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Dermatology (Expert Forum)
Skin and nerve damage from very potent topical steroids on genitals
Answered by
Alan Rockoff, MD - dermatology, Child Skin Problems
The Rockoff Dermatology Center
Brookline - MA
Welcome to the DERMATOLOGY FORUM! Questions in this forum are answered by Dermatologists from St. Luke's Roosevelt Hospital, under the direction of Andrew Alexis, M.D., M.P.H.
Skin and nerve damage from very potent topical steroids on genitals
by robert44, Aug 03, 2002 12:00AM
Dear DR.
Male 44.
l have been lead down a very dark and painful road beginning with my GP trying to act like a Dermatologist.
Upon return from a tropical vacation I went in to my GP because I had contracted a rash on my buttocks during high heat and humidity. I was back in town about one week when I called for an appointment as a precaution and responsibility to my partner. At this time all that remained was pink and dry skin and he noted in a letter covering his butt that it almost did not show at all. This was true.
Initial problem dry skin from a fungal infection on buttocks.
Treatment Phizohex soap increased dryness. Next prescription called in Ultravate .05% and the problem begins.
Here is the skinny, my poor genitals and trunk areas have been trashed by steroids. While it still hurts to sit, this is the least of my problems after 4 months my scrotum is still very sensitive, my testicles are swollen 20% and the head of my penis remains raw and highly, highly sensitive. in fact I must cover my penis with a cloth in balm ( from a DR.) with a condom to hold in place just to go outside. As a man contact with clothing now is always a problem.
This is the result hands down... of misapplication of potent steroids now the question remains will I have a life again, a job, a love, a walk in the woods as I was a man before this happened.
Keep in mind each Dermatologist could not identify steroid damage.. So when in doubt prescribe more steroids.
Now they protect themselves by playing dumb because it would implicate their co-workers. Here is a list of the meds given that did the damage, most of which occurred with Doc#1 and Doc #3
DR.# 1
Level 1 Ultra-High potency (Ultravate) .05%. Applied for 16 days to buttocks, and then genitals totaling 55 grams @ up to 30% absorption rate. Resulting is serious burning and reaction. I did not understand what was happening at this point thinking I had some funky rash from the tropics. Biopspys,blood test, urine test are all ok, no fungals, no stds.
Dr.# 2
Apalled at DR#1 I am put on Level 6 Low potency (Aclovate.05%) Applied 16 days to buttocks and genitals totaling 40 grams @ up to 30% absorption rate. Irritation stays status quo to worse.
Dr.# 3
States (Aclovate to strong) then misperscribes Level 3 to 4 moderate to high potency (Triamcinolone.1%) Applied 18 days to buttocks and genitals totaling 80 grams @ up to 30 % absorption rate. Skin becomes dark red and more irritated. Wow!
Total 175 grams over 50 days of multiple potency corticosteroids.
Small break of apx 2 weeks.
DR#4 apply hydrocortisone cream usp 2.5% for apx. 18 more days total of 30 grams, plus 20 to 40 mg of Prednasone for 10 days followed by 5 low level radiation rays to genitals to promote healing. (Unbelievable)
( No further steroid use after apx. June 14 th)
Request ACTH test, similar test done with no prep 7-02-02 Cortisol level 15
What can I do to heal myself or can this damage be permanent? Please help
Male 44.
l have been lead down a very dark and painful road beginning with my GP trying to act like a Dermatologist.
Upon return from a tropical vacation I went in to my GP because I had contracted a rash on my buttocks during high heat and humidity. I was back in town about one week when I called for an appointment as a precaution and responsibility to my partner. At this time all that remained was pink and dry skin and he noted in a letter covering his butt that it almost did not show at all. This was true.
Initial problem dry skin from a fungal infection on buttocks.
Treatment Phizohex soap increased dryness. Next prescription called in Ultravate .05% and the problem begins.
Here is the skinny, my poor genitals and trunk areas have been trashed by steroids. While it still hurts to sit, this is the least of my problems after 4 months my scrotum is still very sensitive, my testicles are swollen 20% and the head of my penis remains raw and highly, highly sensitive. in fact I must cover my penis with a cloth in balm ( from a DR.) with a condom to hold in place just to go outside. As a man contact with clothing now is always a problem.
This is the result hands down... of misapplication of potent steroids now the question remains will I have a life again, a job, a love, a walk in the woods as I was a man before this happened.
