以下繼續引用Marvin J. Rapaport, MD有關“紅皮症”的論文。
“Corticosteroid Addiction Patterns－Approximately 90% of our patients had a history suggestive of atopy. The only significant variation from this pattern occurred in patients with facial dermatitis of whom approximately 20% had seborrheic dermatitis or ‘dry skin’. When dermatitis first developed in these patients, many of them self-prescribed over-the-counter 1% hydrocortisone cream or ointment. For those who sought medical consultation, many had been given moderate strength corticosteroids initially, and in the past 5 years, super potent corticosteroid preparations were commonly prescribed at the outset. When pruritus or rash persisted or when rash recurred, stronger corticosteroids or more frequent application was recommended. As skin complaints worsened, but now accompanied by burning, systemic corticosteroids, eg, IM triamcinolone or betamethasone, were administered from 2 to 8 times a year. Patients with red face syndrome, actinic dermatitis, and multi sited atopic rashes commonly received this therapy. In addition, oral prednisone 20–80 mg/ day was sometimes prescribed for varying periods of time. In these initial phases of the addictive process, the corticosteroids were usually effective, and patients felt relief for weeks to months. As time passed, however, many patients required systemic corticosteroids at more frequent intervals, some every 6 to 10 weeks. Daily topical treatment only maintained tolerance of symptoms and mild diminutionof the rash. Patients complained that corticosteroids ‘were not working anymore.’ It was at this time that the authors were consulted. By this time, the initial limited areas of dermatitis had expanded significantly. The itch had mostly disappeared but had been replaced by severe burning that was only relieved by further topical corticosteroid application. The appearance of the dermatitis changed and was now more of a hyperemia. Most topical non steroidal preparations increased the burning, and this led patient and physician to believe that an occult allergen was the cause. In fact, in many cases the purpose of the initial referral was to identify that obscure allergen. This ‘addictive phase’ took from 3 months to several years to develop.”（對皮質類固醇成癮的模式－我們的患者當中，約90％人士有經歷過異位性皮炎。另外一大類患者是面部皮炎患者，而他們當中約20％人士有脂溢性皮炎或‘乾性皮膚’的經歷。當他們首次患上皮炎時，大部分人都在藥房購買不需處方的氫羥腎上腺皮質素［Hydrocortisone 1％］藥膏為自己治療。另外選擇了去看醫生的一群中，他們的醫生為這一群中的大部分人在初期開了中度強度的皮質類固醇處方，但到了他們被轉介到本診所前的最近5年內，一律都看到類固醇處方的強度提升到最強的級別。每當持續性的皮膚搔癢或皮疹出現，或皮疹復發情況下，醫生們都建議患者進一步提高皮質類固醇強度或者增加用藥的頻度。前述皮膚症狀惡化到出現皮膚有灼熱感時，醫生還有對他們使用過全身性的皮質類固醇如每年2－8次的Triamcinolone或Betamethasone注射，而患有‘紅面綜合徵’［Red face syndrome］，日光性皮炎和多處出現異位性皮疹的患者們都普遍接受過此療法。此外，雖然服用期間長短不一，部分患者也有使用過每日20－80毫克的Prednisone。 在這些上癮過程的初期，皮質類固醇通常會有效，患者可以感覺到症狀得到緩解長達數星期，甚至數個月。但隨時間的推移，多個患者要求增加用藥頻度如每6－10星期的一次的情況便出現。此時日常的外用皮質類固醇治療最多只能緩和症狀與稍為減輕皮疹，而患者也抱怨皮質類固醇‘已經對症狀起不到作用’。被轉介到本診所的患者都已經處於這樣的狀態，而原有皮炎範圍明顯擴散；痕癢的症狀雖減少，但取而代之的是嚴重的皮膚灼熱感而這個狀況只能依賴進一步的外用皮質類固醇治療緩和。皮炎的外觀也出現變化而此時的症狀更看似皮膚充血的狀態。由於多數的外用非皮質類固醇藥物使皮膚灼熱進一步惡化，通常患者和醫生都誤認為狀況由某種隱匿性致敏源導致，所以事實上多數被轉介到本診所的病患其實是為找出這個不明致敏源而來。而這樣的“上癮階段”通常在3個月到數年時間內形成。）
