Get the tools and support you need to best manage your eczema

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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 classes — and strengths — of topical corticosteroids to learn which is best for you or your child
  • Get the facts about long-term steroid use, plus tips to increase your medication’s effectiveness
  • Learn the basics of topical steroid application, including the tried and true “fingertip rule”
  • Find out the common risks associated with steroid use and how you can minimize them

Understanding how to treat eczema with topical steroids

There are many different treatments that people who live with eczema can use to control symptoms and avoid flare-ups: over-the-counter remedies that are available in drugstores, medications available only with a prescription from a doctor, or alternative therapies (natural and herbal remedies) that may be available from a naturopath or in health food stores.

One of the most commonly prescribed medications for eczema are topical corticosteroids, which can ease redness and reduce inflammation and itching so that your skin can begin to heal.

What are steroids? And why are they so effective at treating eczema?

Steroids are naturally occurring substances that our bodies make in order to regulate growth and immune function. There are many different kinds of steroids including: anabolic steroids like testosterone (produced in the testicles); female hormones like estrogen (produced in the ovaries); and corticosteroids like cortisol (produced in the adrenal glands).

This last type — corticosteroids — have been used for over 50 years in topical medications (applied to the skin) to treat many kinds of inflammatory skin conditions including eczema. They’re still one of the most effective treatments available. And if used properly, can greatly help to control eczema symptoms and restore skin health.

Are certain kinds of steroids stronger than others?

There are a number of different topical corticosteroid, “steroid,” types and a few different vehicles (ointment, cream, lotion, spray) that they’re contained in. The type of steroid used will determine the overall strength of the medication.

Topical corticosteroids are classified based on their strength, which ranges from “super potent” (Class I), 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.

Some brand-name topical steroids, from most potent to least potent:

Class 1 - Super potent
0.05% clobetasol propionate Clobex Lotion/Spray/Shampoo,Olux E Foam, Temovate E Emollient/Cream/Ointment Gel/Scalp
0.05% halobetasol propionate Ultravate Cream
0.1% fluocinonide Vanos® Cream
Class 2 - Potent
0.05% diflorasone diacetate ApexiCon E Cream
0.05% halobetasol propionate Elocon Ointment
0.1% fluocinonide Halog Ointment
0.25% desoximetasone Topicort Cream/Ointment
Class 3 - Upper mid-strength
0.05% fluocinonide Lidex-E Cream
0.05% desoximetasone Topicort LP Cream
Class 4 - Mid-strength
0.1% clocortolone pivalate Cloderm Cream
0.1% mometasone furoate Elocon Cream
0.1% triamcinolone acetonide Aristocort A Cream, Kenalog Ointment
0.1% betamethasone valerate Valisone Ointment
0.025% fluocinolone acetonide Synalar® Ointment
Class 5 - Lower mid-strength
0.1% clocortolone pivalate Cloderm Cream
0.1% mometasone furoate Elocon Cream
0.1% triamcinolone acetonide Aristocort A Cream, Kenalog Ointment
0.1% betamethasone valerate Valisone Ointment
0.025% fluocinolone acetonide Synalar Ointment
Class 6 - Mild
0.05% alclometasone dipropionate Aclovate Cream/Ointment
0.05% desonide Verdeso Foam, Desonate Gel
0.025% triamcinolone acetonide Aristocort A Cream, Kenalog Ointment
0.1% hydrocortisone butyrate Locoid Cream/Ointment
0.01% fluocinolone acetonide Derma-Smoothe/FS Oil
Class 7 - Least potent
2%/2.5% hydrocortisone Nutracort Lotion, Synacort Cream
0.5- 1% hydrocortisone Cortaid Cream/Spray/Ointment and
many other over-the-counter products

What do I need to keep in mind when using a topical steroid?

  • Only apply the corticosteroid to eczema-affected areas of your skin as prescribed by your doctor
  • Corticosteroids are most effective when applied within three minutes after bathing
  • Only use the corticosteroid as often as prescribed by your doctor — more often increases the risks of side effects. For many topical corticosteroids, once-a-day application is enough
  • Do not use a topical corticosteroid as a moisturizer. It is recommended, however, that you apply a moisturizer on top of your topical corticosteroid
  • Whenever possible, avoid using large quantities of corticosteroids for long periods of time
  • Be aware that certain areas or types of skin — the face, genitals, raw or thin skin, and areas of skin that rub together, such as beneath the breasts, or between the buttocks or thighs — absorb more medication than other areas and therefore 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 corticosteroid, it will increase the potency and absorption of the medication into your skin. Only use dressings with topical corticosteroids if advised by your physician.
  • Once inflammation is under control, reduce or stop using the corticosteroid. A proper bathing and moisturizing routine will help prevent future flare-ups

Are there risks to using topical steroids?

There are side effects to using topical steroids. However, with proper use of the right topical steroid for your specific type of eczema and its severity, you may not experience any of these side effects, or they may be very minimal and not permanent. It’s important to remember that steroid medications are safest when used as prescribed: in the right quantity, for the appropriate length of time.

Some of common side effects:

  • 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, can cause other types of side effects (some of them more severe), especially when used for a long period of time.

Some other possible side effects:

  • Glaucoma (damage to the eye’s optic nerve)
  • Cataracts (clouding of the eye lens)
  • Tiny pink bumps on the skin
  • Acne
  • Red, pus-filled hair follicles (called folliculitis, which is rare)
  • Adrenal suppression (when too much steroid application over a large portion of the body inhibits cortisol production)