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What next after steroid cream?

Q.Patients like using steroid creams as they improve facial seborrhoeic eczema, but what is the best long-term management of skin yeast populations and the resultant dermatitis?

Q.Patients like using steroid creams as they improve facial seborrhoeic eczema, but what is the best long-term management of skin yeast populations and the resultant dermatitis?

A.Seborrhoeic eczema is a chronic relapsing skin condition that responds to a variety of treatments, but there is no cure. As such it is very important that patients understand control is the aim of treatment, not cure.

Mild steroid preparations are not contraindicated, but a non-steroid alternative is 2% ketoconazole cream which is almost as effective as 1% hydrocortisone.

Both are safe and well tolerated and associated with similar relapse rates. Combination therapies, such as hydrocortisone and miconazole, clotrimazole or econazole are also effective.

There is some suggestion that rotation therapy may be beneficial and will also reduce the long-term use of topical steroids. With this, patients may be advised to alternate a topical antifungal and a topical steroid every one to two months.

If there is any co-existent rosacea, avoid topical steroids as much as possible.

Patients who also suffer from scalp seborrhoeic dermatitis should try ketoconazole or selenium shampoo, which can be lathered in the hair and then used to wash over all affected areas to reduce yeast populations.

Dr Olivia Stevenson is consultant dermatologist at Kettering General Hospital

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