“Corticosteroid Addiction Patterns－Approximately 90% of our patients had a history suggestive of atopy. The only significant variation from this pattern occurred in patients with facial dermatitis of whom approximately 20% had seborrheic dermatitis or ‘dry skin’. When dermatitis first developed in these patients, many of them self-prescribed over-the-counter 1% hydrocortisone cream or ointment. For those who sought medical consultation, many had been given moderate strength corticosteroids initially, and in the past 5 years, super potent corticosteroid preparations were commonly prescribed at the outset. When pruritus or rash persisted or when rash recurred, stronger corticosteroids or more frequent application was recommended. As skin complaints worsened, but now accompanied by burning, systemic corticosteroids, eg, IM triamcinolone or betamethasone, were administered from 2 to 8 times a year. Patients with red face syndrome, actinic dermatitis, and multi sited atopic rashes commonly received this therapy. In addition, oral prednisone 20–80 mg/ day was sometimes prescribed for varying periods of time. In these initial phases of the addictive process, the corticosteroids were usually effective, and patients felt relief for weeks to months. As time passed, however, many patients required systemic corticosteroids at more frequent intervals, some every 6 to 10 weeks. Daily topical treatment only maintained tolerance of symptoms and mild diminutionof the rash. Patients complained that corticosteroids ‘were not working anymore.’ It was at this time that the authors were consulted. By this time, the initial limited areas of dermatitis had expanded significantly. The itch had mostly disappeared but had been replaced by severe burning that was only relieved by further topical corticosteroid application. The appearance of the dermatitis changed and was now more of a hyperemia. Most topical non steroidal preparations increased the burning, and this led patient and physician to believe that an occult allergen was the cause. In fact, in many cases the purpose of the initial referral was to identify that obscure allergen. This ‘addictive phase’ took from 3 months to several years to develop.”（對皮質類固醇成癮的模式－我們的患者當中，約90％人士有經歷過異位性皮炎。另外一大類患者是面部皮炎患者，而他們當中約20％人士有脂溢性皮炎或‘乾性皮膚’的經歷。當他們首次患上皮炎時，大部分人都在藥房購買不需處方的氫羥腎上腺皮質素［Hydrocortisone 1％］藥膏為自己治療。另外選擇了去看醫生的一群中，他們的醫生為這一群中的大部分人在初期開了中度強度的皮質類固醇處方，但到了他們被轉介到本診所前的最近5年內，一律都看到類固醇處方的強度提升到最強的級別。每當持續性的皮膚搔癢或皮疹出現，或皮疹復發情況下，醫生們都建議患者進一步提高皮質類固醇強度或者增加用藥的頻度。前述皮膚症狀惡化到出現皮膚有灼熱感時，醫生還有對他們使用過全身性的皮質類固醇如每年2－8次的Triamcinolone或Betamethasone注射，而患有‘紅面綜合徵’［Red face syndrome］，日光性皮炎和多處出現異位性皮疹的患者們都普遍接受過此療法。此外，雖然服用期間長短不一，部分患者也有使用過每日20－80毫克的Prednisone。 在這些上癮過程的初期，皮質類固醇通常會有效，患者可以感覺到症狀得到緩解長達數星期，甚至數個月。但隨時間的推移，多個患者要求增加用藥頻度如每6－10星期的一次的情況便出現。此時日常的外用皮質類固醇治療最多只能緩和症狀與稍為減輕皮疹，而患者也抱怨皮質類固醇‘已經對症狀起不到作用’。被轉介到本診所的患者都已經處於這樣的狀態，而原有皮炎範圍明顯擴散；痕癢的症狀雖減少，但取而代之的是嚴重的皮膚灼熱感而這個狀況只能依賴進一步的外用皮質類固醇治療緩和。皮炎的外觀也出現變化而此時的症狀更看似皮膚充血的狀態。由於多數的外用非皮質類固醇藥物使皮膚灼熱進一步惡化，通常患者和醫生都誤認為狀況由某種隱匿性致敏源導致，所以事實上多數被轉介到本診所的病患其實是為找出這個不明致敏源而來。而這樣的“上癮階段”通常在3個月到數年時間內形成。）
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