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Frequently Asked Questions

This FAQ page contains many common questions you may have about our processes, services, medications, and how Dr. Van Wagoner uses the Aron Regimen® for your benefit.

Topic Summary

Commonly Asked Questions

Both Dove and Vanicream make a good line of hand soaps for sensitive skin. In general, you want to find a soap that is fragrance-free and dye-free. In terms of moisturizers, we recommend an ointment over a cream- brands such as Vanicream or Cerave are typically recommended. Using Vaseline or Petroleum Jelly is also very effective to keep the hands moist and it also acts as a great barrier to prevent irritation and infection from occurring.

Yes, with the correct treatment, healing of one’s skin can be found. Typically, most patients may need controller therapy to maintain healing and prevent remission. It is important to remember that atopic dermatitis is a chronic condition for which there is no cure, but there are ways of maintaining and managing this condition to prevent recurrent flares and achieve remission.

Yes, in some cases. I have seen the effective treatment of patients with mild to moderate cases of psoriasis with the Aron Regimen®. Topical steroids are considered the first-line treatment of psoriasis; there is ongoing research on the role of skin bacteria and its role in the pathogenesis of psoriasis. Some patients with psoriasis also have concurrent eczema. Although the Aron Regimen® compound is not intended to treat psoriasis, we do have some patients with psoriasis who have seen improvement with the Aron Regimen® compound.

Yes! For Dr. Van Wagoner, looking at digital photos uploaded by online patients mimics what he is already experienced in doing during his education and training. He is very familiar with analyzing and diagnosing many conditions based on just images and a written history – which makes an online eczema practice such a natural extension of his practice.

Most of the patients I treat have moderate to severe atopic dermatitis. Typically, a minimum of 6 months of frequent follow-ups is required. The goal is to have my patients following up once or twice a year. Some patients have required many years of treatment- typically on a very infrequent application regimen of once per week or only as needed after remission is achieved. 

Most cases of eczema are genetic in origin and are the result of abnormal skin protein number and/or function, thus curing eczema is not that simple in these cases. Using topical and/or oral agents that lessen the inflammatory reaction on the skin can counter these genetic factors in many patients. Avoidance of common allergic triggers (food, environment, psychosocial stress, and/or chemical allergens) is also helpful in many patients. Thus, the management of each case is different and requires a thorough knowledge of potential causes and available treatments.

We welcome helping those patients who are not capable of caring for themselves or are perhaps uncomfortable using technology. We can only provide these services through a guardian or surrogate contact who is legally authorized to act on behalf of a patient. All that is required is the surrogate’s relationship to the patient, the surrogate’s contact information, the patient’s name, and the surrogate’s electronic signature to attest that the surrogate is legally authorized to act on the patient’s behalf.

Treating eczema is all we do and focus on. We are experts in the diagnosis and treatment of eczema for both children and adults. Our results speak for themselves. We typically see dramatic improvements for patients with mild, moderate, and even severe forms of eczema. We use a method of treatment that is different than what other contemporary providers utilize. The recognition that most patients with atopic dermatitis have an underlying infection on the skin that is promoting the course of the disease is a critical understanding. Thus, our treatment not only addresses the longstanding inflammation but also the underlying infection of the skin when deciding on the treatment medications we use. Plus, our close follow-up model allows customization of care that other providers can not easily duplicate given their already busy schedules. Our online model allows us the opportunity to provide you with needed and required follow-ups in a recurrent and timely fashion. Once control is achieved, those follow-ups are spaced out accordingly.

Yes, the Aron Regimen® can be effective for most cases of dyshidrotic eczema. These patients may need a more potent topical steroid for these areas of concern compared to what is used for the rest of the body.

Common Questions About Eczema

Yes, aeroallergen (cat, dog, dust mite, tree pollen, grass pollen, weed pollen, or other animals) allergies are a very common trigger for AD. Avoidance would be indicated if testing suggested one is sensitive. Allergy shots have shown to be helpful in some studies in children with atopic dermatitis.

Many different environmental irritants can trigger eczema, and swimming pool water is no exception. Some people with eczema may experience irritation or drying of their skin; others experience no negative effects (especially if they wash well with emollients and apply moisturizers before and after swimming). Some people with eczema may experience irritant dermatitis after swimming. This can be due to the skin reacting to chlorine or to any of the other chemicals added to sanitize or alter the chemical balance of the swimming pool water. If this happens to you, it may be worth changing where you swim as different pools may use different chemical treatment systems. Alternatively, try to find a salt-water pool, or swim in fresh or seawater (especially in the summer months).”

These types of exposures have been implicated in AD but are hard to test against.

Most cases of eczema are genetic. Possibly, someone in your family or a close relative has either eczema, asthma, or allergies.

Every case is unique. Some flares can last hours while others could last weeks depending on the source and/or type of exposure and/or the severity of one’s eczema. It is not uncommon for patients to see new areas of eczema appear if they already have persistent eczema.

Dyshidrotic eczema (DE) is a form of eczema. Atopic dermatitis (AD) is another form of eczema and the most common type of eczema. AD is commonly seen in patients with DE, but not necessarily the other way around.

Yes, it is okay to bathe daily. We typically recommend bathing anywhere from every other day to no more than 2 times a day. If your skin becomes dry after bathing, apply a moisturizer immediately after bathing to moisturize the skin.

Seasonal changes and certain weather conditions can be a trigger for eczema flares. Typically, the warmer weather in the summer months and the colder/drier weather in the winter months are the most common weather-related eczema triggers. However, each patient is different and has different triggers – seasonal allergies can also trigger eczema flares. The Aron Regimen® treatment is effective for patients living in all states no matter the weather. Adjustments are made to each patient’s individual treatment plan based on their specific triggers, including seasonal triggers, if needed.

There are many available treatments for atopic dermatitis (AD). The most commonly used and most effective treatments for AD are topical steroids. Alternative treatments would include topical nonsteroidal medications, biological agents, antibiotic treatments if appropriate, avoidance of known triggers of eczema, and/or systemic anti-inflammatory medications. The Aron Regimen® is an attractive and effective treatment because we are able to offer a treatment method that uses diluted topical steroids combined with moisturizer and topical antibiotics, that when combined together can provide a safe and effective treatment while exposing the body to smaller amounts of topical steroids because of the synergistic effects obtained with this combination. Unfortunately, no cure is available for AD. Most cases of pediatric eczema are outgrown over time.

Although some people with eczema will improve when exposed to chlorine (because it can help kill the bacteria on the skin), chlorine is actually a common trigger for eczema flares because it is an irritant. I recommend avoiding swimming while the eczema is actively flared. However, when the skin is stable, I am okay with swimming. I recommend you apply an emollient (moisturizer) prior to swimming in order to provide an extra barrier to the skin while in the pool. In addition, I recommend washing the pool water off the skin in the shower or bath immediately after swimming and then applying either the Aron Regimen compound or an uncompounded moisturizer to prevent the skin from getting too dry.

