Reported side effects of topical corticosteroid use include "cutaneous and/or local effects" such as: "acneiform eruption, including folliculitis, rosacea... periocular and perioral dermatitis... atrophy of the epidermis and dermis, skin fragility (elderly or sun-damaged skin, intertriginous areas, and the face are most susceptible)... delayed wound healing... gluteal granulomas... purpura... telangiectases and erythema... striae, hypopigmentation, hypertrichosis, masking or aggravation of dermatophyte infection, secondary infection or aggravation of existing infection, and contact dermatitis... due to preservatives or other ingredients of the vehicle [or]... due to the corticosteroid molecule, in which case cross-reaction may occur with corticosteroid molecules of similar structure.

"Systemic Side Effects"

Systemic side effects are "seen most frequently from prolonged and extensive use in children or with the use of very-high-potency topical corticosteroid compounds" and include: "cataracts and glaucoma with periorbital use... adrenal suppression (hypothalmic-pituitary-adrenal axis)... growth retardation (infants and young children)... however... catch-up growth is expected when corticosteroid use is discontinued... Continuous long-term treatment near puberty should be avoided. If growth is suppressed during what would normally be a prepubertal growth spurt, epiphyses may close during puberty before catch-up can occur." Systemic side effects from topical CS may also include hypertension as well as Cushing's syndrome.

Heather Blackwell is a Dermatologist Assistant to Dr. Puente at Raleigh Dermatology and Skin & Cosmetic Solutions in Raleigh NC. 919-876-9576. The practice specializes in cosmetic dermatology and skin disease solutions.

When did you first experience hand eczema?
I had it all my life, but it became more severe in nursing school. Every winter the condition got progressively worse in my first nursing job at a convalescent nursing home, while taking care of 58 elderly patients.

How did you know you had eczema?
I found out in nursing school. I had all the typical symptoms - dryness, redness, itching, cracking, occasional bleeding. Like other people, I used typical hand lotions. They were greasy and I would usually end up washing it off because it felt so tacky. Nothing really helped.

How many nurses do you know have hand eczema?
A majority. Just about all nurses have it to varying degrees if they wash their hands the way you're supposed to.

Is there any risk associated with having eczema as a nurse?
Of course. With cracking and bleeding there is a portal of entry for bacteria and viruses. That puts both the nurse and the patients at risk.

Did you use steroids and did they work?
I did and they worked. They are not easy to use. A lot of time you have to wait. It is not like putting on a lotion throughout the day. You can use them to get it under control, but they are not safe long term. As soon as I came off the steroid cream, it would flare as bad or worse. It was just a roller coaster kind of cycle.

Why can't you use corticosteroids long term to manage your hand eczema?
You risk the thinning of the skin as a long-term side effect. Also, from a patient care standpoint it is not the best thing to be transferring the topical corticosteroid to the patient's skin, especially touching a patient's face. Most of the steroids are in a delivery vehicle that leaves a sticky, dirty film especially after contacting all the materials a nurse has to handle all day.

Did patients notice your condition?
Oh yes. The bleeding and the scabs were very unsightly, unclean and non-sterile looking to a patient.

If I had been using Proteque starting in nursing school I wouldn't have the permanent red rings you see around the nail base, which cosmetically does not look nice.