Topical steroids are available as creams, lotions, gels and ointments; selection of an appropriate product can also provide good moisturization of the skin. The wide spectrum of potencies and bases allows these mediations to be used both effectively and safely while under the care of an experienced physician.
During flares, over-the-counter moisturizing preparations that include a topical corticosteroid (such as clobetasone butyrate and hydrocortisone) are helpful to control inflammation and restore the skin barrier. The intensive use of emollient-based products can reduce the need for topical steroids.
Although the safety of inhaled corticosteroid therapy has been established, physicians should prescribe the lowest dosage possible. In addition, there may be a need to increase the corticosteroid dosage and add a long-acting beta 2 agonist in patients at high risk for exacerbations, such as those with a history of hospitalizations or emergency department visits because of asthma. 27 , 28 Combination therapy with an inhaled corticosteroid and a long-acting beta 2 agonist is more cost effective than treatment with an inhaled corticosteroid plus a leukotriene modifier. 29
Usually no treatment is necessary. Spontaneous remission occurs in