This responds best to steroids in an ointment base, but
is also often helped by non-steroid applications such
as ichthammol and zinc cream or paste.
The strength of the steroid is important.
Nothing stronger than 0.5 or 1% hydrocortisone
ointment should be used on the face or in infancy.
Even in adults one should be reluctant to prescribe
more than 200g/week of a mildly potent steroid,
50g/week of a moderately potent or 30g/week of a
potent one for long periods. Very potent topical
steroids should not be used long-term.
Bacterial superinfection may need systemic antibi-
otics but can often be controlled by the incorporation
of antibiotics, e.g. fusidic acid, mupirocin, neomycin
or chlortetracycline, or antiseptics, e.g. Vioform, into
the steroid formulation. Many proprietary mixtures
of this type are available in the UK. Chronic localized
hyperkeratotic eczema of the palms or soles can be
helped by salicylic acid (16% in emulsifying oint-
ment) or stabilized urea preparations.
