Hormonal ointment withdrawal syndrome on the face: how to treat

Successful treatment of some dermatological problems is impossible without the use of hormonal external preparations. However, the use of such products, in addition to the benefits, has another "side of the coin": long-term treatment with them leads to the skin becoming accustomed to them - the so-called "hormonal ointment withdrawal syndrome" occurs. What do those who are planning or already undergoing such treatment need to know about this syndrome?

Epidemiology

According to the few statistical data, withdrawal syndrome from hormonal ointments develops in more than 90% of patients who were treated with such drugs.

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Causes hormonal ointment withdrawal syndrome

Sometimes a person finds himself in a situation where he is forced to use hormonal ointments - for example, to treat dermatitis and various skin rashes. If such diseases are chronic, the ointment is used often or even constantly. This can turn against the patient - the skin condition deteriorates sharply, and the reason for this is the withdrawal syndrome of hormonal ointments.

Thus, the only risk factors that can lead to the development of the syndrome are chaotic or constant (daily) use of hormonal ointments.

At the moment, the following types of hormonal drugs can be considered the most unsafe:

• Lorinden A ointment;
• Flucinar;
• ointment with hydrocortisone or prednisolone;
• Dermovate;
• Triderm or Celestoderm ointment;
• Sinaflan ointment;
• Elokom;
• Oxycort ointment;
• Betasalik.

Any of the above hormonal ointments can provoke the development of withdrawal syndrome, regardless of the percentage concentration of the drug.

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Pathogenesis

Abrupt discontinuation of hormonal ointments leads to the so-called "breakdown syndrome", the signs of which appear depending on the principle of action of a particular drug. After the use of glucocorticoid hormones, a worsening of the course of the disease for the treatment of which these external agents were prescribed is observed.

In severe cases, even adrenal insufficiency may develop - this is a rapidly increasing syndrome that poses a considerable danger to the patient.

To prevent the negative impact of hormonal ointments on the patient's health, the doctor will always explain the scheme of gradual reduction of the drug dosage. The patient's body gradually "gets used" to the reduction of the amount of ointment used, and the hormonal balance is not disturbed.

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Symptoms hormonal ointment withdrawal syndrome

Typical symptoms of withdrawal syndrome from hormonal ointments include:

• maroon-red erythema;
• zonal peeling, thinning, subatrophy of the skin;
• spider veins;
• rash in the form of papules and/or pustules;
• atrophy zones;
• areas with increased pigmentation.

The first signs of the syndrome appear approximately 6-8 days after stopping the use of local hormonal drugs:

• swelling of the face;
• severe hyperemia;
• pimples (abscesses).

The swelling increases over several days, and persistent erythema develops.

How long does withdrawal from hormonal ointments last?

Doctors are unanimous in their opinion: self-medication will not give an effect in case of withdrawal syndrome of hormonal ointments. A comprehensive medical approach is necessary here.

But even with proper treatment with medications, the syndrome is not cured immediately. The epidermal tissue must not only recover, but also restore its functions - and this can take from 4 to 12 weeks, and sometimes longer. Everything depends on the complexity of the syndrome. In particularly severe cases, consultative participation of doctors of different profiles may be required: dermatologist, endocrinologist, therapist.

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Stages

There are three clinical stages of withdrawal syndrome from hormonal ointments:

• Stage I – persistent redness of the skin;
• Stage II – the appearance of swelling, redness, rash, dryness;
• Stage III – pathological tissue proliferation.

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Complications and consequences

Withdrawal syndrome from hormonal ointments can be complicated by the development of dermatitis: the skin becomes wet and crusty, cracks and causes pain and discomfort. This condition is very dangerous for the body, as an infection can get in through the cracks and cause more serious complications.

The longer the treatment with hormonal ointments, the greater the risk of developing adverse effects.

