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Topical corticosteroids or “steroids,” work by reducing inflammation in the skin. They also make blood vessels near the surface of the skin tighter, which helps decrease redness. Topical steroids come in varying strengths and formulations. When using topical steroids, follow the provider’s directions closely and do not apply on sensitive areas such as the eyelids or genitals.
Topical steroids are effective in helping to heal cracked and broken skin from eczema. If your skin is tender, warm or hot to the touch, and swollen it may be infected. If you suspect an infection, make an appointment with your health care provider for further evaluation.
When used correctly, topical corticosteroids are unlikely to affect a child’s growth or their ability to fight infections. It is important to closely follow your health care provider’s directions when using topical steroids on children.
Babies and young children are at increased risk of side effects from topical steroids if the medication is applied over large areas of the child’s body, applied in large quantities, used too often or for prolonged periods of time, or otherwise used improperly.
When making a decision about topical steroid therapy for your child, it is important to weigh the potential risks of the treatment against the overall benefits to your child’s health and well-being when disease symptoms are managed.
When used as prescribed, topical corticosteroids rarely cause permanent skin changes in the color of the skin. Skin discoloration is much more likely to result from the eczema itself, because skin inflammation can change the amount of pigment in the skin. Skin discoloration from eczema will typically resolve over time.
If topical steroids are used for long periods, they can occasionally cause a temporary increase in fine hair growth in the treated areas. Frequent scratching can also cause a temporary fine hair growth.
There is no evidence that topical corticosteroids prolong or worsen the natural course of the disease. If the eczema symptoms are not improving or appear to be getting worse, it may be due to an allergic reaction to the steroid or cream formulation. Any worsening (or failure to improve) should be evaluated for allergic contact dermatitis by a health care provider.
Proper bathing and moisturizing are essential to managing most types of eczema. However, moderate to severe eczema generally cannot be treated effectively with moisturizers alone. Once the redness associated with eczema becomes widespread on the skin, additional medication (such as a topical steroid) is needed to control the inflammation.
It is true that only a thin layer is needed, but it is important to apply enough topical steroid to cover all the red areas. A useful way of knowing the correct amount to apply is the fingertip rule: Squeeze a ribbon of the topical steroid onto the tip of an adult index finger, between the fingertip and the first finger crease. This amount of topical steroid represents “one fingertip unit” and should be enough to cover an area of skin the size of two flat adult palms of the hand (including fingers).