- Prescription Topical Treatment
- What are topicals?
- Topical steroids
- Topical calcineurin inhibitors
- Topical PDE4 inhibitor
National Eczema Society
- For some people with eczema, the regular use of emollients is all that is needed to keep the condition under control.
- However, for many people there will be a time when a steroid preparation is required as part of their treatment in order to bring an eczema flare under control. Topical steroids are the most common treatment for eczema flares. This is when eczema becomes red, sore and very itchy.
- Topical steroids are used in short treatment bursts and should be used in conjunction with emollients. Emollients for washing, cleansing and moisturising are essential to a good skin care routine for treating and preventing dry and itchy skin.Emollients need to be used all the time. For more information on emollients.
- What are topical steroids?
- When are topical steroids used to treat eczema?
- How are topical steroids applied?
- Range of topical steroids and their potencies (strengths)
- Are topical steroids a safe treatment?
- Do You Need a Topical Steroid to Help Control Your Eczema?
- How Using Topical Steroids Can Help Relieve Eczema
- How to Know When to Use Topical Steroids and at What Strength
- Side Effects and Complications of Topical Steroid Use
- Why You Should Try to Avoid ‘Steroid Phobia’
- What are topical steroids used for?
- Are there any differences between topical steroids?
- Are topical steroids safe?
- What are the side effects of topical steroids?
- Fear keeps many eczema patients from using steroid creams
- Medication for Eczema & Dermatitis
Prescription Topical Treatment
What are topicals?
Topical treatments, or “topicals,” for eczema are medications that are applied to the skin to manage symptoms and reduce inflammation. There are a few different types of topicals for eczema. The most common include prescription steroids in varying strengths, calcineurin inhibitors, and PDE4 inhibitors.
One of the most commonly prescribed medications for all types of eczema is topical corticosteroids, or just “steroids,” which can ease redness and reduce inflammation and itching so that your skin can begin to heal.
Steroids are naturally occurring substances that our bodies make in order to regulate growth and immune function. Corticosteroids have been used for more than 50 years in topical medications (applied to the skin) to treat many kinds of inflammatory skin conditions including eczema.
I already moisturize twice a day, do I really need a topical steroid?
Moisturizing is one of the most effective treatments, but it’s only able to control the mildest forms of eczema when used on its own
- Explore the different types of topical treatments to learn which is best for you or your child
- Get the facts about the mechanisms behind each type of treatment including steroids, calcineurin inhibitors and phosphodiesterase 4 inhibitors
- Discover which topical treatments are recommended for each type of eczema
Sign up for more facts about eczema medications
And you’ll also get the NEA “Eczema Basics” booklets for adults and children
Are certain kinds of steroids stronger than others?
There are a number of different topical steroid types and a few different vehicles (ointment, cream, lotion, spray) that they’re contained in.
Topical steroids are classified by strength, which ranges from “super potent” (Class 1), to “least potent” (Class 7). Many brand-name topical steroids also have generic versions. If your doctor feels it’s important to treat your eczema with a particular steroid formulation, they may not prescribe the generic version. If your doctor wants you to try a brand name steroid, check drug manufacturer’s website for any kind of co-pay assistance program.
Topical steroid strength by class
Some brand-name topical steroids, from most potent to least potent:
Class 1 – Super potent
0.05% clobetasol propionate
E Foam, Temovate E
0.05% halobetasol propionate
Class 2 – Potent
0.05% diflorasone diacetate
ApexiCon E Cream
0.05% halobetasol propionate
Class 3 – Upper mid-strength
Topicort LP Cream
Class 4 – Mid-strength
0.1% clocortolone pivalate
0.1 mometasone furoate
0.1% triamcinolone acetonide
Aristocort A Cream,
0.025% fluocinolone acetonide
Topicort Cream, Topicort Ointment
Class 5 – Lower mid-strength
0.05% fluticasone propionate
Cutivate Cream, Cutivate Lotion
0.1% hydrocortisone butyrate
0.1% hydrocortisone probutate
0.1% triamcinolone acetonide
Aristocort A cream
0.025% fluocinolone acetonide
Class 6 – Mild
0.05% alclometasone dipropionate
0.025% triamcinolone acetonide
Aristocort A Cream
0.01% fluocinolone acetonide
Class 7 – Least Potent
0.5 – 1% hydrocortisone
and many other over-the-counter products
What do I need to know when using a topical steroid?
