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Abuduyev NK, Plahova XI, Katunin GL. Current state of the red scrotum syndrome. VESTNIK DERMATOLOGII I VENEROLOGII 2022. [DOI: 10.25208/vdv1357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Red scrotum syndrome is a chronic, difficult-to-recognize dermatosis affecting middle-aged and elderly people. It is manifested by erythema of the scrotum with clear boundaries, without neck. The etiology and pathogenesis of the disease have not been established. Hypotheses about the causes of dermatosis as a consequence of uncontrolled use of topical steroids, neurological inflammation, formation of microbial biofilm are based on anamnestic data and the results of trial treatments. Etiologically and pathogenetically justified therapy has not been proposed. Therapy with the use of doxycycline, gabapentin, pregabalin, indomethacin, tacrolimus was carried out in small groups of patients. The lack of clarity in the etiology and understanding of the mechanism of development of the disease explains the lack of a unified focus of the proposed therapies based on isolated clinical cases. In general, the problem of diagnosis and treatment rests on the absence of major clinical, epidemiological and laboratory studies that allowed to establish the pathophysiology and assess the true prevalence of red scrotum syndrome.
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Tan SY, Chandran NS, Choi ECE. Steroid Phobia: Is There a Basis? A Review of Topical Steroid Safety, Addiction and Withdrawal. Clin Drug Investig 2021; 41:835-842. [PMID: 34409577 PMCID: PMC8481181 DOI: 10.1007/s40261-021-01072-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/01/2022]
Abstract
There is a growing concern amongst patients about topical corticosteroid (TCS) side effects, with increasing discussion of topical steroid addiction (TSA) and topical steroid withdrawal (TSW) particularly on social media platforms. However, the acceptance of TSA/TSW as a distinct condition remains controversial within the dermatological community. We conducted a literature search using PubMed, MEDLINE, Cochrane Library, Google Scholar, Embase and Web of Science to identify original articles addressing TSA/TSW. We described the definition and reported clinical features of TSA/TSW including its classification into erythemato-edematous and papulopustular subtype. To assess the validity of TSA/TSW, we summarised and objectively appraised the postulated mechanisms for this condition, including tachyphylaxis, dysregulation of glucocorticoid receptors, rebound vasodilation and impaired skin barrier leading to a cytokine cascade. Understanding the evidence including its limitations and uncertainties highlights areas for future research and helps medical practitioners better counsel and provide care to patients who may be experiencing or who have concerns about TSA/TSW.
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Affiliation(s)
- Sean Yilong Tan
- Division of Dermatology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Nisha Suyien Chandran
- Division of Dermatology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore. .,Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, 10 Medical Dr, Singapore, 117597, Singapore.
| | - Ellie Ci-En Choi
- Division of Dermatology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
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Perry TW. Cutaneous microbial biofilm formation as an underlying cause of red scrotum syndrome. Eur J Med Res 2021; 26:95. [PMID: 34412706 PMCID: PMC8375042 DOI: 10.1186/s40001-021-00569-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/09/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Red scrotum syndrome is typically described as well-demarcated erythema of the anterior scrotum accompanied by persistent itching and burning. It is chronic and difficult to treat and contributes to significant psychological distress and reduction in quality of life. The medical literature surrounding the condition is sparse, with the prevalence likely under-recognized and the pathophysiology remaining poorly understood. Formation of a cutaneous microbial biofilm has not been proposed as an underlying etiology. Microbial biofilms can form whenever microorganisms are suspended in fluid on a surface for a prolonged time and are becoming increasingly recognized as important contributors to medical disease (e.g., chronic wounds). CASE PRESENTATION A 26-year-old man abruptly developed well-demarcated erythema of the bilateral scrotum after vaginal secretions were left covering the scrotum overnight. For 14 months, the patient experienced daily scrotal itching and burning while seeking care from multiple physicians and attempting numerous failed therapies. He eventually obtained complete symptomatic relief with the twice daily application of 0.8% menthol powder. Findings in support of a cutaneous microbial biofilm as the underlying etiology include: (1) the condition began following a typical scenario that would facilitate biofilm formation; (2) the demarcation of erythema precisely follows the scrotal hairline, suggesting that hair follicles acted as scaffolding during biofilm formation; (3) despite resolution of symptoms, the scrotal erythema has persisted, unchanged in boundary 15 years after the condition began; and (4) the erythematous skin demonstrates prolonged retention of gentian violet dye in comparison with adjacent unaffected skin, suggesting the presence of dye-avid material on the skin surface. CONCLUSION The probability that microorganisms, under proper conditions, can form biofilm on intact skin is poorly recognized. This case presents a compelling argument for a cutaneous microbial biofilm as the underlying cause of red scrotum syndrome in one patient, and a review of similarities with other reported cases suggests the same etiology is likely responsible for a significant portion of the total disease burden. This etiology may also be a significant contributor to the disease burden of vulvodynia, a condition with many similarities to red scrotum syndrome.
