Chapter 6 Topical Corticosteroid Withdrawal Support Doctor in Beverly Hills - 1
Corticosteroid addiction and withdrawal in the atopic: the red burning skin syndrome
By MJ. Rapaport et al. published in the Clinics in Dermatology Volume 21, Issue 3, May-June 2003, P201-214
Dr. Rapaport, a clinical professor of dermatology of UCLA, has his clinic at high-end medial mall in Beverly Hills and is a genuine topical steroid withdrawal support doctor.
----- Excerpt -----
After extensive workup failed to reveal any relevant contact allergens, systemic etiology, or infectious pathogens, all corticosteroids were stopped. Patients were required to discontinue all corticosteroids both topical and systemic. Approximately 5% of the patients were either unwilling to accept the diagnosis of corticosteroid addiction, or, because their initial flares on steroid cessation were so severe, were unable to comply. All of the others, although frustrated, adhered to the regimen of corticosteroid abstinence. Previous attempts to taper systemic and topical corticosteroid in these patients had resulted in severe rebound; a great deal of support and “hand-holding” were necessary.
----- End of excerpt -----
What an approach! But it’s understandable. There are numerous doctors who prescribe topical corticosteroids (TCS) as patients ask for them. But there are few doctors to advise them to stop using them. Being different from mine, it is one style of medical care.
Dr. Rapaport began to address TCS withdrawal therapy in the background peculiar to Beverly Hills. There is cosmetic operation, not still unfamiliar in Japan, called resurfacing in which skin is shallowly burned with a CO2 laser to regenerate the skin and remove wrinkles or pigmented spots. In the U.S., some people who had undergone the laser treatment suffered from persistent inflammation (erythema).
Dr. Rapaport predicted that such people had already been steroid addicted before undergoing the laser resurfacing procedures and the flare observed in these people was just a rebound phenomenon resulting from temporary suspension or a switch to less potent steroids after surgery.
---- Excerpt -----
Post-Peel (Laser) Erythema Syndrome: We recently reported on 12 patients who developed persistent facial erythema after phenol peel or laser resurfacing for aging skin. Three patients had used topical corticosteroids before the procedure for atopic or seborrheic dermatitis, and one had used a super potent corticosteroid cream for 10 years for chronic eyelid dermatitis. This latter patient also applied the same preparation to the vaginal and anal areas for 8 years and developed a severe flare in these areas when corticosteroids were stopped.
In recent years, corticosteroids have often been prescribed after resurfacing procedures to prevent hypertrophic scarring. Maloney et al used corticosteroids in all postlaser patients. Erythema was seen for up to 1 year in some of their patients. Reviews of laser resurfacing describe prolonged erythema as a fairly common complication of the procedure and suggest that preoperative hydroquinone, tretinoin application, multiple laser passes, and postoperative dressings are the probable causes. The atopic individuals in our series had the most difficult and protracted courses after steroid cessation, whereas non-atopic individuals were usually cleared within 2 to 3 months. Patients undergoing resurfacing procedures should be questioned about prior steroid usage on the face since they may be more likely to develop persistent erythema after the procedure.
----- End of excerpt -----
I have met Dr. Rapaport once. When I decided to change over to cosmetic surgery after resigning from the Nagoya National Hospital due to health problems 6 years ago, I visited Dr. Rapaport to seek some advice.
He was much older than I and working as a clinical professor at UCLA and one of the experienced and leading dermatologists in the local area. After I told my purpose for the visit, he introduced me some doctors.
One doctor I met asked me how come I’d got acquainted with Dr. Rapaport and I replied, “I have read his paper on steroid addiction.” Then he said, “Dr. Rapaport is willing to accept such difficult patients. Not in my life.” Then I knew why Dr. Rapaport was respected by other doctors.
I felt envious because I knew no Japanese senior doctor like Dr. Rapaport.
Corticosteroid addiction and withdrawal in the atopic: the red burning skin syndrome
By MJ. Rapaport et al. published in the Clinics in Dermatology Volume 21, Issue 3, May-June 2003, P201-214
Dr. Rapaport, a clinical professor of dermatology of UCLA, has his clinic at high-end medial mall in Beverly Hills and is a genuine topical steroid withdrawal support doctor.
----- Excerpt -----
After extensive workup failed to reveal any relevant contact allergens, systemic etiology, or infectious pathogens, all corticosteroids were stopped. Patients were required to discontinue all corticosteroids both topical and systemic. Approximately 5% of the patients were either unwilling to accept the diagnosis of corticosteroid addiction, or, because their initial flares on steroid cessation were so severe, were unable to comply. All of the others, although frustrated, adhered to the regimen of corticosteroid abstinence. Previous attempts to taper systemic and topical corticosteroid in these patients had resulted in severe rebound; a great deal of support and “hand-holding” were necessary.
----- End of excerpt -----
What an approach! But it’s understandable. There are numerous doctors who prescribe topical corticosteroids (TCS) as patients ask for them. But there are few doctors to advise them to stop using them. Being different from mine, it is one style of medical care.
Dr. Rapaport began to address TCS withdrawal therapy in the background peculiar to Beverly Hills. There is cosmetic operation, not still unfamiliar in Japan, called resurfacing in which skin is shallowly burned with a CO2 laser to regenerate the skin and remove wrinkles or pigmented spots. In the U.S., some people who had undergone the laser treatment suffered from persistent inflammation (erythema).
Dr. Rapaport predicted that such people had already been steroid addicted before undergoing the laser resurfacing procedures and the flare observed in these people was just a rebound phenomenon resulting from temporary suspension or a switch to less potent steroids after surgery.
---- Excerpt -----
Post-Peel (Laser) Erythema Syndrome: We recently reported on 12 patients who developed persistent facial erythema after phenol peel or laser resurfacing for aging skin. Three patients had used topical corticosteroids before the procedure for atopic or seborrheic dermatitis, and one had used a super potent corticosteroid cream for 10 years for chronic eyelid dermatitis. This latter patient also applied the same preparation to the vaginal and anal areas for 8 years and developed a severe flare in these areas when corticosteroids were stopped.
In recent years, corticosteroids have often been prescribed after resurfacing procedures to prevent hypertrophic scarring. Maloney et al used corticosteroids in all postlaser patients. Erythema was seen for up to 1 year in some of their patients. Reviews of laser resurfacing describe prolonged erythema as a fairly common complication of the procedure and suggest that preoperative hydroquinone, tretinoin application, multiple laser passes, and postoperative dressings are the probable causes. The atopic individuals in our series had the most difficult and protracted courses after steroid cessation, whereas non-atopic individuals were usually cleared within 2 to 3 months. Patients undergoing resurfacing procedures should be questioned about prior steroid usage on the face since they may be more likely to develop persistent erythema after the procedure.
----- End of excerpt -----
I have met Dr. Rapaport once. When I decided to change over to cosmetic surgery after resigning from the Nagoya National Hospital due to health problems 6 years ago, I visited Dr. Rapaport to seek some advice.
He was much older than I and working as a clinical professor at UCLA and one of the experienced and leading dermatologists in the local area. After I told my purpose for the visit, he introduced me some doctors.
One doctor I met asked me how come I’d got acquainted with Dr. Rapaport and I replied, “I have read his paper on steroid addiction.” Then he said, “Dr. Rapaport is willing to accept such difficult patients. Not in my life.” Then I knew why Dr. Rapaport was respected by other doctors.
I felt envious because I knew no Japanese senior doctor like Dr. Rapaport.