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Diagnostics hormonal ointment withdrawal syndrome

The characteristic clinical picture, the treatment with hormonal ointments - all these facts allow us to accurately diagnose the withdrawal syndrome of hormonal ointments. For a final diagnosis, additional studies may be prescribed:

• determination of allergens (skin scarification tests, intradermal and provocative tests);
• blood test (complete blood count, biochemistry, blood for eosinophilia, immunogram, proteinogram, tests for possible allergens, assessment of hormonal levels, determination of blood sugar, determination of antibodies to parasites);
• general urine test;
• stool examination (bacterial culture for dysbacteriosis, analysis for helminths, coprogram).

The correct diagnosis should be based on clinical signs, anamnesis data, and the results of the listed diagnostic tests.

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Differential diagnosis

Differential diagnostics are carried out with allergic reactions, neurodermatitis, lichen planus, mycosis, eczema, and psoriasis.

To clarify the diagnosis, you may need to consult a gastroenterologist, allergist, endocrinologist, therapist, neuropsychiatrist, or otolaryngologist.

Treatment hormonal ointment withdrawal syndrome

Treatment should consist of two mandatory stages:

1. Complete refusal from hormonal external drugs.
2. Drug treatment combined with a special diet.

Medicines used to eliminate withdrawal symptoms from hormonal ointments are usually components of complex therapy:

• Metronidazole or Erythromycin, twice a day until the rash disappears;
• sorbent preparations (Lactofiltrum, Enterosgel)
• antihistamines (Suprastin, Cetrin);
• diuretics (for severe swelling);
• antibacterial drugs – Tetracycline, Doxycycline (if there is an increased risk of wound infection).

	Dosage and method of administration	Side effects	Special instructions
Metronidazole	Take 250-400 mg twice daily, with food or milk.	Bowel disorder, nausea, metallic taste in the mouth, dizziness, allergies, reddish color of urine.	Metronidazole is incompatible with alcohol.
Lactofiltrum	Take 2-3 tablets three times a day, 60 minutes before meals.	Diarrhea, bloating, allergies.	Lactofiltrum should be taken with caution in case of gastric ulcer in the acute stage.
Linex	Take immediately after meals, 2 capsules three times a day.	Very rarely – allergy.	You cannot wash down Linex with hot tea or alcohol.
Ketotifen	Take orally, with food, 1-2 mg twice a day.	Drowsiness, dizziness, fatigue, changes in appetite, constipation, urinary dysfunction.	While taking Ketotifen, concentration is impaired, which should be taken into account when driving and other similar activities.

Skin affected by withdrawal syndrome should be moisturized as much as possible and protected from ultraviolet radiation, wind, and frost. In addition, the following rules should be followed:

• do not touch the affected skin with dirty fingers;
• use proven moisturizing products frequently;
• do not rub the skin, use soft towels;
• regularly take vitamin complexes with vitamins B, C, A and folic acid;
• Use quality sunscreen in summer.

Vitamins

• Vitamin A is responsible for retaining moisture in the skin and for its elasticity, and a deficiency of this vitamin aggravates dryness and flaking.
• Vitamin C promotes the active formation of collagen fibers, accelerates wound healing and strengthens the tissue blood supply system.
• B vitamins protect the skin from the harmful effects of external damaging factors.
• Vitamin E accelerates the renewal and restoration of skin cells and has antioxidant properties.

Among the complex vitamin preparations, it is especially recommended to pay attention to such drugs as Volvit, Aevit, Vitrum Beauty, Alphabet Cosmetic, Perfectil, Revidox.

Physiotherapy treatment

Physiotherapy is not prescribed so often for hormonal ointment withdrawal syndrome, although in many cases it can be quite effective. Each procedure has its own indications and contraindications - and this must be taken into account before starting this type of treatment.

• Phototherapy is the irradiation of affected skin with ultraviolet light.
• Acupuncture, acupuncture.
• Magnetic therapy using alternating or constant magnetic field.
• Hyperbaric oxygenation method.
• Extremely high frequency millimeter wave therapy.

