Topical therapy

Primary irritant dermatitis Virtually all topical treatments, if used excessively, will produce some  erythema  and some scaling . This  'primary irritant dermatitis' is seen especially around  the side of the neck and around the eyes. The possibility of this occurrence must be  explained to the patient who should  be instructed that if there is any discomfort he  ought to reduce the frequency of application or miss  out the treatment totally for 2-3 days.

A moisturizing cream will help and, if the problem is excessive, a weak steroid ointment, such as Haelan (flurandrenolone), will prove beneficial and resolve the  dermatitis in a few days. The patient  can then recommence with the same  preparation  but, if necessary, in a lower concentration and at a decreased frequency. If the problem is recurrent, extensive patch tests are  necessary  to exclude an allergic dermatitis either to the active medicament or its base. This author knows of no record of a positive reaction to retinoic acid itself and the incidence of  allergic dermatitis to benzoyl peroxide  is of the order of 1 in 500.