Originally published on Substack.
In my encounters treating patients in various settings, one thing has definitely increased over time: Patients question everything!
And, as a patient or caregiver, you should question everything! You have a right to gather the most information to make the best informed decision regarding your care.
Doctors should not get upset about medical questions being asked, even if they come from unknown internet sources or social media. We should see it as a time to educate, communicate and strengthen our bond with you. If frustration occurs, it should be due to the fact that there’s often not enough time to answer every question and patients need to be sympathetic to that. Unanswered questions can be dealt with outside of the visit by a variety of ways such as through the patient portal or if necessary, by scheduling a telemedicine or another in-person visit.
Questions about eczema treatment, particularly side effects, are the most frequent ones I encounter. Often, patients are far more fearful about the potential treatment than about the eczema itself.
The bottomline is that the fear of the vast majority of eczema medications, most of which are topical, is without merit. It is based on misinformation or misinterpretation of the information about the treatments being provided.
An example of this, is a parent who absolutely refuses to apply a topical steroid to the skin of a child who is experiencing an eczema flare. He or she is aware of the word “steroid” and is aware that steroids can suppress the immune system, stunt growth, impair vision and lead to many other side effects. As a result, those potential side effects that paralyze the parent lead to a delay in treatment. What is not understood, is that these side effects are extremely unlikely to occur when steroids are applied to the skin topically and when used appropriately.
Furthermore, what the parent is often not taking into account, is the cost of delayed treatment. And I’m not talking about monetary cost, although I can write a whole blog on the massive amounts of money I observe patients waste on various eczema treatments bought online and at various stores and beauty boutiques. I’m talking about intangible costs that are far more expensive and invaluable.
What is the cost of the continued itching? The sleepless nights of the patient and the caregiver? The anxiety? The depression? The avoidance of social settings? The decrease in work productivity? The inability to pay attention in school? The increased risk of allergy development? The increased risk of skin infections? The risk of side effects from antibiotics if a skin infection occurs? The texture and color changes of the skin that embarrass and impair self-confidence? The possibility of Post Traumatic Stress and living in constant fear of being worried about the next flare?
Have you truly sat down and really taken these costs into account? The days spent suffering and any future days that will also be affected-- what are they worth? Truly, what is the cost?
I am here to tell you that the potential side effects of most eczema medications, particularly the topical ones, are leaps and bounds less than those experienced by the untreated eczema itself.
Oral or injectable steroids can cause these unwanted side effects but should only be given in the most severe cases of eczema. Personally, I have only prescribed oral steroids a few times in my outpatient clinics for very difficult eczema cases that I watched closely. Otherwise they are avoided like the plague by specialists due to the potential for worsening or rebound eczema once the steroid has been stopped.
