Eczema--your essential guide by Regina Malan

Author:Regina Malan
Language: eng
Format: epub
ISBN: 9780798169325
Publisher: Human & Rousseau
Published: 2015-07-06T00:00:00+00:00

‘In my career I have never seen skin colour change due to steroid ointments, even in adults who have used very strong preparations for many years.’

– Dr James Halpern

Steroids should be used only until the rash has disappeared, but Dr James Halpern emphasises that the rash must have completely vanished before the steroid use is discontinued. He says the main reason that eczema is often so difficult to control is the under-use of steroid medication. In his opinion, dermatologists are sometimes too cautious about usage over longer periods.

Halpern states that people are often caught in a cycle of stopping ointment application the moment the rash shows mild relief and starting again at the sign of a new flare-up. Using the medication for too short a period simply means the eczema will return. There is also the danger of more severe outbreaks that will need more potent steroids.

An alternative way of using the medication is to continuously apply a weaker steroid twice a day over the long term. When an outbreak occurs, the quantity can be increased and as soon as the rash has healed, it can be reduced again.

Even if only a tiny patch of eczema remains on the skin, it should still be treated with steroids/cortisone. This will prevent the eczema from spreading or worsening. ‘The only time to stop using the steroid ointment completely is when you can see no eczema at all on the skin you treat. When this happens you should continue with moisturisers and restart the steroid ointment as soon as you see the eczema start to return.2

On the other hand many people are guilty of misusing steroid preparations. For the most part, they use too much over too long a period. The skin gets used to the steroids and, if you stop using them, your skin literally shows withdrawal symptoms, explains Van Wyk. Cortisone tablets will then be needed to wean the skin off the ointment.

Unlike moisturisers, which can be applied frequently during the day, steroids should only be applied twice a day, in the morning and in the evening. They should be limited to active eczematous areas and not be applied over the whole body. After a bath or a shower, the steroids and moisturiser should be applied within 20 minutes of each other to ensure proper absorption of both products. Some people prefer applying steroid ointment first, followed by the moisturiser, but there are no strict rules in this regard.

Steroids come in the form of either a cream or an ointment. The cream is generally less expensive and is easier to apply, and does not leave a shine on the skin. For this reason many people prefer cream to ointment, but ointment is more efficient, especially for children. In fact, you will probably see a huge improvement simply by changing from a steroid cream to an ointment. Because ointment has a greasy base, it moisturises the skin at the same time that the steroids are released. Typically dry eczema skin benefits from the extra moisture.

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