Avoiding Steroids for Treating Eczema

“I am a Physician Assistant of dermatology and I pass your website out to all my chapped hand and eczema patients.”

I do not let statements like that go without more probing. Here was an expert… in the field of dermatology… who is recommending MadeOn to her patients. I had to find out how she advises people who struggle with eczema. I asked her about her protocol for such patients and she supplied me with her detailed answer.

With her permission, I’m posting her complete, unedited list of suggestions below. If you or a family member struggle with skin conditions, look through to see if there’s a fix for your skin.

What are your thoughts on steroid use for treating eczema?

This time of the year I see so many patients with cracking, chapped hands. Whether it is eczema (there are several sub-types) or hand psoriasis or just irritant chapped dermatitis, my instructions are the same. In my 15 years of experience I do not find that steroid cream helps much. I only see some benefit in the very early stage of dyshidrotic  eczema where the itchy blisters form, or for some psoriasis patients to help with the inflammation reaction of the nature of the psoriasis. The steroid cream is only a “fire extinguisher” to calm it down a bit. It cannot repair the broken skin barrier or heal the fissures. It is not lotion, but since it is often creamy or greasy, a patient can start to rely on it as lotion and sometimes this can lead to overuse of the steroid cream and with long-term overuse, can cause thinning of the skin. (emphasis Renee’s)

5 Steps to Avoid Flare-ups

In my practice, I stress other steps more heavily than steroid use because I have found that the patient can heal faster and once healed, stay healed and reduce flares.

1. “Regular” soap is the enemy. Soapless cleanser or non-drying soap is key. (Ever seen the Dawn dish soap commercial- how one drop removes the grease from the greasy lasagna pan?? It’s doing that to your skin too!) My recommendations: Cetaphil Restoraderm or CeraVe Hydrating cleanser. These contain ceramides that help to repair the fatty layer of your skin. An all-natural soap (like MadeOn) is fine, too.
2. Lotion with every hand-washing and at any other time the skin feels dry. Recommendations: MadeOn Hard Lotion bar or  CeraVe cream. These repair the barrier and the waxiness, especially of the hard lotion bar, repels water. Other water-repelling options are Gloves in a Bottle or CeraVe Theraputic Hand cream.
3. For cracks and fissures, apply a thin coat of superglue (yes, superglue!) and squeeze the edges of the crack together to let the glue dry. It stings for a few seconds, but acts as liquid stitches (think Dermabond in the ER) and heals a bad fissure in just a few days.
4. If necessary, use a steroid cream once or twice a day for no longer than 2 weeks to only the reddened, itchy areas.
5. Wear gloves whenever possible when doing tasks using cleaning supplies.

I have seen terribly bad hands be better in two weeks’ time with this protocol. Of course, if someone doesn’t see improvement, a dermatology visit is recommended, as there may be secondary infection or a need for bigger therapies like oral prednisone or narrowband UVB therapy or psoriasis treatments. There are many cases of low-grade or moderate allergic contact dermatitis out there that sometimes require patch testing. Occupational contact dermatitis is harder to diagnose and may require patch testing. In my experience, though, the most common offenders are Neosporin, and preservative ingredients or soap ingredients in liquid soaps and liquid hand lotion. Using my protocol eliminates these common allergens anyway, so expensive patch testing could be avoided if someone improves using it.

If you know of anyone struggling with a skin condition, feel free to forward this post.