Don’t use hormone ointments indiscriminately: common misunderstandings in eczema treatment

The misunderstandings about eczema treatment related to hormone ointments are essentially two extremes: "dare not use" and "use indiscriminately". More than 90% of eczema delays in healing and symptoms worsen are directly related to these two wrong behaviors.

Recently, we encountered two extreme cases in the outpatient clinic. One was a young girl who had just graduated. She had a small patch of eczema on her cheek, which was red and itchy. She posted on the Internet that "hormone ointment will ruin your face if you apply it." She endured it for two weeks and was so itchy that she couldn't sleep all night. When she came, the rash had already oozing and scabbed, and half of her face was swollen.； The other was a man in his 60s who suffered from chronic eczema on his calves. He went to the drugstore and bought an "anti-itch ointment". After applying it, the symptoms stopped and he continued to use it for more than three months. When he came, the skin on the affected calf area was so thin that red blood streaks could be seen, and it was painfully itchy at the slightest touch. Later, he checked the ointment he bought and secretly added super powerful clobetasol. It is a type that cannot be used on thin and tender skin for a long time and cannot be used continuously for more than 2 weeks.

Many people's understanding of hormone ointments is that they are either untouchable by wild beasts, or universal anti-itch ointments can be applied to any rash. It is really not the hormone itself that is the problem, but the method of use is wrong.

Currently, the first-line medication recognized by dermatology departments around the world for the acute phase of eczema is topical glucocorticoids, also known as hormone ointments. Nowadays, regular hormone ointments are divided into four levels. Weak ones such as desonide cream should be used in children and on delicate parts of the face as directed by the doctor. If you continue to use it for 1-2 weeks, the so-called "hormone dependence" and "skin thinning" problems will not occur. The medium-effective ones, such as mometasone furoate, are suitable for moderate eczema on the trunk and limbs. The more powerful ones are generally only used for hypertrophic chronic eczema, and the course of treatment must be strictly controlled.

Of course, many researchers in the field of traditional Chinese medicine have suggested that long-term external use of hormones may "suppress evil spirits" and suppress surface inflammation. If the triggers in the body are not resolved, it will easily lead to recurrence of eczema. This is also the idea of ​​​​many integrated traditional Chinese and Western medicine programs: use hormones to quickly control symptoms in the acute phase to prevent patients from infection and rash expansion due to itching and scratching, and then use Chinese herbal wet compresses, moisturizing repairs, and physical adjustment to reduce recurrences. The two ideas are not conflicting. They are essentially to reduce the patient's pain and reduce the probability of recurrence.

Many people say, "I just put hormones on and then I stop. Isn't this dependence?" 」, most of the time it’s not dependence, it’s that you haven’t used enough treatments. For example, when the inflammation of eczema disappears to the point where it’s invisible to the naked eye, there’s still residual inflammatory reaction under the skin. The doctor asks you to apply it for another 3 days to consolidate it, but if you stop once you feel better, of course you’ll have a counterattack. There are also people who use the same ointment no matter where they are, and apply strong hormones on their face. If they use it continuously for half a month, it is strange that hormone-dependent dermatitis such as redness and heat does not appear. What’s even more outrageous is that corticosteroids are applied no matter what the rash is. If the rash is caused by viral fungi such as tinea corporis or herpes zoster, applying corticosteroids will actually “add food” to the pathogen, making it more severe the more you apply it.

When I prescribe hormone ointments to patients, I always say two things repeatedly. One is to apply the "fingertip unit", and the ointment is the length of the first joint of the index finger, which is just enough to apply to the affected area of ​​two palms. Don't apply it too thickly, as it is wasteful and can easily increase side effects.； The other is not to shorten the course of treatment by yourself. Apply it for only a few days, followed by a mild moisturizing cream. Once the skin barrier is well maintained, eczema will be less likely to occur.

By the way, don’t believe the “pure herbal, hormone-free, radical cure for eczema” ointments sold on WeChat Moments or WeChat merchants. Our department has tested many products submitted for inspection, and most of them secretly add super powerful hormones. The results are faster than regular ointments, but you have no idea how much and what type of ointments are added. If you use them for a long time, it will be more harmful than buying random hormone ointments yourself.

All in all, eczema is a disease that varies greatly from person to person. Some people will be cured after applying weak hormones for three days, while others need to take oral medicine and phototherapy for more than half a year. Don’t try blindly based on online experience. Find a dermatologist from a regular hospital for an interview. It will be more effective than reading ten popular science articles.