My topical therapy with steroids is not working. Why?
When an inflammatory skin condition fails to respond to topical steroid therapy, the following factors need to be considered:
-Co-existing infection (bacterial, fungal, viral, scabies etc.)
-Wrong diagnosis (e.g. drug eruption, Pagets disease, mycosis fungoides mistaken as eczema)
-Insufficient potency of steroid for the site or skin condition.
-Inappropriate vehicle or base (e.g. cream is not as effective as ointment for dry lichenifed skin. Adding salicylic acid acts as a keratolytic and aids penetration of hyperkeratotic palms and soles)
-Poor compliance or incorrect method of application and skin care
-Irritant contact dermatitis: due to overexposure to water, detergents, lotions, antiseptics, herbal remedies.
-Allergic contact dermatitis: allergens such as metal, rubber, glue, and medicaments such as a steroid.