I take a detour today from many more Dupilumab stories by concentrating on a new ITSAN appeal for donations over the heading “I wish I would have known (about steroids).” The implications of this new campaign are that it is an evil drug. Steroid creams used properly in the proper strength for the correct amount of time are a wonder drug and solve thousands of medical problems every day. They can easily and fruitfully be used in eczema patients under proper medical management for very short periods of time. The ITSAN comment above is comparable to saying that opioids for a short period of time are evil when in fact they are magical in relieving severe pain when used properly. It is totally inappropriate for ITSAN to be giving this type of uninformed and unscientific medical advice.
ITSAN Rebuke
About the Author: Dr Marvin Rapaport, MD
In 1978 I initiated and set up the contact and photo dermatitis clinic at UCLA. There was a need to evaluate a large group of patients who exhibited severe eczematoid rashes, especially on the face. Patients were referred from all over Southern California. All patients underwent a lengthy history and examination. Further evaluations included blood studies, allergy patch testing, special sunlight (photo) testing and skin biopsies.
From the start it was apparent that most patients experienced a mild dermatitis on various parts of the body that progressively worsened. Their histories always included numerous doctor visits, multiple physicians, and therapy consisting of an increasing amount of corticosteroids.
My testing failed to reveal any specific culprit chemicals, cosmetics, perfumes, workplace or recreational exposures. It became increasingly clear that the physician’s therapy, the corticosteroids, was invariably causing the problem.
I wrote 7 scientific articles that were published in the most august peer-reviewed dermatologic journals and I gave many lectures at various dermatology meetings. To this day an unfortunate reluctance exists on the part of most physicians to accept this simple concept.
Dr. Rapaport, I’ve been reading the ITSAN Facebook posts and think they’re unnecessarily scaring people about steroids. Steroids are safe and helpful when used properly. It puzzles me as to why they, with several people on their board, don’t revise their platform and postings to say it’s the “overuse” of steroids that can cause harm to people. Am I the only person who thinks like this?
Dr. Rapaport,
I think that is one of the things that the doctors who malign you and your approach are constantly misunderstanding. They believe you to be 100% anti-steroids, calling you a fool who is causing innocent people to suffer by avoidance of steroids. No matter how much us RSSers insist that you allow, even recommend, steroids for appropriate patients following specific guidelines in regards to potency, age, length of use, and area of application, they blacken your name, claiming you misinformed. It is truly a sad state the medical establishment is in when highly intelligent, well-researched, and vastly experienced doctors as yourself are treated as fools, only through virtue of others’ lack of true knowledge.
Dr. Rapaport, the day will come when the world will rue they way they have treated you — just like they did Semmelweiss…
Dr. Rapaport –
Thank you for your extremely important work. Just a note though that the campaign you’re referring to was not from ‘ITSAN’ but from a member of the community who wanted to bring awareness to the possible outcome of RSS from steroids and to help raise funds for this shoestring nonprofit that is also doing important work. You’re right of course that steroids can be helpful for most people if used correctly.