- Only apply the steroid to eczema-affected areas of your skin as prescribed by your doctor
- Steroids are most effective when applied within three minutes after bathing
- Only use the steroid as prescribed by your doctor — more often increases the risks of side effects. For many topical steroids, once-a-day application is enough
- Do not use a steroid as a moisturizer
- After you apply the steroid, follow up with a moisturizer on top
- Avoid using large quantities of steroids for long periods of time
Certain areas or types of skin — the face, genitals, raw or thin skin, and areas that rub together, such as beneath the breasts, or between the buttocks or thighs — absorb more medication and care must be taken when applying steroids to these areas
If you apply a dressing over the area of skin you’re treating with the steroid, it will increase the potency and absorption of the medication into your skin. Only use dressings with topical steroids as advised by your physician.
Once inflammation is under control, reduce or stop using the steroid. If you are using high-potency steroids and/or have been using steroids for awhile, please consult your health care provider to avoid the risk of a “rebound” flare after stopping the medication.
Are there risks to using topical steroids?
There are side effects to using topical steroids. It’s important to remember that steroid medications are safest when used as prescribed: in the right quantity, for the appropriate length of time.
Common side effects of steroids include:
- Thinning of the skin (atrophy)
- Skin thickening (lichenification)
- Stretch marks (striae)
- Darkening of the skin
Some of these, like stretch marks, usually only appear in limited areas of the body (on the upper, inner thighs, under the arms, and in the creases of your elbows and knees), and are very rarely permanent with proper use of the medication. However, frequent use of steroid medications on certain parts of the body like on the face and around the mouth may cause more severe side effects, especially when used for long periods of time.
Less common, but more severe side effects of steroids include:
- Glaucoma (damage to the eye’s optic nerve)
- Cataracts (clouding of the eye lens)
- Tiny pink bumps on the skin
- Red, pus-filled hair follicles (folliculitis)
- Adrenal suppression
- Topical Steroid Addiction/Withdrawal – learn more
Frequently Asked Questions about topical steroids.
Topical calcineurin inhibitors
Topical calcineurin inhibitors (TCIs) are nonsteroidal medications that are applied to the parts of the skin affected by eczema. Once absorbed in the skin, TCIs work by stopping a piece of the immune system from “switching on,” preventing it from causing certain eczema symptoms such as redness and itch.
TCIs can be applied to all affected areas of the skin, including the eyelids and can be used for extended periods of time to control symptoms and reduce flares. TCIs do not cause certain side effects associated with steroid overuse, such as thinning of the skin, or stretch marks, spider veins or skin discoloration.
Common side effects with TCIs include mild burning or stinging sensation when the medication is first applied to the skin. A very few number of patients on Elidel received a diagnosis of skin cancer or lymphoma, a type of blood cancer. However, a link to Elidel and these cancers has not been shown.
As with any new medication, it’s important that you talk to your doctor about the benefits and risks of using a TCI to control your eczema.
Some things to remember:
- Use TCIs only on areas of the body where the skin is affected by eczema
- Do not use TCIs on children under two years old
- Do not use TCIs at the same time as phototherapy treatments.
- Do cover and protect your skin when out in the direct sunlight while using TCIs.
There are two topical calcineurin inhibitors available by prescription, Protopic and Elidel.
Topical PDE4 inhibitor
This drug blocks or “inhibits” an enzyme called phosphodiesterase 4, or PDE4 from allowing too much inflammation in the body. PDE4 is produced by cells in our immune system and helps the body function in part by controlling cytokines. Cytokines are bits of protein also produced by our cells that contribute to inflammation. When cytokines are mistakenly triggered in the body, the resulting inflammation can contribute to the development of certain diseases, including atopic dermatitis.
Currently, there is one topical PDE4 inhibitor for atopic dermatitis. Approved by the U.S. Food and Drug Administration in late 2016, Eucrisa (crisaborole) is available for people with mild to moderate atopic dermatitis ages 2 years and up.
