Each month on Health Central’s skin care site, we select one member question to ask of our consulting dermatologist, Dr. Lawrence Green, a practicing dermatologist and Assistant Clinical Professor of Dermatology at the George Washington University School of Medicine. This week we are going to ask Dr. Green about eczema, a common skin condition which affects infants, children and adults.
This month’s question comes from member "Software Architect" who asks:
Q: This may be a stupid question…but I just learned that I have eczema. The good news is that what I believe to be the standard treatment is working for me (Triamcinolone Acteonide cream). I looked up the medication on Wikipedia and am left wondering why this is a prescription med? Maybe cost or IP rights (patent(s)) perhaps. Doesn’t look like there are any/many allergic reactions and it looks to be relatively benign as far as drugs go (limited/no risk for abuse/etc.).
Dr. Green: Triamcinalone topical preparations are mid potency-mid strength steroids (also called cortisones). This means there are many topical cortisones that are weaker and many that are stronger that can be prescribed. The weakest topical cortisone is 1% hydrocortisone, which you can get without a prescription. The strongest is called clobetasol.
The stronger topical cortisones work on most all eczema rashes, but they have higher risks such as causing permanent white discoloration, or stretch marks on the skin where you use it. Sometimes, they can even be addictive, where if you don’t use them every day your skin actually makes a worse rash than you had before unless you use it.
On the other hand, a low potency cortisone, like 1% hydrocortisone may not have the potency to work that well on many eczema rashes, but is much less likely to cause the above mentioned adverse effects. Triamcinalone, being in the middle, works on many eczema rashes, but still may cause some adverse effects, especially if you use it on sensitive skinned areas like the face.
So, the dermatologist basically picks a cortisone topical preparation for you that she/he thinks will be strong enough to work for your eczema, while trying to not give you something so strong that you will have an adverse outcome.
Q: Wouldn’t an OTC hydrocortisone cream work in a similar way? Is it not strong enough?
Dr. Green: OTC hydrocortisone cream is a low potency steroid cream that may work on minor eczema rashes or perhaps an eczema rash on a sensitive skinned area like the face. But, more often, stronger steroid topical medications are needed.
Q: A relative of mine told me to warn the dentist that I was using this cream. That seemed odd to me and then I didn’t see why on Wikipedia. Should I? Is there a rationale behind this?
Dr. Green: I cannot think of a rationale either, to be honest-unless you were using the cream on your lips or in your mouth. Perhaps you should check with your dentist, and see if she/he has a reason.
We also have some additional questions for our doctor about eczema.
Q: What is eczema and what are the symptoms?
Dr. Green: Eczema is a general term for any rash that is not allergic or irritant in nature. Eczema rashes are red scaly areas that usually itch a lot. Some of examples of eczema are hand eczema (also called pompholyx), nummular eczema, and dry skin (or aesthetotic) eczema. Atopic eczema, also known as atopic dermatitis, is another specific type or subset of eczema that is inherited, starts often in childhood, and is associated with allergies and asthma. Atopic dermatitis is often present in skin creases, like the neck, knee, and elbow creases.
Q: What is the best way to treat this skin condition?
Dr. Green: The best way to help prevent eczema from worsening is to avoid skin fabrics and products that can irritate the skin. For example, wearing cotton clothes and using fragrance free moisturizing creams or petrolatum based products help to minimize eczema. Actually, frequent use of fragrance free creams and ointments are always a good idea to keep any eczema soothed. Dermatologists often prescribe cortisone (steroid) topical ointments to treat eczema as well.
Thank you so much Dr. Green for answering our questions
For more information about eczema including symptoms, diagnosis, and treatment please refer to our Eczema Resources page.