Occlusive therapy is highly effective. Apply the topical steroids mentioned above under subacute eczema and cover with a plastic wrap such as Saran wrap. The plastic dressing does not have to be airtight. Secure the dressing with tape on either end. A sock will hold the plastic dressing against a foot. The dressing may stay on for 2 hours or overnight. Remove the dressing and apply an emollient or more medication. It is not necessary to wash the skin each time a plastic dressing is applied. The appearance of pustules indicates a secondary infection. Stop treatment and prescribe topical or oral antibiotics for this side effect of occlusive therapy.
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.
Fragrances are complex substances that contain hundreds of different chemicals. Some examples are Balsam of Peru, cinnamic aldehyde, cinnamyl alcohol, hydroxycitronellal, geraniol, isoeugenol, eugenol and oak moss. These chemicals make up the most common causes of ACD to cosmetics. They are also present in many topical preparations, soaps, perfumes, toothpastes and other personal care products. Sensitized patients must use "fragrance free" products. "Unscented" products are not suitable since they may still contain masking fragrances. It is important to note, however, that fragrance free products may contain large quantities of botanical extracts. These extracts are used to improve the odor of the product but can also be a source of sensitizers. It is necessary to perform patch testing with a sufficient number of chemicals to detect a delayed hypersensitivity to fragrances. Once a fragrance allergy is diagnosed, a treatment plan to avoid exposure to culprit fragrances in products should be established.