Steroid-induced Occular Rosacea?

[Brighteyes]

Below is an article about steroid-induced rosacea. Obviously we are all trying to discover the root of our own affliction. In my case, I had bleph in my right eye which I was able to keep under control for the better part of three years. That is not to say that I didn't have an occassional flare-up - but I was usually able to get it under control rather quickly. One of these flare-ups caused me to panic and visit a new doctor. He prescribed me steroid eye-drops to be administered short term. For whatever reason, I used the drops in both eyes, even though I had never had ANY problems with my left eye. Within a week both eyes were out of control and my condition has not really improved. I have seen 4 dermatologists who all say I do not exhibit signs of rosacea on my skin. However, I have read that one can have occular rosacea by itself. I was wondering whether anyone has ever heard of steroid-induced occular rosacea.

http://www.skincarephysicians.com/ro...et/update.html

Steroid-induced Rosacea
For more than 50 years, dermatologists have been using topical steroids to safely and effectively treat a number of skin conditions. Today, these medications continue to be widely used. Under the knowledgeable supervision of a dermatologist, topical steroids benefit a great many patients. However, if used improperly, topical steroids can harm the skin.

What it is. Frequent, long-term, or unsupervised use of a topical steroid can cause an adverse drug reaction called steroid-induced rosacea. What distinguishes this condition from rosacea is that steroid-induced rosacea is not limited to the central face. Intense redness along with acne-like pimples and bumps may develop on any part of the face or groin treated with a topical steroid. With long-term use, small blood vessels usually appear. The other key difference between rosacea and steroid-induced rosacea is that with proper treatment, steroid-induced rosacea can be cured.

Who gets it. Some patients develop steroid-induced rosacea within weeks of applying a topical steroid; others may not experience it for years.

Medical researchers believe that anyone can develop steroid-induced rosacea; however, it is possible that the people most likely to develop rosacea are more susceptible. Those at highest risk of developing rosacea are adults between 30 and 50 years of age who have lighter skin, blond hair, and blue eyes.

Treatment. Treatment for steroid-induced rosacea differs slightly from that of rosacea. For steroid-induced rosacea, dermatologists generally prescribe an oral antibiotic and advise the patient to stop using topical steroids. In some cases, the patient also gets a prescription for tacrolimus ointment (an anti-inflammatory medication). Although tacrolimus ointment does not effectively treat rosacea, dermatologists are reporting that tacrolimus often resolves the itch, redness, and tenderness of steroid-induced rosacea in 7 to 10 days with twice daily application. Complete clearing of steroid-induced rosacea usually takes 1 to 2 months. Sometimes clearing takes a bit longer. Avoiding rosacea triggers, such as caffeine, spicy foods, and alcohol, also may help clear the skin.

Probably the most difficult part of treatment for a patient with steroid-induced rosacea is the intense flare-ups that occur when the patient stops applying the topical steroid. Many patients are tempted to apply a topical steroid to calm the skin. To minimize this reaction, a dermatologist may slowly withdraw the patient from the topical steroid by prescribing topical steroids that are less and less potent. Other dermatologists prefer that the patient stop immediately and advise the patient to throw away all topical steroids. This prevents the temptation to apply a topical steroid when the skin flares.

Once steroid-induced rosacea clears, the skin usually remains clear if the person does not apply a topical steroid.

[Rory]

I am very interested in this condition, steroid induced Rosacea.

When i first developed my eye problem...was it blepharatis ..who knows what i really had> whatever it was my university GP prescribed some steroid eyedrops and then later a consultant opthalmologist prescribed hydrocortisone cream for the eyelids. Anyway i was certainly taking steroid treatment for my eyes for a good year or so.... with great benefits!

Then i was told to stop all these by further consultants...and my symptoms have been uncontrollable ever since!!!

I often felt that these medications gave me a chronic condition that I would not have otherwise had. Who knows? Anyone else know anything or been diagnosed with steroid induced Rosacea?

Could it be possible that 14 years after stopping with steroid eyedrops, cream... that the problem would not have resolved itself? I feel it could be time to go and give some money to a Dermatologist.... lets hope they are not as useless as their optical cousins.

thanks.


I certainly have very very mild facial Rosacea if at all (only flushing in very warm central heating). I have heard that Rosacea is also often called the "curse of the celts"... but i dont know many blonde blue eyed celts... i am irish and pretty dark.

[Rory]

Has anyone tried Tacrolimus (Protopic) to treat ocular Rosacea?

Seems to be the main treatment from my very limited internet research.

[Brighteyes]

Rory,

I was actually looking into protopic for its use treating atopic blepharitis. There are a couple threads on this site that discuss protopic - although I believe there are some studies showing it may cause cancer with long term use.

[armyoftwo2007]

Thanks for the information! I wonder the same thing. I kept getting sty's and the Dr gave me a steriod.. And I have had nothing but issues also!! They couldn't figure out what it was.. I do know that a person can be allergic to the preservitives in the medication and that alone can shut down your oil glands and lead to dysfunction.

[Kathel]

I have also wondered if topical steroids can induce a steroid ocular rosacea. I am a dermatologist, and have dealt with steroid rosacea of the skin, so it makes some sense to me that it could happen in the eyes too. I haven't seen anything in the literature about it. It seems that ophthalmologists prescribe topical steroids simply because there aren't that many alternatives to treat inflammation. (although I think there is an ocular form of tacrolimus in the pipeline, and now there is Restasis).

My problems exploded right after I had refractive surgery, and I thought at the time that maybe I was allergic to the prednisone drops I was using. Now I wonder if the steroids triggered a flare of ocular rosacea that was previously subclinical. I now avoid topical steroids in my eyes at all costs, due to my suspicions. I am using Azasite drops (azithromycin) and lid hygeine, and lots of cool compresses. I am slowly getting better. I think this question is a valid one and should be looked at by the ophthalmology community.

Kathel

[Rebecca Petris]

although I think there is an ocular form of tacrolimus in the pipeline,

Was, but as far as I know this is not in active research now. Sucampo had some trials going but stopped in 2005. There have been a lot of studies of tacrolimus in canine dry eye though.

Here is a list of everything I know of that is in active research for dry eye.

[Annekee]

azasite

Hi Kathel,
How are experiences with Azasite? How long do you take them and when did you notice relief, if any? I also have dry eyes due to mgd/ocular rosacea.

[happy88]

i have occular rosecea too

hi,
im wondering if your occular rosecea was already in full bloom with the things going on in your eye.
I know i had the same thing going on in my eye for quite a while and when i finally went to a good eye diesese doctor she immediatly did many tests and came up with occular rosecea
Now i take restasis eye drops twice daily and doxcycline daily i had a follow up visit and she said it didnt come in 6 weeks and its not going to go in 6 weeks so i am on continued therapy till i see her again.
Of course the hot compresses and lid scrubs are important too
Good luck to you

[Gerri55455]

Within a week both eyes were out of control and my condition has not really improved..

Brighteyes, I'm reading this some six years later .... This is exactly what happened to me. How I would love to know whether you found a solution. Thanks. ~Gerri

[Gerri55455]

Although tacrolimus ointment does not effectively treat rosacea, dermatologists are reporting that tacrolimus often resolves the itch, redness, and tenderness of steroid-induced rosacea in 7 to 10 days with twice daily application. .

Hello all,

I'm looking for a doctor who can prescribe this in the upper Mid-West.

Thanks.