Steroid reaction causes B.C. dentist to question prescription
Dr. Frances Tavares believes the treatment prescribed for a rash caused him unnecessary pain
A Vancouver dentist who was prescribed a steroid cream for a skin condition says that not only was the underlying cause of the rash misdiagnosed, he believes his body's reaction to the treatment was worse than the original problem.
Dr. Frances Tavares first went to his family doctor just over two years ago about a rash that had appeared on his forehead. He left with a prescription for hydrocortisone cream and a diagnosis of eczema.
Things seemed to improve, and then the rash came back. Tavares was referred to a dermatologist who switched his treatment, prescribing an alternative corticosteroid cream.
Still, the rash persisted, prompting a referral to a second dermatologist, and yet another brand of corticosteroid.
"Every time you think this is the worst it is going to get," Tavares says. "It gets worse."
Finally, after two years on the various creams and with no improvement, Tavares was referred and tested for allergies. And the results were significant.
Tavares tested positive for an allergy to propylene glycol, a common moisturizing agent found in everything from shampoo to toothpaste. The rash coincided with the dentist's switch from powdered laundry detergent to a liquid detergent.
He cleared out his entire house of everything that contained the offending chemical, the rash cleared up, and he stopped using the prescribed ointment.
'I felt helpless'
And then his face really erupted.
"It was an explosion," Tavares recalls. "I would have to reach up and pull my eyelids apart to see."
"My face was oozing liquid," he says. "I felt lost. I felt helpless."
Having cleared out all the propylene glycol from his life, Tavares believes the painful reaction was connected to his two-year steroid use.
The doctor who diagnosed Tavares' allergy says there's no problem with the prescription of corticosteroids, but it is a mistake for patients to come off them cold turkey.
"When they stop abruptly, they have a horrendous rebound of inflammation," says Dr. Gillian De Gannes, an expert on contact dermatitis. "[It can be] quite painful for some—pustular, oozing, itchy."
Who pays for allergy testing?
The real problem, Tavares says, is how long it took for an allergy patch test to be requested.
Dermatologists in B.C. are slow to suggest it because, they say the provincial government doesn't cover the full cost. Unlike much of the rest of Canada, patients here are charged $300 out of their own pockets.
"I think that's unfortunate and unfair," De Gannes says.
Meanwhile, the government says that given the amount they pay dermatologists, the test should be fully covered, and that the two sides need to talk.
Now, Tavares is back on a powerful corticosteroid — taken orally — to enable a slow weaning off from a drug he believes he should never have been prescribed in the first place.
"I think a lot of my problems probably would have been solved if I had the patch test right at the beginning."
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With files from the CBC's Eric Rankin