Topical steroids are available as creams, lotions, gels and ointments; selection of an appropriate product can also provide good moisturization of the skin. The wide spectrum of potencies and bases allows these mediations to be used both effectively and safely while under the care of an experienced physician.
During flares, over-the-counter moisturizing preparations that include a topical corticosteroid (such as clobetasone butyrate and hydrocortisone) are helpful to control inflammation and restore the skin barrier. The intensive use of emollient-based products can reduce the need for topical steroids.
The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk. The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin (Retin-A) % may reduce the incidence of atrophy from chronic steroid applications. 30 Other side effects from topical steroids include permanent dermal atrophy, telangiectasia, and striae.
A dermatologist diagnoses perioral dermatitis by examination. No other tests are usually done. The first step in treating perioral dermatitis is to discontinue all topical steroid creams , even non-prescription hydrocortisone. Once the steroid cream is discontinued, the rash appears and feels worse for days to weeks before it starts to improve. Heavy face creams should also be stopped. One must resist the temptation to apply any of these creams to the face when this happens. Think of the face as a cream junkie that needs a "fix"- one needs to go "cold-turkey".