensitivities; and dysbiosis, intestinal permeability. I also suspected food cross reactions with her myriad environmental allergies nickel, latex, pollens, etc.

Ellen had started a full Paleo diet prior to our appointment. This dietary change did NOT benefit her skin, although there was mild gut improvement. Remember that Ellen found our clinic through the Autoimmune Summit. She was savvy with regard to her health.

These dietary changes did NOT benefit her skin, although there were some mild gut improvements. Dairy seemed to worsen diarrhea. As you can imagine, after I removed all the possible food reactions, Ellen was left eating basically leaves and twigs. Not quite. But her diet was Spartan in the beginning. And for this kind of therapeutic- and temporary- restriction, unless you have the time to figure out these diets yourself and determine nutrient sufficiency not to mention recipes, shopping lists, palatability, restaurant options, etc.

In the beginning, I stopped the various supplements she was already on so we could monitor skin. I was careful in prescribing a simple, traceable starting protocol of hypoallergenic nutrients primarily geared toward dampening the possibility of rebound dermatitis. These included an essential amino acids blend, diamine oxidase for possible histamine intoleranceand very low dose probiotics lactobacillus and bifido-specific species for allergy.

Homeopathic sulfur for itchcromolyn sulfate mast cell stabilizerand bicarbonate anti-histamine were all prescribed as needed. I also added a prescriptive ceramide topical and dilute bleach baths. The sulfur, bleach baths, ceramide topical were reported as useful; bicarbonate and cromolyn sulfate were never used. Ellen responded to our protocol so rapidly, she stopped steroids before the end of her prescribed taper.

She never experienced rebound dermatitis. Not surprisingly, Ellen lost over 40 pounds — the steroid induced weight gain — over the course of about ten weeks. Her diet was not calorie restricted. She experiences transient, mild rashes on occasion, but she describes herself as totally better.

We are currently expanding her diet very carefully — nickel and histamine containing foods appear to be fine, although they may have been an issue early on; she tolerates many of the common antigenic foods, like egg and soy. We continue to rebuild her gut and improve her nutrient status. In conclusion: If this case has been interesting to you, Stay Tuned!

I intend to write about it in greater detail for publication, will include her laboratory results and will cite references. First follow up photo. Much improvement! Life is good. Off prednisone and Benadryl for about 20 days. She completed the first Counsel on Naturopathic Medicine-accredited post-doctorate position in nutritional biochemistry and laboratory science at Metametrix Clinical Laboratory under the direction of Richard Lord, PhD.

Her residency was completed at Progressive Medical Center, a large, integrative medical practice in Atlanta, Georgia. With the Helfgott Research Institute, Dr. Fitzgerald is actively engaged in clinical research on the DNA methylome using a diet and lifestyle intervention developed in her practice. The first publication from the study focuses on reversal of biological aging and was published in the journal Aging. She has published a consumer book titled Younger You as well as a companion cookbook, Better Broths and Healing Tonics and has an application-based Younger You Programbased on the study.

She runs a Functional Nutrition Residency program, and maintains a podcast series, New Frontiers in Functional Medicine and an active blog on her website, www. Her clinical practice is in Sandy Hook, Connecticut. Additional publications. Your email address will not be published. Post comment. I always learn such clinical pearls from Dr. Your patients are lucky, Dr. My mom has this SAME exact rash!!!!!!

But recently she stopped her steroids!! Is there anything you can reccomend for her to put on her skin for a lotion?? Try an organic product with just a few ingredients.

Some folks in my practice use just plain oils like olive or coconut. See how mom does and let us know what works. Amazing results for Ellen. She was lucky to have found you. Do you have any suggestions or tools on youwebsite that may provide some guidance on what to do? Thank you. Hi Maria, Sorry to hear! Itchy skin can have many causes. If you suspect histamine intolerance then trying a low histamine diet and lowering other histamine triggers might be a good first step.

That would likely need some investigation and addressing too. My best, DrKF. The rash is mostly on my face, neckboth arms upper and lowerlower legs, and tops of my feet… it was so bad about a week ago, I had the hives on the palms of my hands!

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Rash returned after stopping prednisone -

    It appears red, raised and somewhat scaly. Thankful you could help her.

This article is giving me hope! Can you give me more specifics on what you did to fully cure this rash? Was it an autoimmune protocol diet?

