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 click here.
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.