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Affiliation(s)
- Theodore W Perry
- Fee-Basis Hospitalist, North Texas VA Medical Center, 4500 South Lancaster Road, TX, 75216, Dallas, USA.
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Moll I. Rotes-Skrotum-Syndrom – Übersicht und Fallbeispiel. AKTUELLE DERMATOLOGIE 2021. [DOI: 10.1055/a-1351-5643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDas Rote-Skrotum-Syndrom (RSS) ist ein chronisches Erythem der Ventralseite des Skrotums, das scharf umschrieben ist und typischerweise weder Exkoriationen noch Lichenifizierung oder Schuppung aufweist. Es verursacht rezidivierend brennende und ziehende Schmerzen, aber keinen Juckreiz. Es ist selten und betrifft meist ältere Männer. Die Ursachen des RSS sind unklar. Diskutiert werden neurogene Entzündungen, Formen der Erythromelalgie, Rosacea erythematosa oder eine Hypervaskularisation. Ebenso existiert keine etablierte Therapie. Verschiedene topische Therapien, insbesondere Steroide, führen häufig zu Verschlechterungen. Vorsichtig können PEA, Calcineurin-Inhibitoren und pflegende wasserreiche Cremes versucht werden. An systemischen Therapien kommen NSAIDs zur Linderung der Schmerzen, Doxycyclin, Metronidazol, Steroide, Penicillin oder Antihistaminika in Betracht, bei ausbleibender Besserung daneben Gabapentin, Pregabalin, Amitryptilin oder Carvediol. Die Differenzialdiagnosen umfassen generalisierte und lokalisierte Dermatosen.
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Affiliation(s)
- Haya S. Raef
- Tufts University School of Medicine, Boston, Massachusetts
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarina B. Elmariah
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Verma SB, Wollina U, Das A. A curious observation of passive transfer of steroid antifungal combination creams to the scrotum in patients of tinea cruris-Is this forme fruste of red scrotum syndrome? Dermatol Ther 2020; 33:e14212. [PMID: 32829512 DOI: 10.1111/dth.14212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/06/2020] [Accepted: 08/13/2020] [Indexed: 11/26/2022]
Abstract
We report 16 patients of tinea cruris who presented with an asymptomatic red scrotum due to fixed dose combination creams containing antifungal agents and topical steroids applied to the thighs as a treatment of tinea cruris. The erythema resolved upon starting appropriate treatment with single molecule antifungal creams and oral antifungal drugs in about six weeks' time in majority of cases. We propose that this clinical presentation may be akin to red scrotum syndrome (RSS). Due to its asymptomatic nature in most of the cases, we propose that this could be a forme fruste of RSS.