How was the gut healed? Was there medication? Thanks for your help! The protocols are personalized dietary and lifestyle plan based on potential triggers and isolating environmental factors as well, while simultaneously addressing all other aspects like gut healing and dysbiosis.

For Ellen it took working with the nutritionist to dial in the nutrition plan and isolate her triggers food sensitivities, metals, and food cross reactivity to environmental allergies. Consider working with a FxMed practitioner with experience in layering plans to address allergic disease. I have suffered with eczema for 60 years however the last three have been hell. Recently diagnosed with Systemic nickel allergy and angioedema to go along with the excels.

I have had gives, angio and extensive eczema for the last three years.. I am on s nickel free diet which is horrible and poor quality foods.. So sorry to hear that, sounds frustrating!

Generally we see when we approach systemically and work on the whole picture, sensitivity and inflammatory response is significantly reduced and tolerance and symptoms improve. I broke out with this rash last year in October. My homeopath has me on supplements and elimination diet.. Any suggestions? You are more than welcome to work with a provider here,at our practice. Keep me posted on how you make out- DrKF. Hi Dr. Very interesting article. I have had an ongoing rash for the last year but only on my face.

It appears red, raised and somewhat scaly. I have taken about 4 courses of prednisone and it works very well to clear the rash but about days after finishing the course, it reappears. My dermatologist is now recommending that I see an allergist. Is there any input you may have for me? Greatly appreciated! So frustrating that you need to deal with this!

Hi , this information helps me a lot to get rid of this skin problem and I have been very thankful to you for providing this solution. Keep updating thankyou. Hello Thank you for the article. My teenage son has dermatographia. He itches mostly at night when he is trying to sleep! You mentioned: The sulfur, bleach baths, ceramide topical were reported as useful; bicarbonate and cromolyn sulfate were never used.

Did they help? Does she basically have to keep using all 6 of those protocols every day sulfur, bleach baths, ceramide, amino acids, diamine oxidas and probiotics?? Also, the part about the diet was a bit confusing. Simply put- are there common things to avoid for this? Shannon, We have a functional nutrition residency program. The senior nutritionist residents are available to work with you and are closely monitored by a full staff nutritionist.

Your son is a great candidate for this program…. The cost of the resident services is very reasonable- and they work hard! The doctors in our practice including me share our opinions on the residents cases in our weekly Clinical Rounds.

Consider scheduling an appt! Hi — I am very interested in reading the further publication of this case and blog. Could you please send me the link? Thank you! The more I restricted the diet the more sensitivies I got. I did allergy shots 4 yrs ago that didnt help anything so I stopped. Then again for the last year but I started to have throat narrowing the further I got into them so stopped at the year mark. A low nickel diet is helping but that is more avoidance of foods, especially vegetables.

Every other probiotic causes small boil like pimples on my body. All supplements cause the boils or a itchy rash. You mentioned bicarbonate for this patient, how do you have patients use that? We do see this fairly commonly in our clinic.

Nutrient status can also play into the picture, of course. I would suggest working with a Functional doctor or nutritionist to help you identify this root cause. They should also help guide you on first, increasing your tolerance to prevent developing more serious reactivity, and gradually and safely expanding your diet. My story is very similar. The all over body rash that I get only stays away after steroid shots and prednisone packs.

Then it comes back with a vengeance. I have seasonal allergies but nothing significant. The rash spread considerably to other parts of his body. Three and a half months after stopping the steroids, his eyelids and surrounding area have almost regained their normal colouration and the swelling has subsided. With topical corticosteroids, a number of adverse reactions are recognised, including irritancy, change in barrier function, allergy, tolerance, dependency, rebound and lack of response Dermatologist personal communication, 19 February The risk of an adverse effect depends on the strength of the steroid, the length of the application, the site of application and the skin problem.

Steroids are absorbed at different rates from different parts of the body. At least for a few weeks and then slowly add in processed foods that should be safe and is normally gluten free. Avoid even certified gluten-free products as 20 ppm maybe be too much for you at this time. Might not be dh if it goes away after a few days of going gluten-free. I even had to avoid all gluten-free alternative foods that were 20ppm. I had DH from childhood until I was diagnosed in my 40's.

Within a week of being gluten free and dropping iodized salt I stopped getting new lesions. However for the first couple years even a bit of CC would cause a new lesion within hours. It took at least a couple years of being very strict before the lesions became the last thing to let me know I had been glutened.

