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Topical Steroids

One of the most commonly prescribed medications for 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 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

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 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:

Strength, by class

Brand Name


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®


0.05% diflorasone diacetate

ApexiCon E Cream

0.05% halobetasol propionate

Elocon Ointment

0.01% fluocinonide

Halog Ointment

0.25% desoximetasone

Topicort Cream/Ointment


0.05% fluocinonide

Lidex-E Cream

0.05% desoximetasone

Topicort LP Cream


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®

0.05% desoximetasone

Topicort Cream, Topicort Ointment


0.05% fluticasone propionate

Cutivate Cream, Cutivate Lotion

0.1% prednicarvate

Dermatop Cream

0.1% hydrocortisone probutate

Pandel Cream

0.1% triamcinolone acetonide

Aristocort A cream

Kenalog Lotion

0.025% fluocinolone acetonide

Synalar® Cream


0.05% alclometasone dipropionate

Aclovate Cream/Ointment

0.05% desonide

Verdeso Foam

Desonate Gell

0.025% triamcinolone acetonide

Aristocort A Cream

Kenalog Ointment

0.01% hydrocortisone butyrate

Locoid Cream/Ointment

0.01% fluocinolone acetonide

Derma-Smoothe/FS Oil


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 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
  • Acne
  • Red, pus-filled hair follicles (folliculitis)
  • Adrenal suppression
  • Topical Steroid Addiction/Withdrawal - learn more

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.

Meant to be used after other topical treatments have failed or another treatment is not recommended, TCIs are intended to be used for a short period of time to bring symptoms under control.

TCIs can be applied to all affected areas of the skin, including the eyelids. 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. Uncommon side effects include skin cancer and lymphoma, a type of blood cancer. Therefore, it’s important that you talk to your doctor about the benefits and risks of using a TCI to control your eczema.

It’s important 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 continuously for longer than six weeks

TCIs should not be used at the same time as phototherapy treatments. Take care to 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 AD 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.