Doomed to itch or do I risk it?
January 16, 2012 3:25 PM   Subscribe

So, what's the deal with 1% OTC hydrocortisone, for chronic skin problems? The recommendations to use it (and the stuff) are so ubiquitous, yet the warnings so dire! And it seems to be the only thing that works at all well with my…

…itchy, flakey, drive-me-crazy! inner ear lobes. Of course as soon as I stop the hydro, the problem comes back. So, is the stuff cumulative/forever/lifetime limit, or is there some safe rotation scheme that will let me use it (maybe 1, 2 or 3 times a week if not everyday?) from here on out, or…? Many thanks for your experiences, info, etc. (No way I can afford to pay an MD for advice on this…)
posted by dpcoffin to Health & Fitness (16 answers total) 11 users marked this as a favorite
Response by poster: BTW, seems my problem is basic seborrheic dermatitis, based on other problem areas that I've seen dermos about, and never gotten rid of. But these ears are the worst… And I've tried EVERYthing, including all the itching-skin recs on AskMe.
posted by dpcoffin at 3:29 PM on January 16, 2012

Which side effects are you worried about?

No way I can afford to pay an MD for advice on this…

Ask your pharmacist.
posted by grouse at 3:45 PM on January 16, 2012

Have you ever tried Apple Cider Vinegar?

There's a Yahoo group about using ACV to combat sebderm. It's run by a bit of a nut who will ban you for discussing non-ACV treatments (especially steroids) and who will also ban you if you fail to post updates on your condition. In addition to the ACV treatment, they have a restrictive diet they advocate.

I'll tell you my experiences. Started on my nose/ears, eventually spread to more of my face and chest. The steroid creams (whether OTC hydrocortisone or others) do, as you say, work. But they eventually lost a lot of their effectiveness. More importantly, they thin your skin. I really do not think it's wise to be using them long term.

Based on that Yahoo group, I decided to quit the creams, and as the group warned, the flare-up was horrible. For weeks I looked like I had horrible horrible acne where I had been using them. Eventually went away, but that basically scared me to not ever use steroid creams for a prolonged period.

The ACV works pretty well for me. When I stop using it, it comes back. But at least I'm not permanently damaging my skin. I also have a horrifically bad diet. I think others have some success with the diet alone, but I ignore the diet and use the ACV.

If you're interested in trying the ACV routine I'd recommend finding that Yahoo group and reading a lot, but the basics are:

1) You want non-filtered ACV "with the mother". I buy Bragg's. Not sure about other brands.

2) I use it full strength, which can sting, especially if the flakiness is not yet under control. More importantly, if you have weak skin, you don't want to start off using it full strength. In other words, dilute it with a lot of water first, and slowly build up to full strength. Otherwise it might turn you red and/or hurt for a while.

3) Before bed, you want to soak any affected areas with it, including your scalp if you have dandruff (which is basically the same thing). Let it dry, wash it off in the morning in the shower. Until it's under control, they also advocate showering before using it at night.

Hope that helps. Good luck!

Oh, the derms I've seen have all been useless. They just prescribe steroids and tell me to keep using them.
posted by User7 at 3:46 PM on January 16, 2012 [2 favorites]

I found you the link:

As I said, I'd recommend reading into it first, e.g.:

"Read the acvwm (apple cider vinegar with mother) application routine, before you "even" think about applying Full strength acvwm, which can hurt you if you have rosacea in addition to sd or steroid/chemical damaged skin."

It appears in addition to the group moderator's other crazy tendencies, he is now asking for a donation for some mentally ill woman in order to join. I have no idea what that's about; group has been there for like 7+ years without that. As I said, he's nuts, and will ban you for all sorts of things. But I've found the advice in the group really invaluable.

You'll notice it also mentions ethyl alcohol. Apparently he has personally replaced the ACV with alcohol which works for him and some others. I've never tried that, in large part because I was banned from the group for not posting status updates. It would be nice if that worked, as you smell like vinegar when you dump it on yourself (at least until it dries).
posted by User7 at 3:52 PM on January 16, 2012

I just wonder if you have tried head and shoulders shampoo on the affected area yet.
posted by St. Alia of the Bunnies at 3:57 PM on January 16, 2012

I believe I have seb. derm. and the only routine that has worked for me is to use 2% Nizoral (prescription in the US but OTC elsewhere) first, and then Neutrogena 3% salicylic acid shampoo, with a few squirts of Desert Essence or Trader Joe's Tea Tree Face Wash mixed in. Nizoral is an anti-fungal shampoo, salicylic acid removes skin build up, and tea tree is believed to be an anti-fungal. Like you, I'm too nervous to use steroids for extended periods of time because of the warnings, but this has worked for me. Might be worth trying, at least on your ears.
posted by UniversityNomad at 4:00 PM on January 16, 2012 [1 favorite]

The following is taken directly from ABC of Dermatology by Buxton, 3rd ed 2003:
Dry, Scaling, lichenified lesions:
  • Use emollients.
  • use steroid ointments, with antibiotics if infection is present
  • A weak coal tar preparation or ichthammol can be used on top of the ointments. This is articularly useful at night to prevent itching. 1-2% coal tar can be prescribed in an ointment. For hard, lichenified skin salycylic aci can be incorporated and the following formulation has been found useful in our department: a) Coal tar solution BP 10%, salicylic acid 2%, and unguentum drench to 100%. b) 1% ichthammol and 15% zinc oxide in white soft paraffin is less likely to irritate than tar and is suitable for children.
  • In treating psoriasis start with weaker tar preparation and progress to a stronger one.
  • For thick, hyperkeratotic lesions, particularly in the scalp, salicylic acid is useful. It can be prescribed as 2-5% in aqueous cream, 1-2% in arachis oil, or 6% gel.
  • On the subject of steroids, the book suggests starting on a strong steroid and applying frequently for a few days to bring the condition under control, then to switch to a weaker steroid applied less frequently. The only prolonged-use cautions I see are regarding the extended use of strong steroids, the possibility that steroids may cover up a bacterial or fungal infection, and the possibility that telangiectasia may develop when anything stronger than hydrocortisone is used on the face. The book recommends minimal use of soap on the affected area, as dry skin tends to be itchy (this is also why they recommend emollients).