After around ten years I went to just getting one or two little sores if I was glutened badly. Prednisone when I was a kid would stop the lesions and that would last about a month after I stopped the drug. Then they would be back. I think there is a lot of variety amoungst us in our reactions to gluten even with DH. I am so thankful that the diet worked so quickly for me.

I wish it did for everyone. I have ANA drawn which I think they were testing for lupus. My thyroid also came back good. I think one of your posts mentioned your rash now presenting as hives. I have autoimmune hives. These have lasted about six months and a daily cocktail of antihistamines help, at least with the itching. My skin is clear each morning. Once resolved maybe my autoimmune flare has diminished , I only get hives when I get a bug bite or react to a medicine like acetaminophen, not too long ago.

One bite and my arm or leg can be completely covered. Again, antihistamines help. I have also had just itching but no rash usually when my celiac disease is active and I have had little blisters that I have scratched off, literally.

BTW, recent endoscopy showed healed small intestine. Autoimmune can present so strangely! How is RSS diagnosed? How is RSS treated? Can you prevent RSS? How we reviewed this article: Sources. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.

You can learn more about how we ensure our content is accurate and current by reading our editorial policy. Share this article. Read this next. Difference Between Eczema and Dermatitis Dermatitis and eczema are both often used to describe a number of skin conditions that consist of red, dry patches of skin and rashes. Medically reviewed by Debra Sullivan, Ph.

Behring on August 31, What is TSW? What is TSW syndrome? In addition, people with TSW syndrome may experience the following symptoms: insomnia fatigue hair loss chills depression. What are the symptoms of TSW? How is TSW diagnosed?

What are topical steroids? Common topical steroids used to treat eczema include: over-the-counter hydrocortisone prescription hydrocortisone 2. What is the treatment for TSW? What are the risk factors for developing TSW? What is the outlook for people with TSW? The bottom line. How we reviewed this article: Sources. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations.

We avoid using tertiary references.

By JlewisrnDecember 31, in Dermatitis Herpetiformis. I just finished 60 of prednisone and had a steroid shot before starting those. I came back from DC with the worst my rash has ever been. Let me first say that I have not been diagnosised. When my steroids started to taper to. The day after I took my last tab I got a rash on my leg this is where it always starts. I almost cried! I thought I have been so careful. I started reading the labels and found out the lindor chocolates I have been eating over Christmas have barley in them.

I went back to the dermatologist who said it was eczema. It can go from looking like eczema, tiny blister or hives at any given time and different areas on my body. My legs may look eczema one day and my stomach look like hives it seem to change which i think makes it hard to diagnosis. I wish I could get a real diagnosis. Did prednisone work for anyone else while they were on it? I have been trying avoid eat gluten but sometimes it sneaks in like chocolate while on prednisone. One showed atopic dermatitis the other showed a drug ereption.

If you don't stop getting glutened then you're going to continue to get the rash if it's dh. I'm sorry but trying to avoid gluten is not good enough; you absolutely MUST not eat any gluten. So you ate the Lindor chocolates without reading the ingredients. Bad move. We have a mantra:. And if you have dh, then you are celiac and that means every time you get glutened your villi gets damaged. And they have to do it in a clear area next to the rash.

But you have to be eating gluten for 12 weeks at least for that. Unless you've already been dx? I'm totally confused by your post history whether or not you have been. I have not been diagnosed. I guess this post was confusing.

Some HX. I got a rash exactly 1 year ago. I was diagnosed with scabies at that time. Treated twice. I have been to 2 dermatologist, 2 allergists, and 2 natuapathic doctors. Only one dr the natuapathic said DH. She was sure of it after just one look. I have had 2 biopsies and have been on creams and pills and nothing works. I have had gut issues my whole life. I was always nauseated.

When I was in high school I had my first episode of stomach cramps so bad I was on the bathroom floor about to pass out. Those cramps are deep and not menstral.

They last about 3 days. Before getting the rash I had no idea what the cramps were. When I was researching the cramps I came across celiac disease and wondered if it wAs all a piece of the puzzle.

I would love to have an official diagnosis. I do know that I do NOT want that rash to return. I consumes my life and I honestly think they may have to commit me if it comes back like before. I have been so careful. Or so I thought. If gluten is causing this rash I need to know and avoid it.