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Affiliation(s)
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
| | - Anupam Das
- Department of Dermatology, KPC Medical college and Hospital, Kolkata, West Bengal, India
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Martinez JD, Soria Orozco M, Cardenas-de la Garza JA. Oral ivermectin for the treatment of red scrotum syndrome. J DERMATOL TREAT 2020; 33:1102-1103. [PMID: 32436753 DOI: 10.1080/09546634.2020.1773378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Red scrotum syndrome is an infrequently reported dermatosis characterized by scrotal erythema accompanied by burning, pain, or dysesthesia. It has been increasingly associated with prolonged use of topical corticosteroids. Treatment is challenging and symptoms may persist for months or years after discontinuation of the topical corticosteroids. We report three cases successfully treated with oral ivermectin.
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Affiliation(s)
- Jose Dario Martinez
- Department of Internal Medicine, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
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Khalil S, Kurban M, Abbas O. Red scrotum syndrome: An update on clinicopathologic features, pathogenesis, diagnosis, and management. J Am Acad Dermatol 2020; 87:614-622. [DOI: 10.1016/j.jaad.2020.05.113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
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Elias M, Patel S, Schwartz RA, Lambert WC. The color of skin: red diseases of the skin, nails, and mucosa. Clin Dermatol 2019; 37:548-560. [PMID: 31896409 DOI: 10.1016/j.clindermatol.2019.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Red color is pervasive in local and systemic skin conditions. It is a color that often reflects variations of dermal blood flow and extends beyond the rubor and calor of inflammation. The pathophysiology of red skin involves remote and local chemical mediators that dilate arteriolar smooth muscle and increase blood flow to superficial vessels and capillary beds. Incident light hits hemoglobin, which preferentially absorbs light of shorter wavelengths, such as blue, and reflects warmer colors. Due to its pervasiveness and consistency, red color is a useful descriptive factor in helping narrow a differential diagnosis. Red skin disorders include a variety of conditions involving endocrine mediators, cardiovascular responses, and the disruption of the skin barrier. An understanding of the blood's role in these disorders equips clinicians to generate differential diagnoses through the lens of pathophysiology. Dermatologists can improve management by considering red skin as part of systemic disease rather than as an isolated incident.
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Affiliation(s)
- Marcus Elias
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Shreya Patel
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Robert A Schwartz
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - W Clark Lambert
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
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Cardenas-de la Garza JA, Villarreal-Villarreal CD, Cuellar-Barboza A, Cardenas-Gonzalez RE, Gonzalez-Benavides N, Cruz-Gomez LG, Ocampo-Candiani J, Welsh O. Red Scrotum Syndrome Treatment with Pregabalin: A Case Series. Ann Dermatol 2019; 31:320-324. [PMID: 33911598 PMCID: PMC7992738 DOI: 10.5021/ad.2019.31.3.320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 12/25/2022] Open
Abstract
Red scrotum syndrome (RSS) (also known as male genital dysesthesia) is a rarely recognized entity characterized by scrotal erythema accompanied by a burning sensation, pain, hyperesthesia/dysesthesia, increased temperature and pruritus. Although its physiopathology is unknown, it has increasingly been associated with chronic topical steroid use in the male genital area. Treatment is challenging and no standardized treatment is currently available. Because current treatment relies on case reports and small case series, the need for more information about drug efficacy in RSS is warranted. The aim of this study is to describe the therapeutic response to pregabalin in patients from an outpatient dermatologic clinic in a tertiary-care hospital diagnosed with RSS. Five patients with a confirmed diagnosis of RSS were included. Ages ranged from 28 to 63 years. All patients had chronic steroid use in the genital area, mostly in the form of combined formulations of corticosteroids, antifungals, and antibiotics. Four patients were prescribed pregabalin monotherapy, 150 mg once daily at night. One patient was prescribed pregabalin and doxycycline. Two patients had complete remission after one month of therapy, one at two months and two at three months. None experienced recurrence at an average of 9.4 months' follow-up. One patient experienced morning drowsiness that did not require suspending treatment. Pregabalin is a well-tolerated and effective treatment for RSS.
