I have a lot of respect for Dr. Peter Lio — at least he is trying to learn about and raising awareness about TSW — but this article is wrong on a couple fronts, already pointed out in other comments. This article puts the blame on patients for misuse of topical steroids, but the reality is that many doctors (the majority it seems) either don’t know about or don’t believe TSW is real, and they ignore the risks of steroids noted in the drug inserts. Many patients end up with TSW after relying on their doctors’ guidance. We did.
The appropriate strength for each person and situation depends on many factors. For example, babies absorb topical steroids faster than adults, so they may require a low-potency steroid. Areas of the body where your skin touches other skin (think: armpits, rectal area, etc.), as well as sensitive areas like the skin on your eyelids, tend to absorb topical steroids more rapidly, so those regions of the body also usually require a low-potency steroid. However, thick, rough skin on the palms of your hands and the soles of your feet usually absorb topical steroids more slowly than other parts of the body, so those areas typically require a more potent steroid.
Transdermal patches can be a very precise time released method of delivering a drug. Cutting a patch in half might affect the dose delivered. The release of the active component from a transdermal delivery system (patch) may be controlled by diffusion through the adhesive which covers the whole patch, by diffusion through a membrane which may only have adhesive on the patch rim or drug release may be controlled by release from a polymer matrix. Cutting a patch might cause rapid dehydration of the base of the medicine and affect the rate of diffusion.