What kind of steroid cream is safe for dermatitis of the eyelid and periorbital area, and how long can it be used? Are there any adjunct measures that can be taken? How real is the danger of thinning the skin of the eyelid and/or increasing intraocular pressure? — Mansurur R. Khan, MD, Pasadena, Calif.

Given the side effects of topical corticosteroids, especially around the eyes, I routinely recommend the use of a nonsteroid preparation, such as topical pimecrolimus (Elidel) or tacrolimus (Protopic).

If a steroid is used, I choose a low-potency formulation, such as hydrocortisone cream 1% or 2.5%, or an ophthalmic preparation. The risk of thinning the eyelids is real, as is the possibility of increased intraocular pressure. I limit the use of these agents to one to two weeks, while nonsteroids can be used without limitation. — Jeffrey M. Weinberg, MD (157-3)

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