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Affiliation(s)
- Jesus Alberto Cardenas-de la Garza
- Department of Dermatology, Hospital Universitario Dr. José E. González y Facultad de Medicina, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Cesar Daniel Villarreal-Villarreal
- Department of Dermatology, Hospital Universitario Dr. José E. González y Facultad de Medicina, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Adrian Cuellar-Barboza
- Department of Dermatology, Hospital Universitario Dr. José E. González y Facultad de Medicina, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Ramiro Eugenio Cardenas-Gonzalez
- Department of Dermatology, Hospital Universitario Dr. José E. González y Facultad de Medicina, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Nereyda Gonzalez-Benavides
- Department of Dermatology, Hospital Universitario Dr. José E. González y Facultad de Medicina, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Luis Gerardo Cruz-Gomez
- Department of Dermatology, Hospital Universitario Dr. José E. González y Facultad de Medicina, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Jorge Ocampo-Candiani
- Department of Dermatology, Hospital Universitario Dr. José E. González y Facultad de Medicina, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Oliverio Welsh
- Department of Dermatology, Hospital Universitario Dr. José E. González y Facultad de Medicina, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
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Abstract
Psychodermatology, a relatively neglected branch of dermatology in India, refers to a holistic approach to skin diseases involving not only the mind and skin, but also the cutaneous effects of psychologic stress. Among many Indian people, culture, religion, the belief in karma, and the tendency to prefer indigenous medical systems can all have a major impact on lifestyle, as well as the approach to managing various diseases, including dermatologic conditions. The origin of psychodermatology in India can be traced to Buddha's period. Indigenous medical systems, such as Ayurveda, Yoga, and Unani, advocate control of skin disease through meditation, exercises, and related practices. Scientific practice of psychodermatology is still lacking in India, although there is an increasing understanding of the mind-skin connection among both health care providers and patients who have access to information over the Internet. The first dedicated psychodermatology liaison clinic was established in 2010 in Manipal, India. The common problems encountered have been anxiety, dysthymia, and depression, especially in patients with psoriasis, vitiligo, and urticaria.
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12
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Affiliation(s)
- Ribal Merhi
- Department of Dermatology, Holy Spirit University of Kaslik, Kaslik, Lebanon
| | - Nakhle Ayoub
- Department of Dermatology, Holy Spirit University of Kaslik, Kaslik, Lebanon
| | - Marc Mrad
- Department of Dermatology, Holy Spirit University of Kaslik, Kaslik, Lebanon
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Liu JH, Feng SW, Luo ZY, Luo DQ. Red scrotum syndrome: A form of corticosteroid addiction, a variant of erythermalgia, or a distinct entity? DERMATOL SIN 2016. [DOI: 10.1016/j.dsi.2016.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Miller J, Leicht S. Pregabalin in the treatment of red scrotum syndrome: a report of two cases. Dermatol Ther 2016; 29:244-8. [PMID: 27087268 DOI: 10.1111/dth.12354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jonathan Miller
- University of Tennessee College of Medicine; Chattanooga Tennessee
| | - Stuart Leicht
- Division of Dermatology, Department of Internal Medicine; East Tennessee State University; Johnson City Tennessee
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Wollina U. Three orphans one should know: red scalp, red ear and red scrotum syndrome. J Eur Acad Dermatol Venereol 2015; 30:e169-e170. [DOI: 10.1111/jdv.13474] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- U. Wollina
- Department of Dermatology; Hospital Dresden-Friedrichstadt; Dresden Germany