The list of additives used in the food industry is extensive and includes thousands of natural and synthetic substances used as flavorings, coloring substances, preservatives, sweeteners, antioxidants, thickeners, etc. However, only a small number of additives have been implicated in immunoglobulin E (IgE)-mediated or other (immunologic or nonimmunologic) adverse reactions. Allergic reactions to nutritive foods (eg, tree nuts or seafood) are far more prevalent than reactions to food additives, and food allergy must always be considered first in the differential diagnosis. The role of food coloring and preservatives in AD is controversial and has not been verified in well-controlled trials. I recognize that every case is different and that this type of allergic reaction is true in some individuals. Unfortunately, reliable testing is not available other than the use of double-blinded placebo-controlled challenges with the coloring and/or additive in question.

Controlling one’s underlying eczema would be the first line of treatment. In addition, the liberal use of moisturizers before bed is recommended. Use of sedative antihistamines may also be needed in the short term to help with nighttime itching, but these are not recommended for long-term use.

Every case is different, but most children do outgrow their eczema. Research shows that 1 in 5 children (20%) do not outgrow eczema. Regarding risk factors for more persistent/chronic diseases include: Most studies found there was a greater risk for persistence with more severe disease at the time of the initial diagnosis. Most studies found NO relation between the persistence of atopic dermatitis (AD) and sensitivity to allergens, as reflected in skin-prick testing and/or antigen-specific IgE. Silverberg and colleagues note that while they found disease severity, older age of onset, and female gender as risk factors for persistent AD, they also determined that 80 percent of childhood AD did not persist beyond 8 years, and less than 5 percent persisted 20 years after diagnosis. Reference: Persistence of atopic dermatitis (AD): A systematic review and meta-analysis; August 2016 Volume 74; Issue 4;

Food Allergies

These issues are very different. A “sensitivity” refers to a presence of a positive result seen on blood or skin allergy testing. False positives are routinely seen, but false negatives are rarely seen. “Allergy” is reserved to describe patients that are truly clinically allergic to the food, thus they have an adverse clinical reaction (experience symptoms) with exposure to the food, and the blood/skin allergy test objectifies the allergy.

Food allergy is typically NOT the main culprit/cause of eczema- especially in adult patients. Children are more likely to suffer from food allergies in general. In children, common food allergens would include: dairy, egg, wheat, soy, peanut, and tree nuts. BUT note that most children with atopic dermatitis (AD) DO NOT have significant food allergies contributing to their AD. A consultation with a local allergist could help determine if a food allergy is an issue for you or your child and further determine whether this food allergy is playing a role in you or your child’s eczema. Typically, elimination diets are not recommended when helping patients with flares of their eczema since food allergy is less likely the reason for these flares of AD.

Milk, egg, wheat, and soy are typically outgrown while peanut, tree nut, fish, and/or shellfish are more long-lasting. The mechanism by which patients outgrow a food allergy is complex but would involve a reduction in the IgE-mediated reaction against the food. But other immune cells and cytokines are involved in this process and are not fully understood how this process is turned off and/or outgrown over time.

Vitamin D deficiency has been seen in some children with difficult to treat eczema, and vitamin D supplementation has been shown to help in some cases to improve severe eczema. A zinc deficiency can lead to an eczema-like rash called acrodermatitis enteropathica. Vitamin A deficiency could also lead to eczema.

Oral antihistamines may prevent hives and other histamine-related effects seen with aeroallergen and/or food allergies, common issues seen in combination with atopic dermatitis (AD). I think the risk of their use is low and the potential benefit is helpful, especially in patients with recurrent hives/flushing that is seen with AD. I do not routinely suggest the use of oral antihistamines to mitigate the negative effects of a known food allergen. I would avoid the food allergen instead of trying to mask it with an antihistamine.

Food allergies are more likely to affect younger children than older children. The more severe eczema, the more likely that a food allergy may be contributing to one’s eczema. Most children with severe eczema have multiple triggers for their eczema and it is not always driven by food allergy. Increasingly restrictive food diets are not recommended in patients with atopic dermatitis (AD). Assistance from a board-certified allergist could help in these cases of severe AD in infants and young children.

I would seek the guidance of an allergist before attempting to reintroduce foods into one’s diet. While it could be safe to reintroduce a food, it could prove harmful if one is still allergic to the food.

Some patients have a non-IgE mediated food allergy which may cause a delayed worsening of one’s eczema. Thus, a negative skin or blood allergy test does not help in the identification of this type of delayed-type reaction. But please understand that this diagnosis requires a consistent history of if the ingestion of this particular food worsens one’s eczema while avoiding it improves eczema. This type of allergy is rare. Typically these types of delayed reactions to food are not life-threatening.

More data is needed in this area. While it appears that such an approach of controlling one’s eczema could and should lead to the development of tolerance to food allergens, I am not aware of any good studies that have proven this intervention as definitively instrumental in the induction of tolerance. Many factors are important in the development of food tolerance.

I do recommend allergy testing for toddlers with moderate to severe eczema. Determining and avoiding relevant allergens could prove helpful in managing their eczema.

There are many different types of allergic reactions that have been seen with strawberries. One is an immediate IgE mediated response where ingestion may cause hives, trouble breathing, and/or GI disturbances; skin or blood allergy testing would be positive. Some patients are susceptible to chemicals in strawberries that can cause the release of histamines and in a (pseudoallergic mechanism) non-IgE mediated fashion experience similar immediate-type reactions, but formal IgE type testing would be negative; strawberries are histamine liberating foods. Some patients experience local reactions in the mouth when ingesting fresh strawberries, this may be part of an Oral Allergy Syndrome like reaction when patients have a concurrent severe allergy to tree, grass, and/or weak pollen.

An allergy would be a more severe type of adverse reaction to a food, while an intolerance would be associated with less concerning issues. There is no standardized testing for food intolerances. IgG testing is not clinically helpful and IgE testing is a test to look for food allergy/sensitivity.

Milk, egg, wheat, peanut, and tree nuts are common allergens.

The role of glutamates in eczema is not well defined and currently not widely accepted. Soy sauce, fish sauce, and oyster sauce all have very high levels of glutamate. Soy is naturally high in glutamate, and soy-based sauces will have concentrated levels of the compound. Another common chemical that contains glutamate is MSG. Monosodium glutamate (MSG) is a nonessential dicarboxylic amino acid that is a normal constituent of the food protein. Additional MSG is added to food as a flavor enhancer, particularly in Asian foods. A variety of nonallergic symptoms have been attributed to MSG, while allergic and asthmatic reactions are only RARELY reported and generally not well-substantiated. MSG symptom complex: Perhaps the best known adverse reaction to a food additive is the MSG symptom complex. This is not an allergic reaction. The MSG symptom complex typically appears 1 to 14 hours after ingestion. Reported symptoms include headache, myalgia (body aches), backache, neck pain, nausea, diaphoresis (sweating), tingling, flushing, palpitations, and chest heaviness. Children have been reported with shivering, chills, irritability, screaming, and delirium. The mechanism of these reactions has been proposed to involve an exaggerated sensitivity to this compound, which is metabolized after ingestion to glutamate, a major excitatory amino acid neurotransmitter. I routinely do not tell patients and/or parents of patients with atopic dermatitis to avoid glutamates in food.

