Syndrome of hormonal ointment on face: how to treat

Successful treatment of some dermatological problems is impossible without the use of hormonal external drugs. However, the use of such tools, other than good, has another "side of the coin": prolonged treatment with them leads to the habituation of the skin - there is a so-called "hormone ointment withdrawal syndrome". What it is necessary to know about this syndrome to those who are planning, or already undergo such treatment?

Epidemiology

According to a few statistics, the syndrome for the abolition of hormonal ointments develops in more than 90% of patients who have been treated with such drugs.

[1], [2], [3],

Causes of the hormone ointment 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, then the ointment is used frequently or even permanently. This can turn against the patient himself - the skin condition deteriorates sharply, and the reason for this is the hormone ointment withdrawal syndrome.

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

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

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

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

[4], [5], [6]

Pathogenesis

A sharp cessation of the use of hormonal ointments leads to the so-called "breakdown syndrome", the signs of which are manifested, depending on the principle of the action of a particular drug. After the use of glucocorticoid hormones, there is a worsening of the course of the disease, for the treatment of which these external agents were prescribed.

In severe cases, even insufficiency of adrenal activity may develop - it is a rapidly growing syndrome, which poses a considerable danger to the patient.

To prevent the negative influence of hormonal ointments on the health of the patient, the doctor will always explain the scheme of a step-by-step reduction in the dosage of the drug. The body of the patient gradually "gets used" to reduce the amount of ointment used, and the balance of hormones is not disturbed.

[7], [8], [9], [10], [11]

Symptoms of the hormone ointment syndrome

Typical symptoms of the hormonal ointment syndrome are:

• reddish-red erythema;
• zone peeling, thinning, skin subatrophy;
• vascular asterisks;
• rash in the form of papules and / or pustules;
• zones of atrophy;
• areas with increased pigmentation.

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

• swelling on the face;
• marked hyperemia;
• pimples (abscesses).

Edema in a few days is increasing, there is persistent erythema.

How long does the hormone ointment syndrome last?

Doctors in their opinion are unambiguous: self-medication will not have an effect in the syndrome of hormone ointment withdrawal. A complex medical approach is needed here.

But even with proper drug treatment, the syndrome does not heal immediately. The tissue of the epidermis should not just recover, but also restore its functions - and this can take from 4 to 12 weeks, and sometimes longer. It all depends on the complexity of the course of the syndrome. In particularly difficult cases, it may be necessary to consult physicians of different profiles: dermatologist, endocrinologist, therapist.

[12], [13], [14], [15],

Stages

There are three clinical stages of the hormone ointment withdrawal syndrome:

• Stage I - stable reddening of the skin;
• II stage - the appearance of puffiness, redness, rash, dryness;
• III stage - pathological proliferation of tissues.

[16], [17], [18], [19]

Complications and consequences

The syndrome of hormone ointment can be complicated by the development of dermatitis: on the skin appears moknutie and crusts that crack and cause pain and discomfort. This condition is very dangerous for the body, because through the cracks can get an infection and cause more severe complications.

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

[20], [21], [22], [23], [24]

Diagnostics of the hormone ointment syndrome

A typical clinical picture, taking place with hormonal ointment treatment - all these facts allow to correctly diagnose the hormonal ointment withdrawal syndrome. For the final diagnosis, additional studies can be assigned:

• definition of allergens (skin scarification tests, intradermal and provocative tests);
• blood analysis (OAB, biochemistry, blood for eosinophilia, immunogram, proteinogram, analyzes for possible allergens, evaluation of the hormonal background, determination of blood sugar, determination of antibodies to parasites);
• general examination of urine;
• examination of feces (bakopsev on dysbacteriosis, analysis for helminths, coprogram).

The correct diagnosis should be based on clinical signs, on the history of the patient, and on the results of the listed diagnostic studies.

[25], [26], [27], [28]

Differential diagnosis

Differential diagnosis is carried out with allergic reactions, with a neurodermitis, red planus, mycoses, eczema, psoriasis.

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

Treatment of the hormone ointment syndrome

Treatment should consist of two obligatory stages:

1. Full refusal of hormonal external preparations.
2. Medication in combination with a special diet.

The drugs used to eliminate the hormone ointment withdrawal syndrome, as a rule, are components of complex therapy:

• preparations Metronidazole, or Erythromycin, twice a day before the disappearance of the rash;
• drugs-sorbents (Lactofiltrum, Enterosgel)
• antihistamines (Suprastin, Cetrin);
• diuretics (with severe edema);
• antibacterial drugs - Tetracycline, Doxycycline (with increased risk of infection of wounds).

	Dosage and route of administration	Side effects	Special instructions
Metronidazole	Take 250-400 mg twice a day, with food or milk.	Stool disorder, nausea, the taste of "metal" in the mouth, dizziness, allergies, staining the urinary fluid in a reddish color.	Metronidazole is incompatible with alcohol.
Lactofiltrum	Take three times a day for 2-3 tablets, 60 minutes before meals.	Diarrhea, bloating, allergies.	With caution take Lactofiltrum with a stomach ulcer in the acute stage.
Lineks	Take immediately after a meal, 2 capsules three times a day.	Very rarely - an allergy.	You can not drink Linex hot tea and alcohol.
Ketotifen	Is taken orally, with food, 1-2 mg twice a day.	Drowsiness, dizziness, fatigue, changes in appetite, constipation, violation of urination.	During the reception of Ketotifen, the concentration of attention is disturbed, which should be taken into account when driving vehicles and other similar activities.

