The Dermatitis Factor

While rosacea and seborrheic dermatitis are different skin disorders, sometimes they can coexist at the same time. Approximately 35% of people with rosacea have seborrheic dermatitis which makes for an even more sensitive skin condition.

Seborrheic dermatitis involves overactive sebaceous glands which cause inflammation, flaking, and a red rash in the central portion of the face. If one looks closely, the flakes usually have a greasy look, smell, and feel. The dryness of seborrheic dermatitis is perceived because of the flaking which consists of dried layers of accumulated oil.

Seborrheic dermatitis causes yellowish scales to develop on the scalp, the hairline, and the eyebrows. This is often confused with the crusting and scaling on the eyelids that occur with ocular rosacea. A doctor should check any scaling around the eyes, as the potential side effects of ocular rosacea are more serious than those of seborrheic dermatitis.

Topical steroids used in the treatment of dermatitis can create steroid induced rosacea. This condition typically worsens when the steroid is stopped. In an unfortunate cycle the steroid may be reapplied to diminish the redness which only worsens the condition.

Many times topical steroids are prescribed to treat the symptoms of eczema, a skin condition characterized by itchy, red, scaly skin. They are also used for other inflammatory skin conditions such as psoriasis and dermatitis. They don't cure the conditions but can ease the symptoms. They work by reducing inflammation of the skin and thus easing the symptoms of itching, redness, and swelling that occur with these skin conditions.

Topical steroids frequently cause thinning of the skin if used for long periods of time. They can also cause acne-like pustules, dermatitis, broken blood vessels under the skin, stretch marks, loss of skin color (which may clear-up on stopping treatment) and, when used on the face, a rosacea-like disorder (reddening of the skin), also known as steroid rosacea. Other side effects can include itching, easy bruising, and in some cases skin infection.

Perioral Dermatitis is a rosacea-like eruption around the mouth area. Topical steroid use and fluoridated toothpaste are the most common culprits. Perioral dermatitis appears mainly in women between the ages of 15 and 40. It consists of small red papules or pustules without spider veins which characteristically circle the mouth area but does not affect the lips. There may also be scaling.

Some find that discontinuing the use of fluoridated or tartar control toothpaste for six months may help reduce the symptoms of perioral dermatitis.

The key to an effective treatment is to find a product which can treat the symptoms of dermatitis without aggravating or causing rosacea.

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PERIORAL DERMATITIS

When treating the symptoms of rosacea, one may observe a rosacea-like eruption around the mouth area. Known as perioral dermatitis, perioral refers to the facial area around the mouth while dermatitis pertains to inflammation, redness, or irritation of the skin.

This rosacea-like inflammation generally consists of small red bumps or even pus bumps and mild peeling as the skin is extremely aggravated. This condition may be wrongfully thought of as acne while others believe it to be a manifestation of their rosacea. Perioral dermatitis is often aggravated by fluoridated or tartar-control toothpaste, chapstick, the ingredients in lipstick, and mouthwash. It is also believed that cinnamon, cosmetics, moisturizers, topical steroids, and even residue from asthma inhalers containing steroids contribute to perioral dermatitis. Hormones, sunlight, and stress can cause perioral dermatitis to be more severe. Perioral dermatitis is a common skin problem that mostly affects young women, however, occasionally men and children are affected by it.

Perioral dermatitis symptoms characteristically involve the mouth area, but do not affect the lips themselves. There may also be some flaking of the skin at the site of occurrence. Many times if the flaking is isolated to the lip area it may be mistaken for chapped lips. Perioral dermatitis may be considered a variant of rosacea or as a distinct and separate skin condition.

Although rosacea papules may appear in the perioral area, perioral dermatitis without rosacea symptoms cannot be classified as a variant of rosacea. Perioral dermatitis is characterized by symptoms of microvesicles, scaling, and peeling.

Often the skin around the nose is affected too, and sometimes it can affect the area under and around the eyes. When perioral dermatitis expands to include the eye area, it should more correctly be termed "periocular", or even, "periorificial" dermatitis. Periocular dermatitis consists of similar flaking and redness around the eyes and eyelids with or without the appearance of small papules or pustules.

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THE CONTROVERSY OVER STEROIDS AND ROSACEA

In the treatment of severe facial dermatitis, one may be prescribed a limited time dose of a topical steroid.Initially the anti-inflammatory and vasoconstrictive effects of the topical steroids result in what appears to be clearance of the primary dermatitis. Cortisones work by decreasing inflammation, swelling, burning, and itching at the site of application. When applied in an ointment they can help the skin maintain moisture. In general, steroid ointments are stronger than steroid creams because the medicine penetrates better when in an ointment form.

Topical steroids are generally used to treat the symptoms of dermatitis, a skin condition characterized by itchy, red, scaly skin. They are also used for other inflammatory skin conditions such as psoriasis and dermatitis. They don't cure the conditions but can ease the symptoms. They work by reducing inflammation of the skin and thus easing the symptoms of itching, redness, and swelling that occur with many skin conditions.

When a rosacea patient is treated for a prolonged time with topical steroids the disorder may at first respond, but inevitably the signs of steroid atrophy emerge with thinning of the skin and marked increase in telangiectases. The complexion becomes dark red with a copper-like hue. Soon the surface becomes studded with round, follicular, deep papulopustules, firm nodules, and even secondary comedones. The appearance is shocking with a flaming red, scaling, and papule-covered face.

The persistent use of topical steroids leads to epidermal atrophy, degeneration of dermal structure, and collagen deterioration after several months. Ultimately the skin develops the appearance of rosacea, and it is rendered extremely vulnerable to bacterial, viral, and fungal infection. Patients persist in using steroid creams or ointments because they have typically learned the hard way about the severe rebound inflammation that occurs if they stop. In short, they find themselves caught between rosacea-like steroid dermatitis and the erythematous pustular eruptions of steroid rebound.

Steroid rosacea is an avoidable skin condition, which in addition to disfigurement is accompanied by severe discomfort and pain. Withdrawal of the steroid treatment is inevitably accompanied by exacerbation of the rosacea-like symptoms.

On initial assessment, it can be very difficult to distinguish between true rosacea and its steroid-induced mimic. The neck and scalp are often the giveaway, said Dr.Roger Allen of the University Hospital, Nottingham, England. Steroid-induced rosacea is often diffuse, extending from the face down along the neck. In balding men, the scalp is often affected. True rosacea tends to be less diffuse. Unfortunately there is no easy way to resolve steroid-induced rosacea, short of ceasing steroid use. This is, admittedly, a hard sell to patients who have already experienced the severe erythema, edema, and pustular eruptions associated with steroid rebound. Topical or systemic antibiotics may be needed if the patient has a bacterial infection. Cold chamomile tea compresses are a soothing adjunct for patients in the throes of steroid backlash. It is important to understand the rebound phenomenon in steroid induced rosacea. The rosacea sufferer is often baffled by their observation that the same medicine that was so effective in clearing their primary dermatoses or acne is now causing this distressing rosacea-like condition, and that their skin gets markedly worse if they stop treatment. Prudence in steroid use is essential. Patients with seborrheic dermatitis, acne vulgaris, or other dermatoses simply should not be treated with topical corticosteroids.

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