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To minimise severe flare-up, slow withdrawal is recommended by decreasing how often the topical steroid is applied and choosing another topical steroid that is less potent. For the first 2 months, steroid cream is considered to be adequate and will not cause skin ulceration. Over time, some patients find that the cream has become too irritating and the topical steroid is needed more frequently. Topical steroids are available in cream, gel, suppository, injection and suppositories which are available in several strength, colouring and packaging. The choice of steroid formulation and dosage should also be based on the type of skin, degree of sensitivity, duration of treatment and any other factors affecting skin repair. Treatment of mild to moderate acne Treatment is usually performed under local anesthetic. The recommended treatment of mild acne is to use an oral topical steroid cream containing an antibiotic at a dose of 5 mg a day for as long as tolerated and a second topical steroid at a dose of 1.5 mg a day for 1-2 months. It is thought that this topical treatment can be combined with oral antibiotics. However, the use of oral steroids or antibiotics in acne treatment is more appropriate where there is moderate ulceration and it is believed that there is a good balance between the effectiveness of the topical treatments with the need for regular treatment with antibiotics. The dose of antibiotic is not limited and so topical steroids should be used only in conjunction with antibiotics to avoid side effects. The dose of antibiotic prescribed to take under the guidance of a dermatologist is 0.2 mg per square centimetre (mg). When taking a second steroid product during this treatment period, avoid using a product with an antibiotic at a dose that is greater than the first product. There is also a suggestion that it is advisable to discontinue any other topical steroid products for up to 4-6 weeks, depending on the severity of the acne and the degree of sensitivity of the skin being treated. Topical steroids are sometimes referred to as a "treat-all" acne and this is usually achieved by using the most potent products available. These include: Steroid creams containing a wide range of antibiotics but with low concentrations at the recommended doses Topical creams including an antibiotic, but containing a drug that has anti-bacterial properties Topical creams containing a wide-spectrum antibiotic at 1 mg/kg (approx.) daily Topical creams that contain 5-35 % of a broad class of anti-bacterial drugs, including antibiotics, but containing an antibiotic at a level that is less than 10 times the recommended concentration Topical Related Article:

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