In clinical trials, Eucrisa (crisaborole) was shown to reduce symptoms of atopic dermatitis such as itching, redness, lichenification (thickened skin), weepy rash, and raw, scratched lesions. Overall, participants in the clinical trial achieved clear or almost clear skin after 28 days of use.
Reported side effects include skin irritation where the ointment is applied, and hypersensitivity to Eucrisa’s active ingredient, crisaborole.
Eucrisa (crisaborole) comes in a 2% topical ointment and is applied to the skin two times a day. Go to www.eucrisa.com and talk to your doctor.
National Eczema Society
What are topical steroids?
‘Topical’ means something that is applied to the skin. ‘Steroids’ are a group of natural hormones, produced in the body by a variety of different glands. They are also produced synthetically as medicines. The topical steroids used for treating eczema are totally different from steroids used in contraceptive pills or for bodybuilding.
Topical steroids are a valuable tool in the management of eczema. They reduce redness and soreness (inflammation) and can be very effective in controlling flare-ups, as they make the skin less itchy and sore, giving it a chance to heal.
When are topical steroids used to treat eczema?
Topical steroids are mostly prescribed to treat eczema flares. In this case, you will generally be instructed to apply topical steroid for short bursts of treatment, and then stop or step down use when the eczema flare settles. If you are prescribed a milder steroid you will generally be told to stop after a burst of treatment; but if you are prescribed a stronger steroid, you may be instructed to ‘step down’ back to lower potency preparations as your eczema flare settles.
Sometimes people with more severe eczema whose eczema flares very frequently are prescribed topical steroids to apply on 2 consecutive days a week on the areas where their eczema usually flares. This is known as ‘weekend therapy’ and can help to prevent the almost continuous flare cycle, meaning that in the long run less topical steroid would be needed to control the eczema than if each flare were treated as it occurs.
How are topical steroids applied?
You will generally be advised to apply your topical steroid 1–2 times a day to areas of active eczema i.e. where it is flaring. (NICE Guidelines for children under 12 years recommend once a day.)
It is important to use the correct amount of topical steroid for your eczema, as instructed by your healthcare professional. Topical steroids should be applied with clean hands so that the skin just glistens. It can sometimes be difficult to judge how much steroid to use and there are guidelines on the amount required to cover body areas that are affected by eczema. These are based on the Finger Tip Unit (FTU), and explained in detail in our fact sheet which you can download as a pdf from the related documents to the right of this page.
There are no standard rules regarding whether to apply a steroid preparation after or before using an emollient. However, whichever order of care you choose it is important to leave as long a period as practical, of around 30 minutes, between the two treatments.
You may be given more than one topical steroid to treat your eczema; for example a milder steroid may be prescribed for the face or genital area and a stronger steroid for other parts of the body. Make sure that you are clear which preparation to use on which part of the body. If in doubt talk to your pharmacist /nurse or contact your doctor.
Range of topical steroids and their potencies (strengths)
In the UK topical steroids come as ointments, creams, lotions, scalp applications and impregnated tape/plasters and in four different strengths:
In deciding which type you need, your doctor should take account of your age, the severity of the eczema, where it occurs and any other treatments you are using. Milder preparations are usually used for the face, genital areas or on babies.
The period of time a steroid may be used depends upon the severity of the eczema and the potency of the topical steroid. Your healthcare professional will advise you on this.
Some topical steroids have added ingredients and are sometimes prescribed where eczema is infected.
If you download our topical steroids factsheet – look under related documents to the right of this page – you will find tables listing the topical steroids currently available in the UK showing their potencies also which ones have added ingredients. Bear in mind that outside the UK treatments with the same or a very similar name may have different active ingredients and be of a different potency.
Are topical steroids a safe treatment?
Topical steroids, used appropriately and under supervision, are a safe and effective treatment for eczema. The likelihood of side effects occurring is directly related to the potency of the preparation, where it is being used, and the condition of the skin on which it is used and the age of the person concerned. All these factors should be taken into consideration when a prescription is given to treat eczema.