In cases of prolonged withdrawal syndrome of hormonal ointments, in the absence of effect from drug treatment, it is recommended to undergo spa therapy. Such treatment includes:

• climatotherapy;
• air baths;
• sulphide and radon baths;
• treatment with sea water and therapeutic mud.

Folk remedies

Sometimes, and especially in cases where conventional treatment does not give the expected effect, one can only hope for the action of traditional medicine. Indeed, several traditional recipes are known that can help with the withdrawal syndrome of hormonal ointments. And the sooner such methods of treatment are used, the better.

• Mix one tablespoon of crushed propolis with 4 tablespoons of vegetable oil (preferably olive oil), place in a water bath for 45 minutes. Pour the resulting homogeneous mass into a glass container and use for lotions twice a day.
• Apply compresses based on potato or cucumber juice to the affected areas three times a day.
• Mix 1 tbsp. baby cream with the same amount of birch tar, place in a water bath and warm up a little (no more than +60°C). Apply to skin twice a day.
• Brew and drink dandelion tea at least 4 times a day. To prepare it, steep 1 tbsp. of chopped grass in 0.5 l of boiling water. You can add some currant leaves and honey to this tea.

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Herbal treatment

• Brew 4 tbsp. of an equal mixture of chamomile, marigold and plantain herbs in a 300 ml thermos. After 10 hours, filter the infusion and use for irrigation and lotions on the affected skin.
• Squeeze the juice from the golden mustache plant. Mix one tablespoon of this juice with 1 tablespoon of sea buckthorn oil and mix the mixture into baby cream. The resulting ointment can be used 2 times a day.
• Prepare an infusion based on equal parts of chamomile flowers, nettle leaves, horsetail, birch, celandine and knotweed. Infuse for 1 hour. Use for lotions several times a day.
• Grind the dried thyme to a powdery state. Mix one teaspoon of the resulting powder with 1.5 tablespoons of homemade butter. This ointment can be used to lubricate the affected areas.

Homeopathy

Homeopathic treatment of hormonal ointment withdrawal syndrome is considered as an addition to traditional and folk treatment. Homeopathic specialists use a large number of dilutions, which can be determined from the table:

Clinical sign of the syndrome	Homeopathic dilution
Flakes on the skin	Sulfur, Arsenicum album, Silicea
Bubbles with liquid	Hepar sulfur, Urtica urens, Apis
Cicatricial changes	Graphites, Silicea
Red spots	Aconite
Cracks, burst skin	Silicea, Sulphur, Oleander, Sepia
Crusts	Lycopodium, Calcarea carbonica, Silicea
Papular rash	Potassium iodine, Causticum
Blisters	Cantharis

The above dilutions are used in highly concentrated form C-200. These preparations act as an absorbent and activate the removal of negative substances from the body.

Surgical treatment for hormonal ointment withdrawal syndrome is generally not practiced.

Prevention

All patients undergoing treatment with hormonal ointments should be aware that such drugs cannot be used regularly and frequently, as the development of withdrawal syndrome will be inevitable.

To prevent withdrawal syndrome, it is necessary to stop the constant use of hormonal ointments. But this should be done carefully, refusing the drug, gradually reducing the dosage and frequency of application. After reaching the minimum dosage, you can switch to a similar drug with a lower concentration of the active component.

In no case should you “prescribe” hormonal ointments to yourself without the participation of a doctor.

If it is not possible to avoid the constant use of hormonal ointments (for example, for eczema), then they must be replaced every 3-4 weeks with others with a different active ingredient.

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Forecast

If any change in the skin condition occurs after discontinuing hormonal ointments, you should see a doctor. The majority of patients with such a syndrome are successfully treated at the very beginning of the complication. If the hormonal ointment withdrawal syndrome is treated incorrectly or not treated at all, the pathology may continue for a long time, and its course will be severe.

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