This issue has not been fully explained. Some believe that our diets including more processed foods and/or the movement away from a more rural/farming lifestyle to one that is urban/industrialized have shifted our immune systems from an infectious oriented response (TH1) to a more allergic based response (TH2). Less infection and/or exposure to microbes in our more sanitized communities perhaps is allowing our immune systems to react to our environment in different immunologic ways that are highlighted by more food and/or allergic-type conditions.

IgE testing is the only recognized form of testing that has been shown to be clinically relevant. IgG and/or IgA food intolerance testing is considered experimental and has not been proven to provide clinically relevant results that can be trusted and/or instructive.

Some patients naturally outgrow their food allergies/sensitivities. In others, healing of the inflammation caused by eczema allows the skin to respond in a less reactive fashion to foods and substances that previously may have exacerbated their eczema. Healing of one issue can, in some instances, promote healing in others. This is not a 1:1 correlation though. Some patients will continue to have significant food allergies despite having control of their eczema.

Skin testing in infants is sometimes not reliable. Blood allergy testing can also give false-positive and false-negative results. Under the direction of a board-certified allergist, food testing of an infant could be helpful as they would understand these limitations and could recommend and/or interpret the testing carefully.

Dairy and wheat are common allergens patients can be allergic to, but not all patients with atopic dermatitis (AD) have food allergies. Short trials of avoidance of dairy, wheat, egg, or peanut could be advised in select patients; avoiding one of these foods for a two-week period of time and looking for clinical improvement. More formal testing through an allergist is a quicker way to possibly evaluate for a specific food allergy.

Many patients with AD have evidence of IgE-mediated sensitivities to food: If the patient has previously consumed and tolerated the named food without issue, avoiding it would not be recommended and reintroduction in these situations would not increase the risk of future allergy to the food. Be careful about introducing foods that are positive on a food skin test or a specific IgE blood allergy test if one has never eaten the food that is positive. Introduction of foods that are found to be negative on skin and/or blood allergy tests are generally tolerated without issue. Rarely, patients are allergic to a food in a non-IgE-mediated fashion. In these situations, eating the food causes eczema but skin and blood allergy testing are negative to confirm this allergy. Avoiding these types of food allergens would also be helpful. It would be rare to have multiple non-IgE mediated food allergens that are clinically relevant.

General Eczema Recommendations

Yes, these fabrics would exert an irritant effect on already inflamed and damaged skin and could worsen and/or delay healing. These fabrics should be avoided if possible.

  • Consistent moisturizer
  • Avoiding triggers: heat, spicy foods, allergens, fragrances, etc.
  • Controller medications: Aron Regimen® & non-steroidal medications
  • Reducing staph bacterial infection

Hygiene is important to skin health and to prevent the spread and growth of bacteria (staph). Daily to every other day bathing is sufficient. Sometimes in severe cases, we may adjust those recommendations.

It is a generalized recommendation. These allergens do not always provoke eczema in all patients with AD. Avoiding these foods probably does not increase or decrease the risk of developing a true allergy to these foods in the future.

We recommend this brand for laundry detergent/cleaner and dryer sheets: All® free and clear.

The Aron Regimen® compound will contain a topical antibiotic that will get rid of the bad bacteria on the skin. The combined treatment will allow a healthy microbiome to re-establish.

Hand Eczema

Yes, you may cover your toddler’s hands with socks or mittens to prevent scratching if your toddler allows this. There are pajamas that have mittens already stitched into the suit – these are helpful and cute as well!

No, water does not always have to be bothersome for your child. Getting the deep cracks healed as soon as possible is the first priority in these situations. It may require treatment with a single agent topical steroid to induce quick healing of the skin. Once the skin is healed, water should be less likely to induce pain.

Treating eczema on the palms is not much different compared to treating eczema on other areas of the body with the Aron Regimen® compound. Each treatment plan is individualized based on the severity of eczema – an appropriate Aron Regimen® compound will be prescribed based on each patient’s condition. Since hand eczema can be more difficult to control, we often do not use a base moisturizer in the initial Aron Regimen® compound for severe hand eczema and sometimes undiluted topical steroids are needed in conjunction with the Aron Regimen® compound for more severe cases. We have available some new FDA-approved topical medications that can now also be used if the use of the Aron Regimen® and/or single-agent topical steroids are not helpful. Sometimes the use of an occlusive therapy applied over the last application of the night and left on overnight can be helpful if used for 7-14 days to induce a more rapid improvement in the hand eczema, if tolerated.

There is a fine balance between keeping the hands clean and overwashing, which can cause the hands to become drier. It is important to wash your hands prior to applying any medications/creams to prevent contaminating the medications/creams with bacteria. Avoid washing hands for at least 1 hour after applying the medications/creams to allow the medications time to be properly absorbed.

I would suggest we have the toddler wear some mittens after the application of the medicated treatments to allow proper absorption and to prevent getting the compound into his mouth. After one hour, I would think that enough time is passed to safely remove the mittens and allow the child to suck his hands. If some of the compound does get placed into the mouth at that time, it would be so small and negligible to make a difference and/or be harmful.

For tough hand eczema cases, we typically recommend the use of occlusive therapy where the medications or moisturizer can be more fully absorbed leading to better outcomes and skin healing.

Avoid excessive water use/exposure when the eczema is flared. In addition, we typically recommend avoiding hand washing for at least 1 hour after applying the Aron Regimen® compound or topical steroids to allow the medications enough time to be properly absorbed. After hand washing, it is usually helpful to apply an uncompounded moisturizer (ointments may be better for extremely dry hands) immediately after washing to prevent the hands from getting too dry as long as it is not within 1 hour of applying any topical medications. If you anticipate prolonged exposure to water, I recommend that you wear protective/waterproof or non-latex/nitrile gloves to prevent prolonged water exposure of the hands.

Nail changes due to eczema are typically caused by eczema in the nail beds or fingertips close to the nails. Controlling the eczema on your fingertips and the areas surrounding the nail beds will allow the nail to begin growing more normally again. Unfortunately, once the nail itself has been affected it will take time for the nail to grow before it appears more normal again – this could take several months.

Pompholyx and dyshidrotic eczema are the same things. There are no other types of “hand eczema”, but there are 7 different types of eczema, all of which can affect your hands:

  • Atopic dermatitis
  • Contact dermatitis
  • Dyshidrotic eczema
  • Neurodermatitis
  • Nummular eczema
  • Seborrheic dermatitis
  • Stasis dermatitis

Our treatment is safe, even for pregnant women. The amount of systemic absorption that would take place is minimal to none, especially if we are only applying medicated treatment to the hands only.

Hand and feet eczema can be difficult areas to control. A possible reason is that exposure to various chemicals and irritants is most likely to occur through the hands as one touches items. It is also simply very commonplace for eczema to present in these areas. Additionally, other related immune problems can show up on the hands and feet as well (like psoriasis or other autoimmune conditions); thus these related conditions can complicate the diagnosis. These areas are also easy targets to scratch, which can further disrupt the already malfunctioning skin barrier that is disrupted in eczema.

