What is Red Skin Syndrome?

Red skin syndrome, RSS, occurs as a reaction to topical steroid creams, such as hydrocortisone and similar skin creams and lotions. It is often diagnosed when the capillaries of the skin become dilated and causes the entire body to be inflamed, with red and irritated skin.  Skin usually feels like it's 'burning' and the appearance can look more like a sunburn (generalised red blush) rather than the inflamed, dry skin associated with eczema. However, it is important to note that not everyone’s skin will react the same, and some skin may be inflamed but not red. Topical steroids are commonly used to treat such skin conditions as psoriasis and eczema.

Symptoms of RSS often include red, irritated, itchy skin, and can spread to all parts of the body. Patients with RSS may even be confined to their bed until symptoms subside.

Symptoms of RSS include :

  • Rash that looks more like a red, generalised blush.
  • Itching and burning

Other symptoms may include :

  • Swelling and fluid under the skin
  • Sore eyes
  • Nerve pain
  • Swollen lymph nodes
  • Insomnia
What is Red Skin Syndrome?

Please visit www.ITSAN.org for more information on RSS

International Topical Steroid Awareness Network

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Who Gets Red Skin Syndrome?

It is a self-limiting condition, but it can be very challenging to manage the symptoms. It can take between several months to several years for the skin to return to normal, depending on the type of steroid used, where it was applied and the age of the patient. Treatment focuses on relieving the symptoms. There are no exact statistics, but a study conducted in Japan indicated that about 12 percent of those who use topical steroid creams may get RSS. There is no way to know ahead of time who will get RSS and who won't. It must be emphasized that many people use topical steroids for many years and never have a problem. However, there are a few factors that seem to increase the risk:

  • Using strong, high-dose steroids
  • Using topical steroids for longer than one year
  • Using the product when it's not necessary

You're also at risk if you apply the cream to someone else on a regular basis, say for a child or dependent adult, and you don't wash it off your hands afterwards. No one is really immune to RSS, and both adults and children can contract the condition. Other risk factors include topical steroid use on the face, eye lids or genitals.

Skin after two weeks of using the Anti-Spot Cream twice a day and a few drops of the Active 8 Serum once a day.

Diagnosis

RSS is often misdiagnosed because it can look like a worsening of the same condition for which the steroid cream was applied to begin with. The doctor may even raise the potency of the steroid cream, or frequency of application, making the RSS even worse. However, there is one key difference: RSS spreads to other parts of the body, even the areas where the steroid was never applied. It is unlikely, although not impossible, for a chronic skin condition like psoriasis to suddenly spread within a short period of time like RSS does.

RSS may resemble other skin conditions. To rule them out, your doctor may perform a patch test for allergies and a skin biopsy. If other tests come back negative, and you are a regular user of topical steroids, a diagnosis of RSS may be made.

Treatment

Red skin syndrome cannot be cured. It will clear on its own with time and the absence of topical steroids. Besides stopping the steroid use, your doctor may recommend colloidal oatmeal baths and oral medications containing Diphenhydramine, an anti-histamine, to help sleep, or Pregabalin, a medication commonly prescribed for nerve pain, if you have symptoms such as sharp, stabbing, shooting pains. Epsom salt baths may help, too. Other remedies include Acetaminophen (Paracetamol) or Ibuprofen for pain. Jojoba oil and shea butter may be applied to dry skin, but if the skin has open sores that are slower to heal, Zinc Oxide cream may be applied to the affected area to soothe it and create a barrier while the skin heals.

Manuka oil is also a popular treatment, as it has become one of the most popular essential oils available. Manuka oil contains an abundance of phytonutrients and more antioxidants than many types of tea. The essential ingredient in Manuka Oil that may help to relieve the symptoms of RSS could be the triketones, namely leptospermone, flavesone and isoleptospermone as they have anti-bacterial and soothing properties, as well as anti-oxidants which help support skin healing.

Severe symptoms may require prescription medications like antibiotics, hypnotics and drugs that suppress the immune system. Until the condition clears, use hypoallergenic skin products and switch to all-cotton clothing. This reduces further skin irritation. You can also use cotton, breathable dressing such as Tubifast or bamboo wraps such as Bamboo Buddy, to help prevent scratching.

Recovery time will vary, as everyone is different. Some people will see improvement in a matter of weeks. Others will need longer, perhaps even months or years. You can choose to consult with a dietitian or naturopath if you need more support to make lifestyle changes and find the best natural supplement to help manage stress, support the adrenals, boost the immune system or balance your gut microbiome. 

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