Return to 'tried and true' when newfangled medications don't work

April 1, 2006

Cleveland ? "What if there were no topical corticosteroids? Or if a patient were unable to use them?"

Cleveland - "What if there were no topical corticosteroids? Or if a patient were unable to use them?"

Those are some of the questions asked by Jerome Z. Litt, M.D., a private practitioner in the greater Cleveland area and an assistant clinical professor of dermatology at Case Western Reserve University School of Medicine, Cleveland. In practice for more than 50 years, Dr. Litt says in that scenario, it's possible that a lot of younger doctors probably wouldn't know how to approach many of dermatology's common problems that respond so well to steroidal therapy.

"I'm not saying, 'Don't use steroids' - I use them all the time - but what if you've tried them all - to no avail? What if the patient comes to you after the internist or pediatrician has tried everything? What if potential side effects make the use of steroids unacceptable?

Dr. Litt outlined more than 50 treatments - medicated baths, soaks, lotions, creams, ointments, pastes, solutions, tinctures, gels and powders - that dermatologists might want to consider if, for any reason, it isn't possible to use steroids. Some of these treatments he prefers even when steroids are an option.

Treatments to try

Dr. Litt admits there can be some drawbacks, such as the purple stain that accompanies the gentian violet, but he thinks that the inconvenience of the staining is worthwhile if a bothersome condition is alleviated. Sometimes the staining can be handled simply - and sometimes not.

"Try aromatic spirits of ammonia to remove skin stains," he says. "For clothing stains, forget it!"

"This is very simple," he tells Dermatology Times. "It costs the pharmacist less than a dollar for the ingredients and eight ounces of such a cream or lotion can usually be bought for about $12. That's a big difference from the $150 a patient usually pays for two ounces of a steroid cream like betamethasone, diflorasone or clobetasol."

Specialist required

A major disadvantage of using these nonsteroidal treatments is that a pharmacist must make many of them up - and not just any pharmacist can do this.

"You are not going to get this compounded at Walgreens or CVS or Rite-Aid. You have to go to a real pharmacist who mixes them up. That's something older pharmacists used to do on a regular basis, but younger pharmacists don't know how.

"In most large or moderate-sized towns, you'll usually find an older-type pharmacy that has a pharmacist who knows how to compound medications."