Sometimes additional testing can be helpful and may be important to rule out a fungal infection, a chemical allergy, a metal allergy, an irritant exposure, and/or other conditions that can masquerade like hand eczema. In some situations, a biopsy of the skin may be helpful to confirm the diagnosis. Sometimes using an alternative treatment may induce a better response as well. We would be glad to review your case and make specific recommendations, if possible.

How Our Services Work
  • For those that purchase the Premium Consultation Service, you will receive your completed consultation within 3 Business Days.
  • For those that purchase the Advanced Consultation Service, you will receive your completed consultation within 4 Business Days.
  • For those that purchase the Basic Consultation Service, you will receive your completed consultation within 7 Business Days.

We adhere to the national patient information security standards found in both HIPAA and HITECH regulations. Your photos, personal and medical information, or diagnosis will never be made public unless you give us consent to use your testimony.

Seeing your skin condition from different angles and distances helps Dr. Van Wagoner make a more accurate diagnostic and treatment decision. For best results, make sure the photos are also taken where there is good light and that they are in focus. Do not alter the photos in any way (i.e. no filters or effects). The photos must be in JPEG format and under 400kb per photo.

You can use your desktop computer, tablet computer, or smartphone to access our destination website at www.eczemaspecialist.com to start your request for consultation. A mobile app is not required, however, you can use your smart phone to complete the online intake forms.

We always strive to give our patients the best possible medical advice from the information we are provided. You will receive an answer; however, Dr. Van Wagoner may be less certain if the information provided was bad, blurry, vague, inadequate or hard to interpret.

Your treatment plan will be very thorough and should provide you with all the information you need. A very useful Eczema Guide of common recommendations will be sent with your treatment plan and should be reviewed thoroughly by all patients. This guide answers most questions patients may have about their eczema and its treatment. However, if you have an additional question for the doctor, you may ask for a “Follow-Up Consultation” or “Ask a Medical Related Question”- all for NO additional fee for those that purchase the Premium Consultation Service Plan during the 6-month service term and for Advanced Consultation Service Plan, it includes 3 Recommended Follow-Up Consults and two “Ask A Medical Related Question” provided for no additional fee within the first 4 months of treatment.

Asking a “Medical Related Question” will cost an additional $25 each, and “Follow-Up Consultation” will cost $50 each. Please see our Pricing Page for further details on each package type.

Your visit with the eczema specialist covers only the online visit. Depending on your case, Dr. Van Wagoner may determine that an in-office diagnostic or therapeutic procedure is needed to best address your condition. That in-office visit would be outside of the visit completed online through this service, and payment for those services would be separate.

An online visit with Dr. Van Wagoner will ask for much of the same information needed for an in-office visit. You will be asked about your current condition, include photos of your skin condition and provide a brief medical history.

Dr. John Van Wagoner will review your case and then provide you with a diagnosis and personalized treatment plan. You will be notified by email and/or text message when this plan is available for you to review. Your complete diagnosis and treatment plan will be sent to you in a secure email. From that email, you may then print, email or fax a copy of this information for your records and/or for your primary care physician to review. A copy of this record will be securely stored in your Eczema Specialist account to access at a later date.

Medications

Protopic and Elidel are brand names of medications for the drugs tacrolimus and pimecrolimus, respectively; both are considered topical calcineurin inhibitors (TCI) and can be used to treat atopic dermatitis (AD). Long-term treatment with TCIs and intermittent use of low-to-mid potency topical steroids (TCS) was generally well-tolerated in 27 trials of >5800 and >1900 pediatric patients, respectively, with no evidence of cutaneous atrophy or cumulative systemic exposure and no reports of a cancer called lymphoma. Many recent meta-analyses and reviews have also contributed to the body of evidence that has failed to detect increased lymphoma risk with TCIs [source]. One study compared the incidence of TCI-associated malignancies reported to multiple TCI AE databases and found a rate similar to or lower than the expected rate of malignancy in the general population [source], and another compared incidences of lymphoma in health insurance claims databases and did not find an increased risk among patients treated with TCIs versus TCS [source]. And no increased risk of malignancy was detected in 7457 children enrolled as of May 2014 in the ongoing prospective 10-year observational cohort study of children with a history of AD and pimecrolimus use (Pediatric Eczema Elective Registry, PEER) [source]. A decade’s worth of clinical experience, epidemiological data, postmarketing surveillance, and adverse event database monitoring have failed to demonstrate a causal relationship between TCI use and malignancy, yet TCI labeling continues to include a Boxed Warning. The biggest impact of the warning is to limit patient access to the most well-studied medications for long-term maintenance AD treatment, especially in children.

Dr. Van Wagoner is only able to provide valid medication prescriptions for patients that live in the state of Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana,  Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Texas, Utah, Vermont, Virginia, Washington, Wisconsin, and Wyoming, USA. 

Residents of the following states, we will send the necessary MEDICATION PRESCRIPTIONS for the Aron Regimen® to your local pharmacy. Home delivery of the Aron Regimen® Compound is currently NOT available for patients that live in the following states.  Instead, home-mixing instructions will be sent in your consultation. This prescription-only option is valid if you live in the following states:  Alabama, Arkansas, Kentucky, Mississippi, Nebraska, New Hampshire, South Carolina, Tennessee, and West Virginia.

Dr. Van Wagoner is NOT able to provide the recommended medication prescriptions for you if you live in Alaska. You will need to discuss what medications you need with your own local primary care provider. Dr. Van Wagoner is only able to provide general recommendations about your condition. All necessary medication prescriptions will need to originate from your own local primary care provider.

No, Dr. Van Wagoner does not have access to any medical record you may have established with Dr. Richard Aron. Former and/or current patients of Dr. Richard Aron that need a medication refill must contact his website directly at www.draron.com. Alternatively, if you are a US resident, you always have the option of requesting a New Patient Consultation with Dr. Van Wagoner. See our package list here.

In most cases, the steroid in the Aron Regimen® will not cause clinically significant thinning of the skin because it is significantly diluted by the addition of the moisturizer cream and the antibiotic ointment. Frequent follow-up with our service is required so that we may monitor your skin and look for any side effects and/or complications that may result from using the Aron Regimen®. When the eczema is controlled, the frequency of applications may be reduced and even the strength of the steroid may be reduced. Dr. Van Wagoner will notify you when those changes can take place.

If you need a refill in between Follow-Up Consultations, please use our secure “Refill Request” form. Click here – Refill Request

Beaker pharmacy will supply and deliver all your compounded medication needs if you live in the following states: Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Texas, Utah, Vermont, Virginia, Washington, Wisconsin, and Wyoming. More states are added frequently. Beaker Pharmacy charges $55-$65 for each refill of the Aron Regimen® compounded medication.

For other states, we will send in the required refill requests for the Aron Regimen® medication compound to your local pharmacy; except for the state of Alaska. If you live in Alaska, you will need to obtain prescription refills for the required Aron Regimen® compound from your local physician.

We now use a professional licensed pharmacy (Beaker Pharmacy) to securely prepare and home delivers the Aron Regimen® Compound medications for patients that live in the following states: Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Texas, Utah, Virginia, Washington, Wisconsin, and Wyoming. More states are added frequently.

