In the past 5 years, approximately 350 RSS patients from all corners of the USA and from around the world: Europe, Asia, and South America have sought consultation with me. These patients have either flown in to Los Angeles or I have aided their local physicians in caring for them.
Two weeks ago, an RSS patient from Australia sought my advice after many years of inappropriate medical care by dermatologists continually giving corticosteroids. Ironically, the specialist (dermatologist) mismanaged the medical care, but the patient’s generalist (GP) gave him printouts from the Australian and New Zealand GP Associations discussing the ramifications of topical steroid addiction and withdrawal!
This experience trumps any advice given by GPs or dermatologists here in America! Are they ahead of us on this front?
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.
