A to Z of Corticosteroid Withdrawal: Red Skin

R is for Red Skin

The rebound following cessation of steroid creams has been given many names and titles, but one of the most often used is "Red Skin Syndrome", which was a term coined by Dr Marvin Rapaport when he  treated patients with the condition. He has, to date, treated over 2000 people with RSS and every single patient experienced the typical red skin associated with this condition.

When I went to London for an ITSAN meetup last month, one of the things that really hit me was how alike we all looked. We all had red faces and it was so clear that we were all suffering from the same thing and that this was clearly NOT eczema.

The red skin is caused by the nitric oxide in the blood vessels.Steroid creams suppress the blood vessels and artificially blanch the colour of the skin. By removing this suppressant, the vessels widen excessively and allow blood to rush close to the surface of the skin, causing a red appearance. The level of redness is sometimes quite shocking and takes a long time to go away.

Here are some pictures of people with red skin caused by steroid withdrawal:

You can see that the symptoms can be every severe and interestingly, the redness can have a clear demarcation line.You can see on the foot photo that the redness does not affect the toes and heels of the patient. It is also common for the redness to stop at the sleeve, causing the classic "red sleeve" sign of steroid withdrawal. The lady in the photo on the right has white fingers in contrast to her red hands.

 

To illustrate the fact that this is completely reversible with time, here is a photo of the same lady, in the same pose, now, after over a year off steroids (from the patients section of Itsan.org):

With time, the nitric oxide levels get lower and the blood vessels go back to normal and stop dilating. This can take several years.

 

Here are a few comments about red skin from the members of the ITSAN forum:

 

"Today marks a milestone of 5 months recovering from cortisone steroids that ravaged by body, destroyed my adrenal system and sent my skin bright red and dry.

Since stopping use of cortisone steroids, my body has been the victim of a horrendous recovery; bright red skin, very very very dry cracked skin, hair loss, swelling, insomnia and much much more."

 

"...I used low potency for 8 months leading to TSW (OTC hydrocortisone mostly) and developed full body tomato red skin after about 3 months. First it was localized and severely itchy and dry and red on the places I used but eventually the red blotches all merged into uniform red."

 

"I never had the actual red skin before withdrawing, I had cortisone induced eczema with pimples that looked like acne + I had the oozing (from my armpits + upper legs+ fingers) and itching really badly. I only have red skin since I went into the withdrawal. Also, I only started to show the red sleeve on my wrists from about 3 months in TSW because my hands were the worst at the beginning and they oozed and my palms were red too."

 

The worst thing about the redness is that it is embarrassing and makes us feel self conscious. I remember last summer, I felt quite happy to see that a lot of people were slightly red from catching the sun and so I didn't feel so out of place!

 

As distressing as it is, many thousands of Dr Rapaport, Dr Fukaya and Dr Sato's patients have seen it go away eventually. I am more pink than red now, so I'm optimistic.