If you do not live in the states mentioned above, we will send you specific instructions on how to mix the required Aron Regimen® medications in the convenience of your home. This process is simple and very straightforward. Typically, it will take about 20 minutes to complete this mixing process. You are always welcome and encouraged to ask your local compounding pharmacy to mix these medications for you if you are not comfortable mixing the medications. Typically there is a fee charged by the pharmacy for that process. This fee is not part of the fee paid to this website.

All cases are different. Typically Dr. Van Wagoner will require a paid follow-up consultation request if you have not been seen in over 6 months and need a refill. Sometimes, Dr. Van Wagoner will require a paid follow-up consultation request before refilling your medications even if it has been less than 6 months since your last visit, especially if you have missed any recommended follow-up appointments. Most patients need close monitoring for side effects and response to medications and Dr. Van Wagoner may require you to submit a follow-up consultation request before refilling your medications. It is important that patients follow up as recommended. If the patient does not follow up within 12 months, they will NOT be considered an established patient and will need to start over as a new patient.

The Aron Regimen® compound is relatively safe to apply long-term, but it still does not come without risks and needs to be monitored appropriately. If you need to book a New Patient appointment, please click HERE.

We highly recommend that a professional compounding pharmacy be utilized to mix the ingredients used in the Aron Regimen® compound. IF that is not available, we can/do provide mixing instructions for patients to be able to mix the ingredients themselves at home, if desired.

No, unfortunately, Dr. Van Wagoner and Dr. Aron do not share patient information. As such, Dr. Van Wagoner is unable to “convert” Dr. Aron’s prescriptions, or write prescriptions for patients not being cared for under our service. Dr. Van Wagoner is also unable to honor and/or apply for any money already paid to Dr. Richard Aron.

Yes, we have different medication types (oils, solutions, etc.,) that we can use as alternatives to treat eczema on the scalp. We are now offering a foam version of the Aron Regimen® compound for the scalp which should be much more aesthetically pleasing.

1. Compounding by Beaker Pharmacy is beneficial because you will have a professional pharmacist mix your Aron Regimen® compound for you, which ensures that the mixing process is done correctly. Oftentimes, when patients do not initially respond well to the Aron Regimen® compound it may be related to improper mixing of the compound at home. By using a professional compounding pharmacy, you eliminate this variable from the very beginning.

2. In addition, the cost of having your Aron Regimen® compound professionally mixed AND mailed to you through priority mail is relatively inexpensive when using Beaker Pharmacy compared to paying for separate ingredients at your local pharmacy. Some ingredients in the Aron Regimen® compound can become expensive, depending on what adjustments may be needed for your specific Aron Regimen® compound. Beaker Pharmacy has a flat rate of $55 for the majority of the Aron Regimen® compounds.

3. By having your Aron Regimen® compound professionally mixed with Beaker Pharmacy, you can ensure that the entire mixing process is completed in a sterile environment. This eliminates the possibility of your Aron Regimen® compound being contaminated with bacteria that could cause eczema to worsen. This is usually not possible when you mix the compound at home.

4. Your Aron Regimen® compound will also be mailed to you in an air-tight container, which is another step toward minimizing the risk of bacteria and mold growth.

5. By using Beaker Pharmacy, we can ensure that the exact ingredients needed for the Aron Regimen® compound are available for you. This eliminates the need for using other suboptimal ingredients that are often substituted by local pharmacies when the preferred ingredients are not available.

While most cases of moderate to severe atopic eczema do respond to the Aron Regimen® of medicines we may prescribe, there are definitely cases that may need additional and/or alternative therapies. We recommend that you book a Follow-Up Consultation and describe the issue and/or issues that you are still having. Dr. Van Wagoner will review all previous therapies and your updated photos of the difficult areas. He will then make appropriate adjustments to the treatment plan that will hopefully provide the freedom you are looking for. Please note that atopic dermatitis found on the face, hands, and/or ankles can be uniquely challenging and may need stronger therapy than Dr. Van Wagoner can recommend. If needed, here is a link to book a Work-In Follow-Up, click HERE.

It is important that patients follow up as recommended. Per our Established Patient Policy, if the patient does not follow up within 12 months of their last consultation, they will NOT be considered an established patient and will need to start over as a new patient. The Aron Regimen® compound is relatively safe to apply long-term, but it still does not come without risks and needs to be monitored appropriately by Dr. Van Wagoner. If it has been over 12 months since your last follow-up, please visit our Pricing Page to book a New Patient Consultation: Click HERE

Bacteria can, and do, become resistant to the antibiotic ointment, but the use of the mupirocin ointment in the mixture produces such an incredibly rapid degree of relief from the itch, burn, and redness that any such risk is typically worth taking. When control is achieved, the antibiotic element in the mixture may be removed.

Payment for Our Services

If you live in a state in which Dr. Van Wagoner is not licensed, we strongly suggest you get pre-authorization from your local provider before signing up for our services. Unfortunately, we are unable to refund your money if your local provider is unable to provide the recommended prescriptions.

No. Unfortunately, we do not accept payments from third-party insurance companies for the services we offer. We only accept payment directly from the patient. We accept Visa, Mastercard, Discover Card, and American Express credit cards and debit cards. Checks or cash are not accepted. *If needed, you may request itemized receipts to submit to insurance for possible reimbursement.

No. Unfortunately, we do not accept payment in the form of cash or a personal check. We only accept Visa, Mastercard, Discover Card, and American Express credit cards and debit cards.

Once you have made your payment, you should be redirected to our Booking Site to schedule a New Patient Consultation Appointment. You will receive your New Patient Consultation Form 24 hours prior to the scheduled appointment date. If you were not redirected to our Booking Site after purchasing, please email us directly at info@eczemaspecialist.com for further assistance.

Cancellation Policy: If an appointment is not cancelled or rescheduled at least 24 hours prior to the scheduled appointment time you will be charged a twenty-five dollar ($25) fee.

Missed Appointment Policy: If we do not receive the completed Follow-Up Form by 5:00 pm CST the day of the scheduled appointment, the appointment will be considered missed and you will be charged a twenty-five dollar ($25) fee.

Please email us at info@eczemaspecialist.com and let us know about the issue you are having. We will help you make the necessary payment and make sure you get a link to book a New Patient appointment.

See our pricing page. You will need to select where you live to view the pricing options for your state.

The Aron Regimen® Treatment

The steroids used in the Aron Regimen® have an excellent safety profile given the diluted nature of the compound, which is typically a 10-18 times diluted topical steroid, as compared to single-agent use of undiluted topical steroids.

  • Calamine lotion, Bepanthen barrier cream, or zinc oxide barrier ointment.
  • Non-steroidal medications: Elidel, Protopic, or Eucrisa.
  • Systemic non-steroidal medications like Dupixent can sometimes be effective for eczema in sensitive areas when lessor treatments are not sufficient

All physical activities including any sporting activities which produce sweat and friction are not recommended until a significant improvement in your skin is achieved. Swimming should also be stopped.

