In my experience many of the Red Skin Syndrome people who had atopic dermatitis or eczema as their underlying problem exhibit several episodes of severe redness followed by a calming whitening of the skin and a diminution of the dilated vessels.

They typically have less edema and less oozing and less symptoms of itching and burning, during the quiet times. The sharp spikes of redness become shorter and the quiet times longer. This is one pattern.

There are visual errors in time as well as in space.

With each ensuing flare the symptoms are lessened. The good comfortable times last longer. This is the most typical response and often the patients will have a quiescent period of 2 – 4 months when it is believed that the total withdrawal process is complete and normalcy will return. Then, suddenly, unannounced, with no preceding events, factors, medication, stress or anything else we want to blame there is a severe redness that lasts usually a few days to 1 – 2 weeks. It recedes with the same therapy of baths and cool compresses and symptomatic relief. It is typically not revisited again.

I can offer no grand explanation for this late flare. This appears to happen only in the atopic dermatitis eczema patients not the other underlying diagnoses that over utilize steroids and develop RSS.

I have seen this occurrence in probably 40-50 patients. I have explored all historical data with the patients and performed some blood studies. No answer has been given. An observation to relate to all so that despair does not occur.