Keep in mind each Dermatologist could not identify steroid damage.. So when in doubt prescribe more steroids.
Now they protect themselves by playing dumb because it would implicate their co-workers. Here is a list of the meds given that did the damage, most of which occurred with Doc#1 and Doc #3
DR.# 1
Level 1 Ultra-High potency (Ultravate) .05%. Applied for 16 days to buttocks, and then genitals totaling 55 grams @ up to 30% absorption rate. Resulting is serious burning and reaction. I did not understand what was happening at this point thinking I had some funky rash from the tropics. Biopspys,blood test, urine test are all ok, no fungals, no stds.
Dr.# 2
Apalled at DR#1 I am put on Level 6 Low potency (Aclovate.05%) Applied 16 days to buttocks and genitals totaling 40 grams @ up to 30% absorption rate. Irritation stays status quo to worse.
Dr.# 3
States (Aclovate to strong) then misperscribes Level 3 to 4 moderate to high potency (Triamcinolone.1%) Applied 18 days to buttocks and genitals totaling 80 grams @ up to 30 % absorption rate. Skin becomes dark red and more irritated. Wow!
Total 175 grams over 50 days of multiple potency corticosteroids.
Small break of apx 2 weeks.
DR#4 apply hydrocortisone cream usp 2.5% for apx. 18 more days total of 30 grams, plus 20 to 40 mg of Prednasone for 10 days followed by 5 low level radiation rays to genitals to promote healing. (Unbelievable)
( No further steroid use after apx. June 14 th)
Request ACTH test, similar test done with no prep 7-02-02 Cortisol level 15
What can I do to heal myself or can this damage be permanent? Please help
Doctor's Answer
by Alan Rockoff, MD, Aug 04, 2002 12:00AM
, Aug 04, 2002 12:00AM
Steroid damage is not permanent.
Redness and sensitivity can remain for up to several months. It's necessary, of course, to avoid further steroid use, even a weak and otherwise suitable steroid like hydrocortisone.
As far as I know, there is no specific medication to speed the healing. I recommend bland ointments, such as Aquaphor (over-the-counter), as a barrier against rubbing.
I assume that the fungus which started all this is gone. If there's any doubt on this score, proper antifungal treamtnet should be initiated.
The hardest part of treating what you have is waiting it out. The redness and sensitivity go away slowly. However, to repeat, steroid effects on thin-skinned areas are generally not permanent. There may (not will, may) be some residual redness, but the tenderness you feel will go away if you wait them out, and you will surely be able to walk, have sex, and so forth.
I'm not sure which doctor you're with now, but I suggest regular monthly follow-up with a dermatologist you feel comfortable with, to be sure that progress is steady.
Best.
Dr. Rockoff
Redness and sensitivity can remain for up to several months. It's necessary, of course, to avoid further steroid use, even a weak and otherwise suitable steroid like hydrocortisone.
As far as I know, there is no specific medication to speed the healing. I recommend bland ointments, such as Aquaphor (over-the-counter), as a barrier against rubbing.
I assume that the fungus which started all this is gone. If there's any doubt on this score, proper antifungal treamtnet should be initiated.
The hardest part of treating what you have is waiting it out. The redness and sensitivity go away slowly. However, to repeat, steroid effects on thin-skinned areas are generally not permanent. There may (not will, may) be some residual redness, but the tenderness you feel will go away if you wait them out, and you will surely be able to walk, have sex, and so forth.
I'm not sure which doctor you're with now, but I suggest regular monthly follow-up with a dermatologist you feel comfortable with, to be sure that progress is steady.
Best.
Dr. Rockoff
Member Comments (2)
by frosted, Aug 10, 2002 12:00AM
To: DR.Rockoff
My Dr has given me three steroid shots already this year and a pill to take for a week . I was sent to a dermatologist and she gave me floucinonide ointment .05% along with Elidel(primecrolimus)cream1% to be used dor one mounth.Also cephalexin 500mg 2 a day for fifteen days.The rash on my hands is about gone she said it was excema but didn't know or say what the round rashes where on my arms and leggs.The Elidel doesn't seem to be helping.It's spreading .Any input would be helpfull is this too much steroids for me to be taking?The itching has stopped on my hand but there very red and pealing.I'm to use the fluocinonide 2 times a day with cloth gloves.
by alina_v, Mar 01, 2008 07:24AM
A related discussion, Response to: Skin and nerve damage from very potent topical steroids on genitals was started.