By definition, eczema is an inflammatory-related issue. Sometimes, a superficial fungal/mold infection can be present on the patient’s skin with eczema. However, it is rare that an allergy to airborne fungus/mold is the reason for one’s eczema. The use of topical steroids would be indicated in most cases of eczema; sometimes we use antifungal medications in cases where a fungal superficial skin infection is suspected.

Vaseline is a great barrier ointment used to prevent evaporation and can be used in some patients over the Aron Regimen® compound or other single agent medications to promote more long-lasting and/or effective results.

I use allergy testing extensively in many of my local patients with childhood eczema as well as adult eczema. However, adult-onset eczema is not likely to be triggered by environmental allergies and even less likely to be caused by food allergies; thus allergy testing of adults with adult-onset eczema is less likely to be helpful. Further, it is not likely that allergy testing is beneficial in infantile eczema. Most cases of infantile eczema are genetic in origin; they tend to be significantly triggered by a staph infection and are not typically due to a food allergy.

I use allergy testing extensively in many of my local patients with childhood eczema as well as adult eczema. However, adult-onset eczema is not likely to be triggered by environmental allergies and even less likely to be caused by food allergies; thus allergy testing of adults with adult-onset eczema is less likely to be helpful. Further, it is not likely that allergy testing is beneficial in infantile eczema. Most cases of infantile eczema are genetic in origin; they tend to be significantly triggered by a staph infection and are not typically due to a food allergy.

Dr. Van Wagoner’s intent is to replicate the Aron Regimen® as best as he can with regards to the same medications prescribed and the amounts of each used in the Aron Regimen®. However, the Aron Regimen® is not the only treatment Dr. Van Wagoner offers. Dr. Van Wagoner and Dr. Richard Aron do work very closely with one another but are not partners in a formal way. Dr. Van Wagoner is the preferred and only formally authorized medical provider for the Aron Regimen® in the United States.

Seborrheic dermatitis (SD) is a form of eczema and typically would respond to a steroid-containing treatment. Sometimes, an antifungal is needed to aid in the management of SD. A foam-containing product we offer typically works best, which we can provide if you have long hair.

The use of foam forms of medication provides a much more aesthetically pleasing application of treatment. Solution forms of topical steroids are also a more pleasing form of treatment. Some patients with significant scalp eczema may need 3-4 times per day applications.

Most moderate and severe cases of eczema can be managed with the Aron Regimen®. Many patients that have failed to reach adequate eczema control while on Dupixent have been shown to respond to the Aron Regimen® compound. My many years of experience with the use of both methods of treatment show that there is a place and time for Dupixent. I do have a sizable number of patients that do not respond to the Aron Regimen® and have shown excellent results with Dupixent. Dupixent is a relatively safe and effective therapy for those that have failed the Aron Regimen®.

I do recommend washing your hands before applying any topical medicated cream. Do not use scented soaps and/or antibacterial gels, since these can be irritating.

Every case is different and depends on the severity of one’s eczema. A rapid removal of the suggested treatment medications can cause a rebound worsening of one’s eczema. Unfortunately, most cases of eczema are chronic and there is no cure available. The Aron Regimen® is not a cure but a better way to manage chronic eczema and provide immediate and long-lasting improvement in the health of one’s skin.

Given that eczema is a chronic condition, some people are not able to fully taper off topical treatments. However, eczema can improve over time and many patients can reduce the frequency of applications of the Aron Regimen® compound. I do find that many of my patients are able to completely come off the therapy once we stabilize eczema with our therapy. Hand eczema is especially difficult to control, so it may take longer to taper applications in patients with severe hand eczema.

It is not normal for the Aron Regimen® to cause itching but I have had patients report this. Typically with repeated applications, this sensation dissipates as the medication works to calm the inflammation behind the eczema. If the application of any compound is difficult because of burning or stinging, we sometimes recommend pre-application with OTC Calamine lotion USP, let dry, then apply the Aron Regimen® compound. The Calamine lotion can lessen the sting that sometimes comes with the application of medicated ointments/creams.

While no formal studies have been done with the Aron Regimen® in pregnant patients, the use of low and/or medium doses of topical steroids appears to be very safe during pregnancy. Aron Regimen® is typically formulated by combining a low to medium dose topical steroid with a topical antibiotic and diluted with large amounts of topical moisturizers. According to a recent meta-analysis (citation below). “We found no associations between mothers’ use of topical steroids of any potency and type of delivery, birth defects, premature births, or low Apgar score.

There is some evidence indicating a relation between low birth weight and maternal use of potent or very potent topical steroids, especially when high doses are used in pregnancy, and this may warrant more research. On the other hand, maternal use of mild or moderate topical corticosteroids is not related to low birth weight. We even found that mild or moderately potent topical steroids protect against the death of the baby, but this was not seen when the mothers used potent or very potent topical steroids. This finding needs further examination.

Quality of evidence:

“The overall quality of evidence is low because all available studies were observational. The high-quality study design of the randomized controlled trial that allocates participants to receive either topical corticosteroids or no treatment is not generally feasible in pregnant women due to ethical concerns about possible exposure of the fetus to an experimental treatment.”

References:

Chi C, Wang S, Wojnarowska F, Kirtschig G, Davies E, Bennett C. Safety of topical corticosteroids in pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD007346. DOI: 10.1002/14651858.CD007346.pub3

Most cases of atopic dermatitis (AD) are chronic in nature and require chronic treatment. The goal is to achieve CONTROL of AD using safe and effective treatments. We do always aim to use less frequent applications of topical steroids and/or less potent forms of topical steroids once control is achieved. Once long-standing control and/or remission is achieved, it is much easier to remove the chronic treatment and/or reduce the frequency of application overtime to maintain that control. This removal and/or reduction in the topical steroid is achieved by applying less frequent applications of the compound and/or by removing and/or lowering the gram amount of the topical steroid.

Many patients with mild eczema can be treated with moisturizers and/or low-dose topical steroids and do not need the Aron Regimen® compound. Some patients may also respond to nonsteroidal medications that are now approved for atopic dermatitis.

I would state that the general rate of experiencing side effects in my patients using the Aron Regimen® is less than 5%. I have never had a patient experience adrenal insufficiency while using my treatments. I would state that the rate of patients stopping because of side effects would be less than 2% of all cases.

Bleach baths are not typically recommended.

No formal long-term studies have been performed with the Aron Regimen®, but Dr. Richard Aron’s 50 years of clinical experience in treating patients with atopic dermatitis has revealed an excellent safety record using this method of treatment. Topical steroids have been for almost 50 years with an excellent safety record if used properly under the guidance of a medical professional skilled in the treatment of atopic dermatitis.

It is important to eliminate all colorings, preservatives, and processed foods from the diet. In addition, avoid foodstuffs that allergy testing has indicated you are clinically allergic to. This may include dairy, wheat, eggs, etc. We may advise allergy testing from your local allergist to help us determine what you may be sensitive to.

Every case is different, but most patients can have the antibiotic removed from the Aron Regimen® compound once control of eczema is achieved and maintained. A similar goal of less antibiotic exposure is achieved as we reduce the frequency of the applications of the compound once control is maintained. Note the half-life of Mupirocin (the most commonly used antibiotic in Aron Regimen®) is about 30-45 minutes.

