The role of staphylococcus, which is very commonly found on the skin of atopics as a cause of deeper infections in the skin is seriously over-stated. Amazingly almost all RSS patients have an intact immune surveillance system that wards off infections rather well. Antibiotics are alarmingly over-prescribed. Redness in the skin alone is not a sign of infection.
“Herpeticum” is herpes simplex and is repeatedly being over-diagnosed. Real eczema herpeticum is a rare viral infection that can be exceptionally serious and often requires hospitalization when proved by culture. Physicians seeing what they believe to be blisters often mistakenly diagnose “herpeticum.” Usually these “blisters” go away by themselves within a few days. The blisters are actually the product of the oozing of fluid from the open blood vessels caused by the steroids, not an infection.
I have found that the only antihistamine that works is hydroxyzine or Atarax. I also use Doxepin which is categorized as an anti-depressant but works rather well for itch. For pediatric patients I offer over the counter Benedryl and a liquid form of Atarax.
The drugs Neuontin and Lyrica are used for neuropathies in diabetic patients, back pain patients and many neuropathies of unknown causes. In my usage of these drugs I have found the patients are offered great relief. They also are quite safe but can have minor side effects.
Corticosteroids have the ability to close or constrict blood vessels in the skin momentarily. This causes a blanching (whitening) effect in the skin, but the vessels have a “job to do” so they dilate again causing redness. With this yo-yo effect being repeated endlessly the vessels eventually remain dilated to perform their task. The redness can last days to weeks before normalcy returns and the process repeats itself again.
You must be wary of foreign packages of herbs and “medicines” stamped with languages on the label that are not accurately translated. Testing had identified steroids, pain relievers, and anti-inflammatories as hidden ingredients. I strongly suggest avoiding these substances.
The process of withdrawal takes months to years and there are so many ups and downs spontaneously that no credit can be given to diets, bath additives, anxiety reduction etc. etc. Any perceived benefit is purely coincidental and not causal.
It is the water and the water only that is soothing and eases the itch and burn in the RSS patient. Some patients soak in water for one hour every day, some for 8 hours, and others any number of hours in between. Patients are afforded an immense amount of relief from the water. The intense discussions about bath salts, oatmeal, oils, bleach etc. are all unproductive. None of these additives offer any special benefit and none of them stop infection which is rare. Save your money.
New skin takes about a month to grow and rise from basal layer to the top.
For the last 50 years, the standard treatment for the chronic eczematous patient has been the usage of topical and systemic corticosteroids.
Although it varies, Topical Steroid Addiction can occur as early as four to six weeks after frequent use.
There are large numbers of topical corticosteroids available in a wide range of potency. Seven classes ranking from class 1 (superpotent) to class 7 (low potency) are obtainable according to a new US-American potency ranking.
A substantial portion of the US population symptoms of atopy (eczema, asthma, hay fever). At least 17.8 million have moderate to severe eczema. These are the patients who use topical steroids.
When suffering from RSS wearing 100% cotton clothing can increase comfort. Heat makes the symtoms of itch and burn worse.
To prevent Red Skin Syndrome and other complications, do not use daily TCS [topical corticosteroids] continuously for more than two to four weeks.
Different parts of the body absorb topical steroids differently (eg. the eyelids, the face, the groin absorb the most).
In a study of 3000 patients with Red Skin Syndrome, inherited atopic dermatitis was the underlying diagnosis in 95% of the patients.
Recovery from steroid cream abuse can take between six months and three years depending on the length of use and potency of creams used. Often systemtic (oral and intramuscular) steroid usage lengthens the time
Cyclosporin is an oral medication classified as an immunosuppressant. It impedes the body’s normal defense mechanisms from rejecting transplants and reacting against inflammation. Kidney, liver, and heart transplant patients all take this medication so that the replacement organ is not rejected. Cyclosporin has also been used in a wide variety of skin and joint diseases. It has been given to severe red skin syndrome patients with great success. Its mechanism of action is unknown.
I believe that the earliest manifestation of addiction is when the eczematoid rash spreads, even subtly, and more frequent applications of creams commence. The increased frequency of application is followed by stronger strength steroids that continue to be applied on a daily basis just to keep the worsening rash at bay. In pediatric patients addiction can occur in as little as three to four weeks.
The length of withdrawal time is proportional to the amount of time that steroids were used. The longer the use the longer the withdrawal time. If steroids were used for five to ten years the withdrawal redness and attendant swelling, ooze, pain, itching, and burning will continue in decreasing severity for at least one to two years. As the withdrawal process progresses the flares become less intense and less frequent.
Steroids main actions on the skin are anti-inflammatory and vasoconstrictive. Vasoconstriction temporarily closes down of the blood vessels of the skin resulting in a whitening or blanching effect. Vasoconstriction is then followed by vasodilation or opening of the blood vessels with the resultant redness. It is the redness of vasodilation that gives Red Skin Syndrome its name. When the blood vessels are open there is a pouring out of normal body fluid and an ooze of this fluid to the outside of the skin. Drying the fluid quickly is necessary to prevent bacterial growth and infection.