Hydrocortisone 0.05%, 0.1%, 0.5% or 1% is extremely unlikely to cause adverse effects and can be used as prescribed on the face and in young children. Be careful not to confuse this with hydrocortisone butyrate, which is a potent topical steroid.
If used inappropriately or over long periods of time, topical steroids can thin the skin; blood vessels may become more prominent, and the skin can lose its elasticity, developing ‘stretch marks’. Other possible side effects include increased hair growth of very fine hair and perioral dermatitis (i.e. a spotty rash around the mouth).
Topical steroids have been in widespread use for over 50 years and although side effects can occur, as explained in our fact sheet available to download from the right of this page, this is usually because treatment has been used incorrectly. Under the supervision of a doctor, and used properly and sensibly in combination with good skincare as part of an overall management routine, topical steroids are a valuable treatment for eczema.
Do You Need a Topical Steroid to Help Control Your Eczema?
Your eczema has flared up, and despite keeping your skin clean and moisturized, and avoiding the irritants that can trigger the red, itchy and painful skin symptoms of the condition, you can’t find any relief. What’s next?
One option your doctor may recommend is to apply a topical corticosteroid, also known as a steroid, to ease redness, itchiness, and inflammation so your skin can begin to heal. “Topical steroids are the first line of treatment after you’ve addressed proper skincare using moisturizers, taking warm baths, avoiding irritants and triggers for a flare-up, and treating infections,” says Luz Fonacier, MD, an allergist at Winthrop-University Hospital, part of the Stony Brook University School of Medicine in Mineola, New York, and a board member of the American College of Allergy, Asthma, and Immunology. “If, in spite of these actions, you still have eczema, then we move into low-potency topical steroids.”
How Using Topical Steroids Can Help Relieve Eczema
Eczema, known more formally as atopic dermatitis, is not one specific condition, but a group of inflammatory skin conditions that can produce rash-like symptoms, lesions, scaly or leathery patches of skin, swelling, soreness and dry itchiness on various parts of the body. It can appear on the face, hands, feet, wrists, ankles, insides of the elbows, behind the knees, sides of the neck, around the mouth and other areas of the body.
Scientists haven’t identified any specific cause of eczema, but people with the condition tend to have an over-reactive immune system that produces inflammation as a result of an irritant or trigger, according to the National Eczema Foundation. Common irritants include household products, fragrances, metals, and certain fabrics, such as wool or polyester. Triggers of eczema include letting your skin get too dry or poorly managing stress. People with seasonal allergies or asthma also tend to be at a higher risk of eczema.
RELATED: 12 Common Eczema Triggers and How to Target Them
Topical steroids can help reduce the inflammation that’s causing your eczema symptoms. The drugs are classified by strength on a scale of 1 to 7, with 1 being the strongest and 7 being the weakest. Clobetasol propionate 0.05 percent (Clobex) lotion, spray, or shampoo is an example of a class 1 “super-potent” topical steroid. Cortaid and other over-the-counter hydrocortisone creams and ointments belong to class 7, which is “least potent.” The National Eczema Foundation offers a detailed rundown on the classes of various medication and steroids for eczema.
How to Know When to Use Topical Steroids and at What Strength
If a low-potency topical steroid doesn’t work for you, your doctor may prescribe a stronger one for you to apply, says Dr. Fonacier. A nonsteroidal topical medication, such as crisaborole, may be added to your treatment as well.
“If that’s not working, then you go onto other systemic treatments for eczema,” she explains. “They include phototherapy, Dupilumab, which is an injectable, and then systemic immunosuppressants — which are not FDA-approved for severe atopic dermatitis, but we know they work — like cyclosporine and methotrexate. You may even try oral steroids, but then you’re talking about complications.” The steps she outlines belong to a protocol called the Atopic Dermatitus Yardstick, depicted in this chart from a paper published January 2018 in the journal Annals of Allergy, Asthma and Immunology, which Fonacier coauthored.
Peter Lio, MD, dermatologist at Northwestern University’s Feinberg School of Medicine in Chicago and a member of the scientific advisory committee of the National Eczema Association, takes an alternate approach to deciding when to prescribe topical steroids and at what strength. He integrates alternative medicine techniques into his practice and research, such as the use of probiotics, plant-based treatments, such as sunflower seed oil, and an emphasis on nutrition. “The goal is to try to use as little medication as possible, for as short a period of time as possible, to get people comfortable and to get the eczema under control,” he explains. “However, if it’s more than a mild disease, all of my tricks outside of the conventional medication often are not enough.”