New areas of eczema may appear because of the natural history of eczema in the patient. However, in some cases, they may appear because of the untreated spread or contamination of other body parts with the existing staph aureus infection.

Most infants/children outgrow eczema but some do not. Possible side effects are very minimal and rare to occur. See below for further details: Topically applied corticosteroids are generally well tolerated and typically do not cause any local and or systemic side effects if used appropriately. Some local side effects that may occur while using topical steroids include any and or all of the following: epidermal thinning, striae, dermal fragility, premature aging, atrophy of the skin, telangiectasia, purpura, ulceration, easy bruising, fixed vasodilation, rosacea, perioral dermatitis, rebound phenomenon, facial erythema, allergic contact or irritant contact dermatitis, folliculitis, hypertrichosis, alopecia, stinging, burning, irritation, miliaria, contact urticaria, exacerbation of acne and rosacea, delayed wound healing, hypopigmentation, hyperpigmentation, and or tachyphylaxis. Mucocutaneous infections (tinea versicolor, onychomycosis due to Trichophyton and Candida species, dermatophytosis) are sometimes seen during treatment with topical steroid use as well. The risk of these local side effects is minimized when using the Aron Regimen® medications given the diluted nature of the compound with moisturizer and topical antibiotic but please be aware that any of these side effects could still occur.

Topical Steroids

There are many POTENTIAL SIDE EFFECTS OF TOPICAL STEROID USE. Most of the well-understood and experienced side effects of steroids occur with ORAL AND/OR SYSTEMIC use of steroids and NOT from the proper use of TOPICAL steroids. Under proper guidance and monitoring, these side effects with topical steroids can be further minimized and/or avoided. Improper use of topical steroids can RARELY lead to skin thinning, excessive hair growth, increase in blood vessel appearance, decreased bone growth, acne, rosacea, endocrine suppression, or ocular changes.

Most, if not all, research on the prolonged use of topical steroid use in children has been very reassuring about its safety. However, there are case reports of significant local and/or systemic side effects from the use of topical steroids in all ages. Please understand the risk of side effects from TOPICAL steroid use is much less than the risk of these issues from ORAL systemic corticosteroid use. Side effects from the proper use of topical steroids in children and infants are very rare occurrences. Some of those documented adverse effects of topical steroid use are:

  • Suppression of the hypothalamic-pituitary-adrenal axis
  • Iatrogenic Cushing’s syndrome
  • Growth retardation in infants and children
  • Ocular: Glaucoma and loss of vision
  • Avascular necrosis of femoral head

Yes, mild cases can be treated with moisturizers and avoidance of common triggers. Some prescription NON-steroidal medications are also available for mild cases and can be effective for many. Most other moderate to severe cases of eczema require more effective treatments and may require the use of topical steroids and some other new systemic nonsteroidal biological medications.

There are many causes of osteoporosis. Not all cases are related to steroid use. Most cases of osteoporosis that are caused by steroids are seen in patients using long-term ORAL and/or systemic prescribed steroids, and NOT topically applied steroids. The risk of osteoporosis in patients on topical steroids would be very unlikely to occur. If you already suffer from osteoporosis we would want to stay away from and or limit the use of potent and/or super potent topical steroids that do have a greater chance of systemic absorption.

This subject is controversial and there is not a well-established definition and/or classification currently available. Topical corticosteroids withdrawal (sometimes called “topical steroid addiction” or “Red Skin Syndrome”) appears to be a clinical adverse effect that could occur when topical corticosteroids (TCS) are inappropriately used or overused, then rapidly stopped. It can result from prolonged, frequent, and inappropriate use of moderate to high potency topical corticosteroids, especially on the face and genital area, but is not limited to these criteria. In reviewing the studies that were used for the systematic review, it is thought that adult women who blush easily are a population that is particularly at risk. Very few cases have been reported in children, but no large-scale studies have attempted to quantify the incidence. Thus, continued vigilance and adherence to a safe, long-term treatment plan developed in conjunction with your eczema provider are advised.

No, most properly used topical steroids do not cause long-term toxicity and/or weight gain in children.

It is very rare for low and/or medium-dose topical steroids to get into the bloodstream and cause systemic related issues. Potent and superpotent topical steroids are more likely to be measured in the blood with their use. Further and more importantly, It is rare for topical steroids to compromise the immune system, but it has been seen/reported. It would be important to rule out other causes of immune deficiency before attributing the issue to topical steroid use in general though.

Steroid and/or antibiotic resistance is a very rare complication and/or potential side effect of its use. Close monitoring of your condition because of frequent follow-ups and tailoring your treatment along the way can prevent these things from happening, in most cases.

Being “immune” to steroids is an extremely rare finding for patients with atopic dermatitis (AD), but all cases are different. Having the correct diagnosis is key. I do, however, have many patients who have a severe AD that does not respond sufficiently to even high-dose potent topical steroids. In these cases, we look for alternative nonsteroidal options, treating concurrent infections on the skin if present, avoiding suspected food and/or aeroallergens, avoiding chemicals and/or irritants that could worsen one’s eczema, use of biologic medications, bursts of oral steroids to help calm a significant flare, and/or referral to a dermatologist for biopsy to confirm the correct diagnosis. Many other conditions can look like AD and may not respond fully to topical steroid treatment.

In some cases, It is difficult to assess whether thinning of the skin on a baby is due to topical steroid use, long-standing eczema, or just normal skin. Babies’ skin is naturally not as thick as older children’s, and it is much more likely to reveal thin blood vessels as a function of the intrinsic paucity/lack of fat and its translucent nature at this young age.

Topical steroid withdrawal (TSW) is a poorly understood potential medical problem. At this time, it is unknown if this represents a true medical problem or not. Better controlled studies are needed to validate this possible issue and understand its cause and further its potential treatment. TSW is typically described as a worsening of one’s eczema after days or weeks of having clear skin and the recent discontinuation of high dose topical steroid use. It has not been reported in pediatric patients and typically is reported in adult female patients. Some report that the rash that develops may be worse than the initial eczema one was experiencing before the use of topical steroids. Many dermatological experts do not believe TSW is a real medical condition, but instead a worsening of one’s eczema from improper control. With that proper understanding, this condition typically requires chronic treatment for most patients. It is also important to realize that patients with atopic dermatitis may experience periods of clear skin and then suddenly a worsening of their skin for a number of reasons. It is much more common to see a worsening of one’s eczema as a secondary to exposure to common triggers than to attribute one’s worsening eczema to a steroid withdrawal. Many of the common reasons to see a worsening of eczema include: an improper reduction of topical steroid use, improper overuse of topical steroids, or exposure to other external/internal factors (stress, allergens, irritants, infection, hormonal influences, chemical allergy, and or food allergy exposure, etc).

Your statement is true- unfortunately, long-term studies on the safety of Topical Corticosteroid (TCS) use are not commonly done. Most of the data we have originates from studies that are less than one year of duration.