Since I stopped eating it the rash has gone away. I am sorry that you are still struggling. Besides locating a truly celiac-savvy or other autoimmune dermatologist at a major celiac center, you can try improving your diet. Focus on Whole Foods only. Nothing processed. At least for a few weeks and then slowly add in processed foods that should be safe and is normally gluten free.

Avoid even certified gluten-free products as 20 ppm maybe be too much for you at this time. Might not be dh if it goes away after a few days of going gluten-free. I even had to avoid all gluten-free alternative foods that were 20ppm. I had DH from childhood until I was diagnosed in my 40's. Within a week of being gluten free and dropping iodized salt I stopped getting new lesions. However for the first couple years even a bit of CC would cause a new lesion within hours.

It took at least a couple years of being very strict before the lesions became the last thing to let me know I had been glutened. After around ten years I went to just getting one or two little sores if I was glutened badly. Prednisone when I was a kid would stop the lesions and that would last about a month after I stopped the drug. Then they would be back. I think there is a lot of variety amoungst us in our reactions to gluten even with DH.

I am so thankful that the diet worked so quickly for me. I wish it did for everyone. I have ANA drawn which I think they were testing for lupus. My thyroid also came back good. I think one of your posts mentioned your rash now presenting as hives.

I have autoimmune hives. These have lasted about six months and a daily cocktail of antihistamines help, at least with the itching. My skin is clear each morning. Once resolved maybe my autoimmune flare has diminishedI only get hives when I get a bug bite or react to a medicine like acetaminophen, not too long ago. One bite and my arm or leg can be completely covered. Again, antihistamines help. I have also had just itching but no rash usually when my celiac disease is active and I have had little blisters that I have scratched off, literally.

BTW, recent endoscopy showed healed small intestine. Autoimmune can present so strangely! It is what I did to insure that my endoscopy would reveal a healed small intestine. Unfortunately, they found autoimmune gastritis. So my GI issues are not over yet! But better each day!

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Clinicians, if you read anything today, read this: A case of total body contact dermatitis of unknown etiology, hives and dermatographism. In urticaria or skin allergy, the skin rashes keep coming back after the medications are stopped. Antiallergics, antibiotics, and steroids. I hvae rteached mg/day of prednisone after 2 1/2 year of regular DR. and she did all the blood tests and everything came back normal. To prevent these symptoms while you are stopping treatment with this drug, your doctor may reduce your dose gradually. Withdrawal of treatment. This condition can develop in the weeks after stopping the use of a topical steroid. It can cause a severe rash, swelling, and other. Sign in here. Hives on her calves. The hydrocortisone successfully cleared the rash.

Medsafe has become aware of a patient who suffered a severe rebound effect to topical steroids. Rebound of treated dermatosis, although not common, can be a significant issue with topical steroid use. A young man was prescribed hydrocortisone 0. The hydrocortisone successfully cleared the rash. However, the problem returned when use of the cream was stopped. This improved the condition during treatment but the rash reappeared, with increasing severity, when treatment stopped. The condition deteriorated over the next month or so until both eyelids were completely covered with an angry red rash along with the area around the eyes.

In addition, a rash developed around his mouth. The rash worsened to such an extent that the patient visited a dermatologist. A five-day course of clobetasone butyrate Eumovate was prescribed. This was followed by a five-day course of hydrocortisone. Again the rash reappeared once treatment was stopped and the patient was advised to repeat the course of treatment. This treatment course was unsuccessful and the area around the eyes became more swollen and was continually red and inflamed.

Following some personal research, the patient decided to stop treatment with the topical steroids. After one month, the redness had subsided slightly but still flared regularly. The rash spread considerably to other parts of his body.

Three and a half months after stopping the steroids, his eyelids and surrounding area have almost regained their normal colouration and the swelling has subsided. With topical corticosteroids, a number of adverse reactions are recognised, including irritancy, change in barrier function, allergy, tolerance, dependency, rebound and lack of response Dermatologist personal communication, 19 February The risk of an adverse effect depends on the strength of the steroid, the length of the application, the site of application and the skin problem.

Steroids are absorbed at different rates from different parts of the body. The palms of the hands absorb 0. In atopic dermatitis, where there is a defective epidermal barrier, the penetration of topical steroids is two- to ten-times greater than that through healthy skin 2.

Topical steroids vary in strength from mild, such as hydrocortisone, to very potent, such as clobetasol propionate Table 1. Topical steroids are also available in combination with antibacterial and antifungal medicines. Betamethasone valerate 0.