In these cases, he says, the goal is to minimize drug exposure over the long term, which can mean using a higher class of topical steroid for a shorter period of time than would be needed with one of a lower potency. “We probably do more damage to the skin by using even a mild steroid for a long period of time than we do by using a more powerful one to nip it in the bud and then be done with it,” Dr. Lio explains.
RELATED: The Best Ways to Help Treat Eczema
Side Effects and Complications of Topical Steroid Use
A variety of complications may arise from topical steroid use or overuse. Skin can become thinner (atrophy), thicker (lichenification), or darkened on the site where the medication has been applied. Stretch marks (striae) and small broken blood vessels (telangiectasias) can develop as well. “In skin that’s rapidly expanding in, for instance, teenagers who are rapidly growing in their legs and arms; or a breast-feeding woman whose skin is rapidly contracting and expanding all day to accommodate the breast milk — all of these areas are higher risk for developing striae,” says Jenny Murase, MD, a dermatologist at the Palo Alto Medical Foundation in Mountain View, California, who advises caution with potent topical steroids to help prevent such complications. “Use the topical judiciously in areas where there’s an expansion of skin, or in the armpits and the groin.”
There are also possible systemic side effects of topical steroids, particularly with long-term use, adds Fonacier, supporting research published in September-October 2014 in the Indian Journal of Dermatology. “If you’re putting them on so often, there’s a possibility of absorption, especially with children.” Systemic side effects, which can be similar to those caused by oral steroid medication, include cataracts, glaucoma, osteoporosis, neuropsychiatric effects, muscle weakness, and diabetes, as well.
RELATED: How Reducing Indoor Allergens Can Help Ease Your Eczema Symptoms
Why You Should Try to Avoid ‘Steroid Phobia’
Don’t let fear of side effects prevent you taking advantage of topical steroids, says Lio, a sentiment that Fonacier echoes. “One of the reasons that eczema is poorly treated is steroid phobia,” mostly driven by fear of complications, explains Fonacier. To avoid or minimize complications, particularly with long-term use of topical steroids, simply make sure you are being monitored by a medical professional who can identify any problems before they worsen. Be sure to let your doctor know of any concerns so they can be addressed promptly and effectively.
Finally, if your symptoms persist or onerous side effects develop, says Fonacier, know when it’s time to move on and ask your doctor to look at other treatment options.
Topical steroids are aerosols, creams, gels, lotions, solutions, and tapes that contain corticosteroids (often abbreviated to steroids) and are designed to be applied externally to the scalp or the skin, depending on the condition being treated.
Corticosteroids control inflammation by mimicking naturally occurring corticosteroid hormones produced by our adrenal glands, which are two small glands that sit on top of our kidneys. In addition to reducing inflammation (redness and swelling) in the area that they are applied, topical corticosteroids also suppress the immune response, reduce cell turnover, and constrict (narrow) blood vessels.
What are topical steroids used for?
Topical steroids of low to medium potency may be used for the treatment of various skin disorders that respond to corticosteroids such as:
- atopic dermatitis (mild-to-moderate)
- contact dermatitis
- discoid lupus erythematosus of the face and skin folds (intertriginous areas)
- dry skin
- insect bites
- itching confined to small areas of skin
- itching of the anogenital regions
- lichen planus of the face and intertriginous areas
- nummular dermatitis
- polymorphous light eruption
- psoriasis of the face and intertriginous areas
- seborrheic dermatitis of the face and intertriginous areas.
More potent topical corticosteroids may be used for the treatment of:
- Alopecia areata
- Atopic dermatitis (resistant)
- Discoid lupus erythematosus
- Lichen planus
- Granuloma annulare
- Psoriatic plaques and psoriasis that affects the palms, soles, elbows, or knees
- Severe hand eczema
- Severe poison ivy.
Generally, the weakest effective steroid should be used; however, some doctors may choose to use a more potent topical steroid initially for the first few days.
