Hi Caden, hope you don’t get tired of answering derm questions but I use triamcinolone acetonide steroid cream for my eyelid eczema and i have two questions: 1) I heard from a random doctor (not my derm a generalist i saw once-off to get some prednisone for a bad flare up) that you need to apply it and let it “air out” for a certain period of time before applying other moisturizers or ointments. Do you know if this actually affects the efficacy of the steroid? and 2) This is purely a vanity question but do you know if years of eyelid eczema & using steroid creams and rubbing them so much is gonna fuck the skin around my eyes and my eyelashes irreparably? (i know this one is probably hard to answer without knowing the specific details of my case but just like, in general idk). Thank you I hate my dermatologist ❤️
-in general, topical medicines absorb MORE if you put them under occlusion (cover them). putting on your triam and then putting an occlusive ointment on top will essentially make it so more of the steroid absorbs into your skin. a moisturising cream, unlike an occlusive, does itself absorb into the skin. most of the time an additional moisturiser on top wouldn't affect the absorption of a medicine that's already in a cream base itself, although for simplicity i would personally just wait 30–45 minutes before moisturising more. the thing you don't want to do is put on a moisturiser or occlusive right BEFORE a medicine: this will lower the absorbed dose, bc it creates a barrier between skin and medicine/there are physical limits on how much the skin can absorb at once. (this is also why that 'sandwich method' trend is a bad way to manage topical retinoid dryness in a skincare routine but i digress.)
-yes, eyelid skin is very thin and consequently very prone to long-term/permanent physical changes from both the eczema itself, and the topical steroid. there is a particular loose, crepey look/feel to skin that has had long exposure to steroids, not dissimilar to premature ageing; meanwhile a triad of dark discolouration, vertical wrinkling, and skin thickening ('lichenification') on the eyelids usually signals a chronic eczematous process there. rubbing the skin will accelerate/exacerbate this. with long-term skin clearance, much of the eczema-related change is often reversible; topical steroid atrophy generally is not.
ignore the rest if not relevant, but: i hope that someone has discussed non-steroid options with you, as well as the risks of both chronic topical steroids & oral systemic steroids (prednisone). steroids are great drugs & i don't mean we should be afraid of them. but systemically immunosuppressing someone for an eczema is extreme, should only be a last resort, and tells me their normal treatment plan is wildly inadequate; meanwhile, a topical steroid should never be the only medication for a chronic condition because using it on a chronic basis will certainly atrophy the skin. i don't know what sorts of access barriers you may be contending with. but in a purely pharmaceutical sense, there are a lot of non-steroid options that i would want you to be able to try for daily maintenance, which would ideally mean the topical triam in turn becomes your rescue in a flare instead of being the main/only arm of your treatment.