After 30 years of successfully curing 3200 patients with Red Skin Syndrome (RSS) and after 30 years of unsuccessfully convincing my colleagues that RSS is due to topical steroid addiction (TSA) I have decided to issue a “White Paper.”
A “White Paper” is an authoritative report or guide informing readers in a concise manner about a complex issue. Its purpose is to help readers understand an issue, solve a problem or make a decision.
I am presenting the following white paper on topical steroid addiction in hopes of informing the public about its existence and persuading the medical community to take responsibility for its participation in TSA so that Red Skin Syndrome can be eliminated forever.
Those who do not feel pain seldom think that it is felt.
Topical Steroid Addiction – a White Paper
The sequence of events that results in the vast majority of patients with Red Skin Syndrome is the misdiagnosis, mistreatment, and mismanagement of atopic dermatitis (eczema). The manifestations of eczema initially seen most commonly in children and rarely initially in adults are invariably mild and only in small areas of the skin. Conventional treatment begins with weak strength topical corticosteroid creams, lotions, and ointments. After a few weeks and the continued presence of the rash, stronger topical steroids are prescribed. The rash now flares up and down and a larger area of skin becomes involved. The beginning of addiction to the steroids is underway. The downward spiral continues and is met with more creams, allergy testing, food avoidance, more physician consults and more patient and parental anxiety.
The rash spreads. The child or adult becomes very itchy and if old enough to verbally express it describes a severe burning sensation to the skin. They continue to exhibit flashes of heightened redness in the skin followed by spontaneous diminution over days and always instantly clear with more steroids – this pattern of flares followed by application of topical steroids facilitates the addiction process. The evolution into addiction occurs within 4-8 weeks. The patients now have topical steroid addiction (TSA).
All of this is avoidable. The natural history of eczema is seen in the front of the elbows, behind the knees, sometimes in small areas of “slobber dermatitis” on the face of the infant, a mild eyelid rash in the adult, or mild hand dermatitis. Only after prolonged treatment with topical steroids does the rash spread.
Red Skin Syndrome was unknown before the introduction of topical steroids. Childhood eczema naturally resolved itself with warm baths, cold compresses, lubrication and sunshine. The children “outgrew” their eczema. The advent of topical steroids has created a devastating cycle of flaring and clearing that inevitably leads to topical steroid addiction and Red Skin Syndrome.
So, why do the treating physicians not recognize the obvious fact that the patients are getting worse despite their recommended conventional treatments? The science of careful observation and medical management has been replaced by “beliefs”, “suppositions,” “search for the hidden allergen,” “patient blame for not following orders,” and the insidious interference of pharmaceutical companies peddling their “newest” and “latest” cure for eczema.
Bravo Dr. Rapaport!
Hopefully your White Paper will be the “beginning of the end” of the inappropriate and over-prescribing of topical steroids for eczema or what “appears” to be eczema and end the suffering that has been needlessly endured by countless human beings. You have cured 3200 patients by stopping the steroids and that should be proof enough to any reasonably intelligent person.
Pat M.
NYC
Thank you Dr. Rapaport, there is enough suffering from steroid addiction and it truly needs to stop once and for all for adults and children alike.
Thank you Dr. Rapaport and ITSAN for this white paper opinion piece. I hope that it will be widely circulated and seriously considered by health care providers and educators, patients, and their families in their diagnosis and treatment. In this layperson’s opinion Red Skin Syndrome is a very serious, debilitating disease that is misunderstood, misdiagnosed, and mistreated. I, and many others, would like to support you, patients, and their families, in publicizing and moving forward on these issues. However, many in the patient community appear frustrated that despite efforts over the years, the healthcare community remains resistant to the premise that TCS mistreatment is a significant contributor to RSS. So, a couple of additional thoughts and questions:
1) How can a more compelling case be made that RSS is really serious and TCS mistreatment is a problem?
2) Are there patient surveys and/or scientific studies or even animal studies that support this position? If not, can they be created, and would they be helpful?
3) Can/should partnerships be formed with other organizations like NEA, AAD, NIAID, to move forward?
Please follow the website for the 8 total blogs. Hopefully your questions will be answered in the blogs along with what I propose to do.
Bravo, Dr. Rapaport! Thank you for giving us all the information, support, expertise, and caring to heal.
Thank you Dr Rapaport for your dedication and commitment to revealing the truth behind the horrors of topical steroids in the treatment of eczema. My brave and clever 20 year old daughter discovered that this was the reason for her continual flare ups and worsening skin condition, having used topical, and at times oral steroids, since she was about 12 months of age. It is almost a year since she went completely off steroids. Topical steroid addiction is an unbelievably huge problem and there are and will be thousands if not millions of sufferers around the world, steroids being the only treatment that western medicine has to offer. My advice to those learning they have eczema, go back to traditional medicine. Here in New Zealand we call it Rongoa Maori. We will follow the progression of the White Paper and hope that something similar happens in New Zealand.
Thank you for all the help you have given my son and I. Also, for STILL never giving up on raising awareness to the medical community. End this incredible unnecessary suffering of people all over the globe!!!
There will be 8 papers including the White paper. Please read all of them. Hopefully the last one will be a surprise to all.
May God bless you for your effort. Is there any health practitioners in the UK who look at the bigger picture in relation to skin conditions.I have worsening skin problems and have prescribed elocon, protopic which are not resolving the problem but making it worse.when I use steroid creams it clears up when I stop it flares up and it is spreading. I don’t
May God bless you for your efforts. Ilive in the UK is there any way you could help me I have worsening skin ptoblems and have been prescribed and used steroid ointments and a protopic cream.I look forward to hearing fromyou. Thank you
If you want my personal medical attention please contact Marisela in the office – her information is on the website.
Thank you so much with providing this information. I’m telling all my friends and doctors about so they don’t have to suffer the same fate I did. I was wondering if twitching could be a symptom of withdrawal. It feels like restless leg but on my arms as well.
Dr Rapaport replied by email to you.