Are there any differences between topical steroids?
Topical steroids come in various potencies (strengths), ranging from very high potency (Class 1) to low potency (Class 7).
In some instances, absorption of different formulations containing the same active ingredient can vary (for example, betamethasone ointment is absorbed better than betamethasone cream) which can also affect potency.
Skin thickness can also affect absorption.
- The skin of the eyelids, genitals, and skin creases is thin and potent topical steroids should be avoided.
- The skin of the palms and soles is thick and mild topical steroids are usually ineffective.
Absorption (and potency) is greatly enhanced by occlusion (covering the area with impermeable or semi-impermeable dressings).
Topical steroids are sometimes combined with other ingredients, such as antifungal or antibacterial agents. Combination antibacterial/corticosteroid preparations should only be used short-term (for less than one week) to reduce the risk of antimicrobial resistance developing.
Very high potency (Class 1)
These topical corticosteroids are up to 600 times more potent than topical hydrocortisone.
|Generic name||Brand name examples|
|Augmented betamethasone dipropionate gel and ointment 0.05%||Diprolene ointment/gel|
|clobetasol propionate 0.05%||Cormax cream/solution, Clobex lotion/spray/shampoo, Olux foam, Olux E foam, Temovate cream/ointment/solution|
|diflorasone diacetate 0.05%||Apexicon ointment|
|fluocinonide 0.1%||Vanos cream|
|flurandrenolide 4mcg/m2||Cordran Tape|
|halobetasol 0.05%||Ultravate cream/ointment/lotion|
Potent (Class 2)
These topical corticosteroids are 100-150 times more potent than topical hydrocortisone.
|Generic name||Brand name examples|
|amcinonide ointment 0.1%||Cyclocort|
|Augmented betamethasone dipropionate lotion and cream (0.05%), regular betamethasone dipropionate ointment (0.05%)||Diprolene cream AF, Diprolene lotion, Diprosone ointment|
|desoximetasone||Topicort cream/ointment (0.25%), Topicort gel (0.05%)|
|diflorasone diacetate 0.05%||Apexicon E cream|
|fluocinonide 0.05%||Generic fluocinonide|
|halcinonide 0.1%||Halog ointment/cream/solution|
Upper medium potency (Class 3)
These topical corticosteroids are up to 25 times more potent than topical hydrocortisone.
|Generic name||Brand name examples|
|amcinonide 0.1%||Cyclocort cream|
|Regular betamethasone dipropionate cream 0.05%||Generic|
|fluticasone propionate 0.005%||Cutivate ointment|
|triamcinolone acetonide 0.5%||Cinolar cream/ointment|
Medium potency (Class 4 and 5)
These topical corticosteroids are between 2 and 25 times more potent than topical hydrocortisone.
|Generic name||Brand name examples|
|betamethasone valerate||Beta-Val cream/lotion (0.1%), Luxiq foam (0.12%)|
|desoximetasone 0.05%||Topicort LP cream|
|hydrocortisone 17-butyrate 0.1%||Locoid ointment|
|hydrocortisone probutate 0.1%||Pandel cream|
|hydrocortisone valerate 0.2%||Westcort cream/ointment|
|fluocinolone acetonide 0.025%||Synalar cream/ointment|
|fluticasone propionate 0.05%||Cutivate cream|
|mometasone furoate 0.1%||Elocon cream|
|triamcinolone acetonide 0.025%||Kenalog cream/spray|
|triamcinolone acetonide 0.1%||Triderm cream/lotion/ointment|
Mild (Class 6)
These topical corticosteroids are slightly more potent than topical hydrocortisone.
|Generic name||Brand name examples|
|alclometasone dipropionate 0.05%||Aclovate cream/ointment|
|desonide 0.05%||Desonate gel, Desowen cream/ointment|
|fluocinolone acetonide 0.01%||Derma-Smoothe|
|hydrocortisone 17-butyrate 0.1%||Locoid cream|
Least potent (Class 7)
Hydrocortisone is the least potent topical corticosteroid.
|Generic name||Brand name examples|
|hydrocortisone 1%, 2.5%||Cetacort, Cortaid, Hytone|
Note that potency charts vary depending on the source. This grouping of potencies is based on the best effort accumulation of data.
