Skin reacting to prescription creams?

When skin reactions happen, you’ve probably been recommended a cortisone cream or tacrolimus, also known as Protopic.

Cortisone ointments have been a gold standard in treating skin inflammation for decades. Lately, there has been more concern about them as they have been seen to thin your skin¹, especially with long-term use. This is sometimes referred to as “steroid-induced skin atrophy”².

Tacrolimus (protopic) is a topical calcineurin inhibitor³, which is another avenue for blocking your immune function. Tacrolimus does not have the same risks as cortisone but there are some possible side effects. Initial burning, itching and tingling, and rare possibilities of headaches, flu-like symptoms and herpes eruptions⁴ (likely due to the immunosuppressive action).

To be clear, cortisone and protopic creams give a lot of people much needed relief. However, sometimes upon discontinuation, there are skin reactions from their withdrawal (also known as “rebound effects”).

Causes of cortisone and protopic withdrawal?

First, let me introduce myself. I’m Dr. Kristen Ma, ND and I have been treating skin holistically for over 20 years. I’ve been looking at skin conditions every day, day in and day out for years because I love it. The skin is a reflection of what is happening inside of us. And when I see redness and aggravation, it’s like a mystery of deeper inflammation that is ready to be solved.

Because I have been doing this for so long, I’ve seen a lot of things. Sometimes, other NDs will confer to me with hard cases that they don’t understand.

And I have seen cases of cortisone and protopic withdrawal effects. This can occur upon stopping or lessening usage, resulting in a patient’s severe skin flares up.

What happens is skin redness, sometimes with swelling, pain, burning, stinging…and frustration.

All is not lost. There are ways to alleviate withdrawal effects or quicken recovery. However, it’s always recommended to do so under the care of a healthcare professional.

If you need help or support navigating a withdrawal response to these topical medications, I’m here.

Can you avoid withdrawal?

If you flare, one thing you can do is start using your cream again. But some patients become concerned about dependance.

Another option is to wait it out. Sometimes this reaction is quick and temporary. But I have also seen patients struggle for over one year. It can be hard to ride out flare ups for that long.

If you’re thinking of starting or stopping there are lots of things that make withdrawal inflammation better. Let’s start with how you use your cream then move onto the naturopathic solutions:

1. If you plan ahead, try weaning down with a lower dose cream first. Not everyone can do this but for many, switching to a milder cream can be a helpful step before gradual discontinuation.
2. Upon deciding to start using these creams, a shorter period of usage has less risks of rebound effects. Again, short-term usage is not always possible. To be clear I am not against the use of these creams. They are sometimes needed badly. If your skin is affecting your quality of life, if you cannot sleep because of your skin reaction – you need relief. But ideally it can be a short-term plan (agreed upon by your medical provider) while you figure out how to prevent irritation for the long-term.
3. Wean off very gradually. The less of a dramatic drop there is, the more easily your skin and body adjusts. I can also help you plan this and create a plan in conjunction with your prescribing doctor.

Again these are helpful but some patients react even after they have weaned off gradually. Read on for examples and more information on this.

If you need help or support navigating a withdrawal response to these topical medications, I’m here.

Natural Solutions for cortisone and protopic withdrawal

In my experience, taking a holistic approach can be very helpful.

Here I will talk about real examples and how they were treated.

Case #1 – Long-term, severe withdrawal

A 30-year-old self-identified female came to see me after struggling with Protopic withdrawal for two years. She had started the cream to treat mild Eczema around her eye area, which flared up in the cold, winter season. She used the cream daily for 8 months and then stopped under her doctor’s care.

Her reaction was severe. Her redness was a bruising color. This did not only affect the eye area anymore but progressed down her face in a butterfly pattern and around her mouth, covering her upper lip.

Her biggest complaint was pain. There was itchiness and heat – but the pain on her facial skin was intense and she told me she would often cry from it’s intensity. She was using ice packs on her face daily and most topicals, even sensitive skin creams, made her skin burn and swell.

She was stressed out and embarrassed about her face being covered in purple-red, scaling skin. The skin outside of her inflammation was dry and dehydrated but smooth.

She already had cut out alcohol (which helped) – as well as done some very strict diets she learnt about on the internet. She also recently discovered she had an allergy to nickel and was wondering if she should cut out high-nickel foods.

For me as a practitioner, I was worried about her nutrition with so much being cut out of her diet. As an ND I am used to discovering food sensitivities but I am also very aware of food phobias developing.

We did a series of food challenge tests to discover if it was really necessary to cut all of those foods our for her skin. We found they were not! This alleviated a lot of stress as she no longer had to live with so much restriction. Plus, stress is a contributor to skin inflammation, so this was a double win.

But to really make strides on progress, we put her on GLA, liver supportive herbs, changed her topicals and did a series of skin barrier treatments. To narrow down what was working and what wasn’t took some exploration and experimentation.

She wanted to try red/blue light therapy she learned about on the internet. Since I had one in my clinic, I tested this on her on two separate occasions and found that she reacted badly both times– and there was no after effects of improvement. This just shows how something that works for one person, may not work for another. And why I do not recommend treating yourself based on online accounts.

In ten months her skin finally was completely clear. This included some trial and error that is expected in any complex case.

If you looked at her now, you’d see no evidence she had ever had skin irritation.

Case #2 – A shortened reaction

This case was a patient I had already been treating for many years. We were working together on issues that did not involve skin inflammation before she asked me for guidance on this.

She discovered a scalp lesion that was inflamed, raised and crusted. It had been biopsied by her dermatologist and results showed it was not cancerous.

Her dermatologist prescribed a potent form of cortisone for the area. She used the prescription for 6 weeks then began to wean down – as prescribed by the same MD. Side note: the lesion did not change or diminish.

When she weaned, she began experiencing full-body skin itching. We screened for changes and other potential causes: in skincare, detergents, bedding and linens and other personal care products. All were unchanged.

I had been doing acupuncture on this patient for years with no problems. But now, when I inserted acupuncture needles, she began to welt with red rings surrounding each needle.

We took her off any stimulating skincare – while it was not the cause, it would not aid the situation. We started rehydrating natural topicals and switched her acupuncture protocol to have the goal of “clearing heat”.

We used anti-inflammatory herbs that gently upregulate liver metabolism and clearance. The liver filters your bloodstream and is one route of drug clearance. Since she was a long-time patient, I understood her health patterns well.

In two weeks, her skin inflammation and body itching resolved.

Getting help today

Feeling itchy or in pain is a nagging distraction throughout each day. And the emotional effects of facing the world with redness on your face can also be so hard.

I have spent years treating skin because it is a juncture between the emotional and physical. And I feel grateful to be able to help people feel better and more comfortable in their skin.