    Nowhere in the book is apple cider vinegar mentioned as a treatment. Out of curiosity, I did a PubMed search to see if there was any research on its use in seb. derm. Nothing. Personally, I think it stands to reason that the application of any acidic preparation would cause further dryness which would lead to further itching, but IANADyet and YMMV.
    posted by The White Hat at 4:15 PM on January 16, 2012 [3 favorites]

    ^ Yeah, I'm with you White Hat. I usually try to be scientific about these things, and try not to be a "I found this cure on the internet" nutter. That said, I've been using the ACV for maybe 5 years now. I'm too lazy to use it consistently, so I often go through periods where I stop using it for a while (like when I traveled for 3 months). Each time it came back strong, and it gets under control upon re-use.

    No clue why it works. Perhaps it's anti-fungal because it's so acidic. Or maybe it's a placebo, :).

    As a side note though, if I had a bunch of money I'd start a non-profit that did scientific double-blind studies of all the various free internet cures, that no drug company would fund, and see which actually pan out...
    posted by User7 at 4:30 PM on January 16, 2012 [3 favorites]

    My daughter's dermatologist has us using Epsom salts and distilled white vinegar in a tepid bath (in addition to a 2x daily steroid cream) every night to fight her excema. Its flared up bad... like really bad and the dry winter has really done her in. (Note: she is 6 months old, so we're establishing a baseline here. )

    We did the two week treatmemt.. of 1% hydrocortizone cream on her (and then two weeks off) twice before her GP ordered her an emergency dermatologist appointment. She had maybe a small band around her neck that was the only clear skin at the time... hence the rush.

    From my very limited understanding of what is going on on her skin with the epsom salts and vinegar, she is being effectively softened and conditioned. Reading online about bathing in the combination, folks are using it for some kind of cleansing. That makes sense, given that the two together would effectively lower the ph of the bath. Epsom salts are anti inflamitory, on a cellular level they help the body shed the skin build up a and calm the rash. They help the body return the dermal skin cells to an even water content. Vinegar apparently is also an inflammatory helping return the skin to a slightly lower than seven ph.

    I like to think of things like this though: ever stuck an egg in a vinegar bath for a week? It decalcifies the shell making the egg soft and maluable. The egg retains its strength, just the skin is softer...

    Anyway... as for the warnings for hydrocrtizone, yeah its that bad if things go awry. Tylenol has similarly scary warnings. I take both seriously.
    posted by Nanukthedog at 6:19 PM on January 16, 2012

    I've used hydrocortisone cream for long periods. I've even been prescribed stronger steroid creams to use on my face, and only noticed the 'do not use on your face!' warnings after a month.

    Anyway, first!, make sure it's not something else. I had a fungal infection that looked pretty much the same but was irritated by the hydrocortisone (the steroid stopped my immune system from fighting off the fungus like it normally would). You're probably going to have to go to the doctor, sorry.

    Second, for my problem, I found it really useful to use anti-itch stuff (cream, cool showers/baths, antihistamines, moisturizing all the time, bathing less often) including hydrocorisone cream, really aggressively for a week or two, and then back off on it in. Best case, I'll feel better and be able to completely go off everything. So I guess what The White Hat says but instead of strong/weak steroids, I did weak/no steroids.

    Good luck.
    posted by hydrobatidae at 7:11 PM on January 16, 2012

    Have you tried OTC dandruff shampoos like UniversityNomad suggested?
    posted by radioamy at 7:36 AM on January 17, 2012

    Data point: I took it for an unexplained rash. It worked after a week or so. It made me feel weird. But better than the rash did.
    posted by benbenson at 10:28 AM on January 17, 2012

    Response by poster: Many thanks, all; greatly appreciated. Will post if I solve/improve the problem before the thread is closed.

    Still wondering if hydrocortisone accumulates or if a break from it gets rid of it, or allows any damages to fix themselves.
    posted by dpcoffin at 1:41 PM on January 17, 2012

    Response by poster: SP. Will be sure to ask the next pharmacist I happen upon…
    posted by dpcoffin at 1:42 PM on January 17, 2012

    Response by poster: According to the pharmacist at my local Fred Meyers, one simply needs to take a "drug vacation" from hydrocortisone for a few days every couple of weeks of daily use. Sounds a bit too good to be true, so I'll keep asking others. But my fear that the stuff somehow accumulates in the body seems unfounded, so I'm back to it…

    Also, I found this page which offers a few suggestions I hadn't tried, such as zinc pyrithione soap.

    Incidentally, the answer to all the have-you-tried queries here is yes, I'm sorry to say, but nonetheless, thanks again, everyone!
    posted by dpcoffin at 12:50 PM on January 22, 2012

    Response by poster: OK, last update:

    Asked another pharmacist and got a much less comforting answer: Take 2-3 week breaks after each 7-day course; main danger from steroids is immune-system impairment, not just "eventual skin thinning" as per first consult.

    So, back to start: Works but dangerous; still need good interim or alternate solution… Sigh.
    posted by dpcoffin at 12:17 PM on January 24, 2012

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