Are topical steroids safe?
Serious side effects are uncommon or rare when topical corticosteroids are used exactly as directed and for the time intended, but may include:
- Cushing syndrome: Rare, but the risk is higher if large quantities of a topical corticosteroid (>50g/week of clobetasone propionate or >500g/week of hydrocortisone) are used long-term
- Glaucoma or cataracts caused by excessive use of topical steroids near the eye.
Topical steroids should not be confused with anabolic steroids often abused by body-builders to increase muscle mass.
For a complete list of severe side effects, please refer to the individual drug monographs.
What are the side effects of topical steroids?
Common side effects reported with topical steroids include:
- Easy bruising and tearing of the skin
- Enlarged blood vessels (telangiectasia)
- Folliculitis (inflammation of the hair follicles) and miliaria (sweat rash): ointments
- Increased hair thickness and length in the area of application (hypertrichosis)
- Skin thinning
- Stinging or inflamed skin: creams
- Stretch marks (striae) especially in the armpits or groin.
Side effects associated with more potent topical steroid use include:
- Perioral dermatitis (also called “Muzzle rash”). Consists of small, red, pus-filled bumps and mild peeling around the mouth
- Steroid rosacea: A rosacea-like condition near the middle of the face. Can worsen when the topical steroid is discontinued
- Pustular psoriasis: Clearly defined raised bumps filled with pus
- Topical corticosteroid withdrawal: Symptoms include red burning skin, swelling, or pimples after discontinuation of the topical corticosteroid.
Topical corticosteroids can also mask the symptoms of infections caused by bacteria, fungi, or viruses.
Note that some potent topical steroids have been found illegally in some cosmetic products purchased over-the-counter or via the internet, resulting in steroid-dependent dermatitis and rosacea.
For a complete list of side effects, please refer to the individual drug monographs.
Fear keeps many eczema patients from using steroid creams
(Reuters Health) – Many people with eczema, a common skin disease, may avoid creams and ointments that can help ease symptoms like itching and inflammation because they’re afraid to try topical corticosteroids, a recent study suggests.
Eczema, also known as atopic dermatitis, usually develops in early childhood and often runs in families. Scaly, itchy rashes are the main symptoms. The condition can be treated using moisturizers, avoiding certain soaps and other irritants and with prescription creams and ointments containing corticosteroids to relieve itching.
For the study, researchers examined results from 16 previously published studies and found as many as four in five people were afraid to use corticosteroids for eczema. Between one third and one half of people who were prescribed steroid creams but also expressed concerns about them did not adhere to the treatment – meaning they didn’t use the creams and missed out on their benefits.
“Steroids have developed a bad reputation because of the potential side effects that come with improper or chronic use of high-potency steroids,” said senior study author Dr. Richard Antaya, director of pediatric dermatology at Yale School of Medicine in New Haven, Connecticut.
Common side effects of corticosteroids can include stretch marks as well as thinning, thickening or darkening of the skin. Less often, these steroids can cause acne or infected hair follicles or more serious side effects in the eyes like glaucoma and cataracts.
“The resistance to using topical corticosteroids is definitely partly driven by the confusion over the adverse effects of long term use of high potency steroids versus those of short term use of low potency steroids,” Antaya said by email. “The risks from using short-term low potency steroids are vastly lower.”
For the study, Antaya and colleagues examined studies published from 1946 to 2016 that surveyed patients and caregivers about their opinions of topical corticosteroids. The studies included in the analysis were done in Australia, Canada, Croatia, France, Germany, Hong Kong, Japan, Korea, Mexico, the Netherlands, Poland, Singapore and the U.S.
Two studies compared how often patients used these medicines based on whether or not they had phobias.
In one of these studies, 49 percent of people with phobias didn’t adhere to a prescribed steroid cream, compared with 14 percent of patients without concerns. In the second study, 29 percent of people with phobias didn’t use their steroid cream, compared with 10 percent of patients who weren’t worried.
Five of the studies in the analysis looked at why people had phobias and found skin thinning was the most frequent concern, followed by fear that steroids might affect growth and development. Some previous research has found long-term use at high doses may impact growth and development in children.
