Many people are concerned about using topical corticosteroids because they have read or heard about these treatments from a range of sources including friends, family, the internet, media and even healthcare professionals such as pharmacists and general practitioners. It is important to remember that side effects predominately relate to high doses of systemic or topical steroid treatment in people who are seriously ill. In fact, topical steroids can be used for long periods with complete safety as long as you understand what strength to apply, how often to apply the treatment, how much to apply and how long to continue the treatment . It is a mistake to be too cautious about using topical steroids as sometimes this can mean that your skin condition may be inadequately managed and you then might need a stronger medication such as a tablet, for a longer time to get the disease under control. In general, topical treatments are considered safer than systemic (oral) treatments.
Other combination therapies may lack convenience but are also effective. In the patient with comedones and inflammatory lesions, a comedolytic agent such as tretinoin, adapalene or azelaic acid may be combined with benzoyl peroxide or a topical antibiotic. The combination of clindamycin and tretinoin causes less irritation than tretinoin alone. 30 In using tretinoin and the benzoyl peroxide–erythromycin combination together, the patient should alternate the products daily for two weeks to minimize irritation. When agents that cause irritation are used, patience is necessary, but the results may be well worth the wait.
The doctor may suggest hospitalization simply because it may be necessary to break the cycle of chronic inflammation, or other problems that are exacerbating the illness. Frequently, five or six days of vigorous in-hospital treatment care can result in a dramatic clearing of the eczema. Food tests, allergy skin testing, and the development of an outpatient therapy plan can all be done during the hospitalization. Unfortunately, getting approval from insurers is often difficult. During an acute flare the number of 15-20 minute baths must be increased to three or four per day. Besides hydrating the skin, baths also increase the penetration of topical medication up to ten-fold if the medicine is applied immediately after the bath. Wet wraps after baths may also help hydration and medicinal penetration. Bedtime wet wraps are most practical, and can be done with elasticized gauze followed by ace bandages or double pajamas. (The first pair of pajamas is worn damp but not soaking wet, and a second pair of dry pajamas is worn over them. For a tighter fit, sometimes a plastic sauna suit is used instead of the dry pajamas.) For feet and hands, socks can be used. Additional blankets or increased room heat may be necessary during this three to seven days to prevent chilling.