Data supporting long-term TCS use are limited to low-to-mid-potency products. Currently, there is a lack of information on the safety of commonly prescribed, long-term monotherapy with mid-to-high-potency TCS in pediatric AD.

Experiencing systemic side effects after coming off topical steroids is a very rare complication. It would be much more likely to be experienced with the use/discontinuation of ORAL steroids. The amount of topical steroid that is systemically absorbed and bioavailable is clinically negligible to undetectable in most cases of their use- thus the reason that systemic issues from topical steroid discontinuation are less likely to occur. I would be more interested in understanding and/or ruling out other systemic issues causing adrenal insufficiency than attributing systemic symptoms to coming off of topical steroid use.

Darker skinned patients with eczema tend to be more commonly affected by a process called post-inflammatory hyperpigmentation or hypopigmentation. These changes in the color of skin are not typically due to the topical steroid, but instead, the uncontrolled inflammatory process that exists in the skin of patients with eczema. Once the eczema is better controlled, these changes in skin color abate over time and will take on the color and texture of normal skin.

Every case is different. Most cases of infantile eczema improve by the age of one and/or earlier. Close follow-up and monitoring for side effects when using topical steroids while maintaining control is critical for a healthy baby. Finding a therapy that is effective while safe is the key. In general, I am not overly concerned about using low-dose topical steroids in an infant that has not responded to general skin care measures.

For many patients, topical corticosteroids (TCS) are a safe, very effective therapy for eczema treatment. If TCS therapy is no longer effective for your condition, stopping topical corticosteroids should be done with the knowledge and supervision of a caring physician. There are many side effects that are reported with the inappropriate use of topical corticosteroids. When used with the proper dosage, frequency, and duration, along with close monitoring by a physician, topical corticosteroids have a very low risk of causing systemic problems or thinning the skin. Importantly, there are risks to NOT treating your child’s eczema effectively. Along with the profound effect on family life, uncontrolled eczema can negatively impact your child’s quality of life, causing mood and behavioral changes, poor school performance, bacterial infections, and poor sleep. Embarrassment from eczema can cause social isolation and impacts the daily life activities of childhood such as clothing choices, holidays, interaction with friends, owning pets, swimming, and the ability to play sports or go to school. Typically the risks of NOT treating the atopic dermatitis is much greater than the risks of using a properly orchestrated treatment regimen using topical steroids.

Consult your healthcare provider. Your doctor will most likely rule out other conditions such as allergic contact dermatitis, a skin infection, or, most importantly, a true eczema flare. Confusing the signs and symptoms of eczema for steroid withdrawal could lead to unnecessary under-treatment of the eczema. Once a diagnosis of steroid addiction or overuse is made, the goal should be to discontinue the inappropriate use of topical steroids and provide supportive care. Consideration might be given to some of the treatment options discussed in the literature: supportive care including ice and cool compresses, psychological support, systemic doxycycline, tetracycline, or erythromycin, antihistamines, and calcineurin inhibitors.

Burning, stinging, and bright red skin are the typical features of topical steroid overuse and withdrawal. The signs and symptoms may occur within days to weeks after Topical Corticosteroid (TCS) discontinuation. In general, TCS withdrawal can be divided into two distinct subtypes: erythematoedematous and papulopustular. Clinical features differ between the two types, but there is some overlap of some signs and symptoms. The majority of erythematoedematous type was found in patients with an underlying eczema-like skin condition, like atopic or seborrheic dermatitis. Patients with this type of withdrawal experience swelling, redness, burning, and skin sensitivity usually within 1-2 weeks of stopping the steroid. The papulopustular variant was more often associated with the use of topical corticosteroids for cosmetic purposes or for an acne or acne-like disorder. It can be differentiated from the erythematoedematous type by the presence of papules (pimple-like bumps), nodules (deeper bumps), pustules, redness, and –less frequently– swelling, burning, and stinging. Based on a systematic review of research to date, both types primarily affect the face of adult females and are mostly associated with inappropriately using mid- to high-potency topical corticosteroids daily for more than 12 months.

The most common areas that are most sensitive to thinning from overuse/improper use of topical steroids would include the face, eyelids, underarms, intertriginous areas, and or groin.

Listed below are some of the potential problems that can occur with the improper use of topical steroids. These issues are much less likely to occur with proper management and close follow-up with your eczema medical provider. Potential side effects can include some of the following:

Skin related: thinning of the skin, bruising, redness, acne, stretch marks, rosacea, infection, increased hair growth, the appearance of blood vessels, skin discoloration, etc.

Body related: increases in blood sugar, bone abnormalities, growth issues, adrenal suppression, hypertension, diabetes, cataract, glaucoma, weight gain, etc.

Who May Use Our Services

Unfortunately, our practice is no longer able to accept patients that do not live in the United States. The Aron Regimen® is available throughout the world. Currently, Dr. Michael Wetzler is available for consultation in the United Kingdom; Dr. Richard Aron is available for all other countries except the United States. Dr. Van Wagoner is the only designated provider within the United States. 

Yes, but the patient will need a parent or legal guardian to provide consent, oversee the online visit, and handle payment details.

I have successfully used a very mild Aron Regimen® compound in babies, even those that are a couple of months of age; I use an Aron Regimen® compound that contains a very diluted form of hydrocortisone and have seen excellent responses. All cases are different, however, and some young infants with mild, persistent eczema may respond to the use of emollients by themselves.

We are the only online practice in the United States specifically dedicated to treating adult and pediatric patients with difficult to control eczema. Our services are available to patients throughout the entire United States. Dr. Van Wagoner is able to directly manage your skin condition if you live in the state of Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Texas, Utah, Vermont, Virginia, Washington, Wisconsin, and Wyoming, USA.

Residents of the following states, we will send the necessary MEDICATION PRESCRIPTIONS for the Aron Regimen® to your local pharmacy. Home delivery of the Aron Regimen® Compound is currently NOT available for patients that live in the following states.  Instead, home-mixing instructions will be sent in your consultation. This prescription-only option is valid if you live in the following states:  Alabama, Arkansas, Kentucky, Mississippi, Nebraska, New Hampshire, South Carolina, Tennessee, and West Virginia. 

Dr. Van Wagoner is NOT able to provide the recommended medication prescriptions for you if you live in Alaska. You will need to discuss what medications you need with your own local primary care provider. Dr. Van Wagoner is only able to provide general recommendations about your condition. All necessary medication prescriptions will need to originate from your own local primary care provider. Dr. Van Wagoner will be able to suggest what those medications should be but is unable to provide valid prescriptions for you. Only your own local primary care provider can provide those valid prescriptions for you.

Need help? Email us at info@eczemaspecialist.com. For Non-Medical Related Questions Only, you may call us at (469) 613-3338.

About dr. John Van Wagoner

Dr. John Van Wagoner is our lead eczema doctor. He is passionate about bringing healing and freedom to those who suffer from eczema. He has been successfully treating patients with all forms of eczema for over 15 years. His experience as a Board Certified Allergist and Immunologist provides a very helpful basis of understanding for this condition that is driven by allergic and other immunological factors. Dr. Van Wagoner works in close association with Dr. Richard Aron to provide relief to those around the world who suffer from eczema.

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