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May 30, 2015

Susan Callahan, Contributing Columnist

A round , puffy “moon face” is more than a cosmetic
bother.  But look around you. You're not alone. Moon face
is an increasingly common complaint, mainly because of
the increased incidence of autoimmune diseases whose
steroidal treatments create Moon face. Today, 23 million
people in America suffer from such diseases, according to
the National Institutes of Health.  That number may be as
high as 50 million people, depending on which diseases are
included, according to the American Autoimmune Related
Diseases Association.

Moon face, also known as “chipmunk” or “hamster” face,
indicates a build up of water and fat deposits chiefly in
your cheeks. In addition to dealing with the underlying
illness which necessitates the use of steroids, dealing with
the unfamiliar image that stares back at you in the mirror
can cause depression, seclusion indoors and anxiety.
These reactions make the problem worse, since they tend
to decrease your overall level of physical activity and can
trigger excessive eating as you attempt to self-medicate
your depression and anxiety with food. May people with

To make matters worse, many people learn at this critical,
fragile moment in their lives just how shallow and cruel
people can be. Loved ones you counted on to help you
through the underlying disease may desert you, unable to
deal with the cosmetic changes they see in your face.  
These psychological challenges add more to the burden
you are carrying and can hamper your recovery.

Women and men alike are affected by the psychological
and physical challenges that accompany dealing with Moon
face. It's no laughing matter.

Common Causes of Moon Face

Cushing Syndrome—Cushing syndrome, also known as
hypercortisolim,  is caused by excessive levels of cortisol,
the stress hormone. In men, one of the most common
symptoms – other than the moon face-- is
. You may also experience problems getting
women pregnant.

How do your cortisol levels become so elevated that you
develop moon face?  Corticosteroids such as prednisone
are often the culprit. Your doctor may have prescribed
corticosteroids for a number of reasons including, Crohn's  
disease, rheumatoid arthritis, ulcerative colitis, asthma or
polymyalgia rheumatica.

Moon faces caused by corticosteroids gradually subside in
some people. Most, however, have to endure the swollen
faces –and fat deposits on the top of the back and
abdomens -until the dosage of steroids is lowered.

Too Much Salt Can Cause Moon Face. Moon faces, even
those caused by cortocosteroids, get worse if you eat too
much salt. Salt causes your body to retain water. Try not
to exceed the 1500 milligrams per day recommended by
the American Heart Association for people on low salt
diets.  You should also

  • Avoid processed meats (such as pepperoni slices,
    bologna slices, bacon and ham slices),

  • Potato chips, Doritos, Cheetos and all other crunchy

  • most carbonated drinks (many of contain between 38
    and 65 milligrams of sodium or sodium compounds),
    anchovies, salted olives, and supplements which
    contain salt.  Certain joint cartilage supplements, such
    as glucosamine and chondriatin are manufactured in a
    way which elevates sodium levels in your blood.

Allergies Often Cause Moon Face. Undiagnosed allergies
to food or substances can make your face swell. Studies
have reported face swelling caused by pine caterpillars,
medications, tattooes, seafood, and food colorings found
in chips and other snacks.

4. Excessive Use of Asthma Inhalers Can Make Your Face
Swell.  A 1989 study from Washington University School of
Medicine in St. Louis reports a case of a teenager whose
chronic use of an asthma inhaler resulted in facial swelling.
The study cautions against excessive -over the prescribed
amount – use of  inhaled epinephrine and catecholamines.

Alcoholic Drinks Can Make Your Face Swell. Alcohol can
trigger allergic reaction that make your face swell, a 2003
study from the University of Western Australian has found.
All types of alcohol can cause the reaction –beer, wine,
hard liquor –and many people suffer from it. As many as
40% of asthmatics report facial swelling after drinking
alcohol, the researchers found.

Natural Remedies That Help Moon Face

Because moon face is most often caused either by
corticosteroids or allergies, natural remedies are not as
effective as we might hope in reducing this condition.  
Short of resolving the underlying condition that makes it
necessary for you to take steroids or avoiding the allergy
trigger, you should try to use strategies to avoid making
the problem worse. That said, here are some strategies
that have worked in some cases.

Drink More Water. As counter-intuitive as it sounds, you
need to drink more water even though your Moon face is
caused by water retention. Your body is retaining water
because it believes, mistakenly, that you are dehydrated.
In the course of a day, your body can turnover up to 12
liters of water, according to a 2014 study led by Dr. James
David Cotter of the University of Otago in New Zealand.  

So, it is fairly easy to become dehydrated, especially since
your sense of thirst is an unreliable indicator of your actual
body needs. Do drink enough water – 8 glasses a day –
and eat 5 servings of fruits and vegetables so that your
body can release some of the water it is retaining in your

Yoga and Other Exercise Can Help Relieve Moon Face?

Exercise in general helps to manage Moon face. Though
exercise alone will not in most cases cause a reversal of
Moon face – only stepping down the dosage of prednisone
will do that completely – it will help to  eliminate weight
added by the increased appetite triggered by the steroids.
Exercising regularly also will help to lift your mood by
increasing levels of endorphins, the “feel good” hormones.

Yoga, specifically, may hold promise as a tool for reducing
facial water retention (facial edema).  Scientists from
Department of Dermatology, Churchill Hospital in the UK,
working with colleagues from the Institute of Applied
Dermatology in Kerala, India in 2015 discovered that yoga
practice helped to relieve severe leg edema in 98 patients.

Another group of doctors from Taiwan, led by Dr. Y.T. Lai
of the National Taiwan University Hospital Hsin-Chu Branch
in Hsinchu, discovered that edema in breast cancer
patients was improved by 60 minute sessions of yoga
performed 3 times a week for 12 weeks.

What can we take from these yoga studies? We cannot
conclude that yoga will relive Moon face. These studies
dealt with water retention in legs and arms and not
specifically with water retention in the face. More research
will be needed to confirm yoga's usefulness as a tool for
reducing facial edema.

What You Should Never Do If You Have Moon Face

You should never, ever try to wean yourself off steroids if
you have moon face. Tapering or weaning requires the
highest level of skills an experienced endocrinologist,
according to Dr. Paul Marguiles of Manhasset, New York,
himself a clinical endocrinologist with over 31 years
experience. You can find the complication of questions and
answers about weaning from the National Adrenal
Diseases Foundation

To successfully wean, your own pituitary adrenal system
must be "awakened". If you have been on steroids for
many years, awakening your adrenal glands from its deep
sleep will require patience and some luck.

Your endocrinologist will know if and when you can start
to taper your dosage of prednisone.  It will help, of
course, if the underlying disease for which you are taking
prednisone is in remission.


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Alcohol can cause facial swelling.
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