Limitations of the study include the wide variety of phobia definitions used across the 16 smaller studies in the analysis, the authors note in JAMA Dermatology.
Even so, the findings add to evidence that phobias keep many parents in many parts of the world from using corticosteroids to treat their children with eczema, said Dr. Saxon Smith, a dermatologist at the School of Medicine at the University of Sydney in Australia.
“It is critical to recognize the high frequency of fears patients and parents have about using topical corticosteroids,” Smith, who wasn’t involved in the study, said by email.
Left untreated, eczema doesn’t just leave kids itchy, Smith said. Itchy and discomfort can be so severe that kids don’t sleep at night, impacting normal development and socialization.
“Too often we see infants who suffer and have not slept for months and parents exhausted just because they have wrong fear or beliefs about the treatment or the disease and don’t treat their child,” Dr. Helene Aubert-Wastiaux, a dermatologist at Nantes University Hospital in France who wasn’t involved in the study, said by email.
SOURCE: bit.ly/2tZvKrU JAMA Dermatology, online July 19, 2017.
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Medication for Eczema & Dermatitis
Many people find that topical medications—creams, gels, or ointments applied directly to the skin—relieve itching and reduce redness and swelling. Topical medications may also prevent a rash from spreading.
Corticosteroids are anti-inflammatory medications that can be very effective in relieving symptoms of eczema and dermatitis. Corticosteroids suppress the activity of some immune cells, which can interrupt the inflammatory process and prevent itching, redness, and swelling.
Topical corticosteroids are available in different strengths, including some low-potency anti-itch creams such as hydrocortisone that are available over the counter at drugstores. But moderate-to-severe eczema and dermatitis may not respond to over-the-counter products. Our dermatologists recommend and prescribe a topical corticosteroid based on your age, the location and surface area of a rash, and the severity of symptoms.
Topical corticosteroids are applied directly to the affected areas of skin once or twice a day, depending on the type of corticosteroid prescribed. Doctors recommend maintaining this schedule until symptoms improve or a specified time has elapsed. Typically, corticosteroids relieve symptoms within a few weeks, or sometimes within a few days. At that time, doctors may recommend reducing the frequency of application to once or twice a week to keep symptoms under control and prevent flare-ups.
Your dermatologist determines the duration of topical corticosteroid treatment, which varies depending on factors such as the severity of flare-ups and the age of the person being treated. For severe eczema or dermatitis, topical corticosteroids may be used intermittently for months or years. Continued use requires regular evaluation by your dermatologist.
Side effects of topical corticosteroids may include thinning of the skin, stretch marks, lightening of the skin, and acne. They may also affect the eyes when used for prolonged periods.
Topical Calcineurin Inhibitors
Topical calcineurin inhibitors are a type of anti-inflammatory medication. They are formulated to block an overactive immune system response to the skin, which may reduce itching, redness, and swelling.
Doctors typically prescribe calcineurin inhibitors when topical corticosteroids are ineffective or if eczema or dermatitis affects sensitive areas of skin that can’t be treated with topical corticosteroids for long periods. A dermatologist may recommend this medication for a rash on the eyelids, face, or other sensitive areas where skin touches skin, such as the underarms or groin.
Topical calcineurin inhibitors are available in different formulations and concentrations. Our dermatologists determine which is appropriate based on a number of factors, such as the age of the person being treated and the severity and location of symptoms.
Topical calcineurin inhibitors are applied directly to the affected areas of skin once or twice a day, depending on the formulation prescribed. Doctors recommend maintaining this schedule until symptoms improve. Typically, calcineurin inhibitors relieve symptoms within one to six weeks. After symptoms improve, doctors recommend reducing the frequency of application to once or twice a week to keep symptoms under control and prevent new flare-ups.
These regimens require ongoing follow-up and evaluation. Your dermatologist determines the duration of treatment, depending on such factors as the severity of outbreaks and the age of the person being treated. Topical calcineurin inhibitors generally have fewer long-term side effects than corticosteroids and may be used safely for months or years.
Side effects may include a small risk of infection, and some people may experience a stinging sensation when the medication is first applied, but it generally fades over time.