Skin, affected by the withdrawal syndrome, it is necessary to maximally moisturize and protect from the effects of ultraviolet irradiation, wind, frost. In addition, you must follow the following rules:

• do not touch the affected skin with dirty fingers;
• often use moisturized proven drugs;
• Do not rub the skin, use soft towels;
• Regularly take courses with vitamin complexes with vitamins B, C, A and folic acid;
• in the summer use high-quality sunscreen.

Vitamins

• Vitamin A is responsible for the retention of moisture in the skin and for its elasticity, and the lack of this vitamin exacerbates dryness and peeling.
• Vitamin C promotes the active formation of collagen fibers, accelerates the healing of wounds and strengthens the system of blood supply of tissues.
• Vitamins of group B protect the skin from the harmful influence of external damaging factors.
• Vitamin E accelerates the renewal and recovery of skin cells, has antioxidant properties.

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

Physiotherapeutic treatment

With the withdrawal of hormonal ointments, physiotherapy is not prescribed as often, although in many cases it can be quite effective. Any of the procedures has its own indications and contraindications - and this must be taken into account before proceeding to this type of treatment.

• Phototherapy is irradiation of the affected skin with ultraviolet light.
• Acupuncture, acupuncture.
• Magnetotherapy with the use of an alternating or constant magnetic field.
• Method of hyperbaric oxygenation.
• Extremely high frequency therapy with waves of millimeter range.

In cases of prolonged withdrawal hormonal ointment, in the absence of the effect of drug treatment, it is recommended to have a spa therapy. Such treatment includes:

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

Alternative treatment

Sometimes, and especially in cases when the usual treatment does not give the expected effect, it remains to hope for the action of alternative medicine. Indeed, there are several alternative recipes that can help with the syndrome of hormone ointment withdrawal. And the sooner these methods of treatment are used, the better.

• One tablespoon of ground propolis is mixed with 4 tbsp. L. Vegetable oil (better than olive oil), we place it on a water bath for 45 minutes. The resulting homogeneous mass is poured into a glass container and used for lotions twice a day.
• We apply to the affected areas three times a day lotions based on the juice of potatoes or cucumber.
• Mix 1 tbsp. L. Baby cream with the same amount of birch tar, put it on a water bath and warm up a little (no more than + 60 ° C). Apply to the skin twice a day.
• At least 4 times a day we brew and drink tea from a dandelion. To make it, we insist 1 tbsp. L. Chopped herbs in 0.5 liters of boiling water. In this tea you can add a few currant leaves and honey.

Herbal Treatment

• Brew in 300 ml of thermos 4 tbsp. L. An equivalent mixture of herbs chamomile, marigold and plantain. After 10 hours, the infusion is filtered and used for irrigation and lotion on the affected skin.
• Squeeze the juice from the plant with a golden mustache. One tablespoon of this juice is mixed with 1 tbsp. L. Sea-buckthorn oil and mix the mass with a baby cream. The obtained ointment can be used 2 times a day.
• We prepare the infusion based on equal parts of daisy flowers, nettle leaves, horsetail, birch, celandine and bird mountaineer. We insist 1 hour. We use for lotions several times a day.
• Dried thyme grind to a powdery state. One teaspoon of the obtained powder is mixed with 1.5 tbsp. L. Home-made butter. This ointment can be used to lubricate the affected areas.

Homeopathy

Treatment with homeopathy of the hormone ointment withdrawal syndrome is considered as an addition to traditional and alternative treatment. Specialists in homeopathy use a large number of dilutions, which can be determined from the table:

Clinical sign of the syndrome	Homeopathic breeding
Scales on skin	Sulfur, Arsenicum Album, Silicea
Bubbles with liquid	Gepar Sulfur, Urtika Urens, Apis
Cicatricial changes	Graphite, Silicea
Red spots	Aconite
Crackles, broken skin	Silicea, Sulfur, Oleander, Sepia
Crusts	Lycopodium, Calcaria Carbonicum, Silicea
Papicular eruptions	Potassium iodine, Causticum
Blisters	Kantaris

The above dilutions are used in a highly concentrated form of C-200. These drugs perform the function of an absorbent and activate the removal of negative substances from the body.

Surgical treatment in the syndrome of hormonal ointment cancellation, as a rule, do not practice.

Prevention

All patients who are treated with hormonal ointments should be aware that such medications can not be used regularly and often, since the development of withdrawal syndrome will be inevitable.

To prevent the onset of withdrawal syndrome, it is necessary to stop the constant use of hormonal ointments. But it should be done carefully, refusing the drug, gradually lowering the dosage and the frequency of application. After reaching the minimum dosage, it is possible to switch to a similar preparation with a lower concentration of the active ingredient.

In no case can you independently "prescribe" yourself hormone ointments, without the involvement of a doctor.

If you can not avoid the constant use of hormonal ointments (for example, with eczema), then they must be replaced every 3-4 weeks for others, with another active ingredient.

[29], [30], [31], [32], [33], [34], [35]

Forecast

At any change of a skin condition after a canceling of hormonal ointments it is necessary to seem to the doctor. Most patients with this syndrome are successfully cured at the onset of the complication. If the hormonal ointment cancellation syndrome is treated incorrectly or not treated at all, the pathology can last a long time, and its course will be difficult.

[36], [37], [38]