Despite the revolutionary benefit of topical steroids in the treatment of atopic eczema, they are often feared, and may be avoided or used only cautiously. They seem to be seen more as terrorists than freedom fighters.
Topical steroids are graded in four potencies, from IV: the weakest, to I: the strongest. The natural sensitivity of skin to topical steroids varies with the part of the body being treated. While the strongest steroids are sometimes required for the hands, feet and scalp, the weakest may be appropriate for the face and genital area. Other parts are intermediate in sensitivity, though care should be taken with the thin skin on the inside of the thighs and upper arms.
In disease, lichenification can make otherwise sensitive skin relatively resistant to topical steroids. Then even on the face the strongest steroids may be required, under close supervision and as part of a planned treatment programme.
Apart from different strengths, some areas such as the the scalp, and ears may pose practical problems. Particular preparations are however available on prescription.