but when used it must be remembered that the effect
is merely a suppressive one; it is not recommended
for long-term use. The degree of response is
related to the potency of the preparation used; 1%
hydrocortisone is unlikely to be of much benefit,
while a potent one such as clobetasol should work
rapidly. However, the continuous use of a potent
corticosteroid may lead to irreversible skin atrophy
and unsightly striae, or unstable psoriasis, and if used
on extensive areas of the body, i.e. >10%, may cause
systemic side effects. Therefore, a very potent topical
steroid once daily should not be used for longer
than 4 weeks, or a potent preparation for 8 weeks
and, if repeated, it should be after a gap of 4 weeks.
This usage would apply to lesions on the trunk,
limbs and scalp, but potent preparations should not
be used in the flexures or on the face, where a mild
corticosteroid such as 1% hydrocortisone only should
be offered. Creams are more suitable for weeping
lesions and ointments for dry, scaly or lichenified
rashes (Samarasekera et al, 2012).