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Hajar T, Leshem YA, Hanifin JM, Nedorost ST, Lio PA, Paller AS, Block J, Simpson EL. A systematic review of topical corticosteroid withdrawal ("steroid addiction") in patients with atopic dermatitis and other dermatoses. J Am Acad Dermatol 2015; 72:541-549.e2. [PMID: 25592622 DOI: 10.1016/j.jaad.2014.11.024] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND The National Eczema Association has received increasing numbers of patient inquiries regarding "steroid addiction syndrome," coinciding with the growing presence of social media dedicated to this topic. Although many of the side effects of topical corticosteroids (TCS) are addressed in guidelines, TCS addiction is not. OBJECTIVE We sought to assess the current evidence regarding addiction/withdrawal. METHODS We performed a systematic review of the current literature. RESULTS Our initial search yielded 294 results with 34 studies meeting inclusion criteria. TCS withdrawal was reported mostly on the face and genital area (99.3%) of women (81.0%) primarily in the setting of long-term inappropriate use of potent TCS. Burning and stinging were the most frequently reported symptoms (65.5%) with erythema being the most common sign (92.3%). TCS withdrawal syndrome can be divided into papulopustular and erythematoedematous subtypes, with the latter presenting with more burning and edema. LIMITATIONS Low quality of evidence, variability in the extent of data, and the lack of studies with rigorous steroid addiction methodology are limitations. CONCLUSIONS TCS withdrawal is likely a distinct clinical adverse effect of TCS misuse. Patients and providers should be aware of its clinical presentation and risk factors.
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Affiliation(s)
- Tamar Hajar
- Oregon Health and Science University, Portland, Oregon
| | - Yael A Leshem
- Oregon Health and Science University, Portland, Oregon
| | - Jon M Hanifin
- Oregon Health and Science University, Portland, Oregon
| | | | | | | | - Julie Block
- National Eczema Association, San Rafael, California
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Fukaya M, Sato K, Sato M, Kimata H, Fujisawa S, Dozono H, Yoshizawa J, Minaguchi S. Topical steroid addiction in atopic dermatitis. DRUG HEALTHCARE AND PATIENT SAFETY 2014; 6:131-8. [PMID: 25378953 PMCID: PMC4207549 DOI: 10.2147/dhps.s6920] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The American Academy of Dermatology published a new guideline regarding topical therapy in atopic dermatitis in May 2014. Although topical steroid addiction or red burning skin syndrome had been mentioned as possible side effects of topical steroids in a 2006 review article in the Journal of the American Academy of Dermatology, no statement was made regarding this illness in the new guidelines. This suggests that there are still controversies regarding this illness. Here, we describe the clinical features of topical steroid addiction or red burning skin syndrome, based on the treatment of many cases of the illness. Because there have been few articles in the medical literature regarding this illness, the description in this article will be of some benefit to better understand the illness and to spur discussion regarding topical steroid addiction or red burning skin syndrome.
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Affiliation(s)
| | - Kenji Sato
- Department of Dermatology, Hannan Chuo Hospital, Osaka, Japan
| | | | | | | | | | | | - Satoko Minaguchi
- Department of Dermatology, Kounosu Kyousei Hospital, Saitama, Japan
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Abstract
Corticosteroids, one of the most widely prescribed topical drugs, have been used for about six decades till date. However, rampant misuse and abuse down the years has given the drug a bad name. Topical steroid abuse may lead to two major problems which lie at the opposing ends of the psychosomatic spectrum. Topical steroid addiction, a phenomenon that came to be recognized about a decade after the introduction of the molecule is manifested as psychological distress and rebound phenomenon on stoppage of the drug. The rebound phenomenon, which can affect various parts of the body particularly the face and the genitalia has been reported by various names in the literature. TC phobia which lies at the opposite end of the psychiatric spectrum of steroid abuse has been reported particularly among parents of atopic children. Management of both conditions is difficult and frustrating. Psychological counseling and support can be of immense help in both the conditions.
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Affiliation(s)
- Aparajita Ghosh
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Sujata Sengupta
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Arijit Coondoo
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Amlan Kusum Jana
- Department of Psychiatry, KPC Medical College and Hospital, Kolkata, West Bengal, India
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