Steroid creams aiding in the management of eczema: an overview
Topical steroids are a popular choice for treating eczema, a common skin condition that affects many people, particularly children. These medications, known as corticosteroids, work by reducing inflammation, itchiness, and even a type of bacteria called Staphylococcus aureus.
Topical steroids are available in various forms, including creams, ointments, lotions, gels, and foams. The strength of these steroids varies, with class 7 being the least potent. Some low-potency options are available over the counter, while higher-potency options require a prescription.
When using topical steroids for eczema treatment, it's essential to follow a few guidelines to ensure their effectiveness and minimise potential side effects. These guidelines include:
- Apply the steroid cream or ointment gently and in the correct amount (about a "cream cheese" layer thickness) directly on the affected skin until it disappears, without rubbing vigorously to avoid irritation.
- Use the steroid once or twice daily, depending on the severity of eczema and the specific medication prescribed; once daily application can be as effective as twice daily.
- Treat the affected areas consistently until the skin improves and then continue for 2 additional days before stopping or switching to moisturizers to reduce inflammation fully.
- Before applying steroids, use an emollient or moisturizer about 20 to 30 minutes prior to enhance absorption and maintain skin hydration.
- Choose the appropriate preparation based on the skin condition and location: creams for moist areas, ointments for dry or thickened skin, and lotions for hairy areas like the scalp.
- Avoid using topical steroids on rosacea or acne and be cautious around sensitive areas such as the face, eyelids, or groin unless directed by a doctor.
- For mild conditions or sensitive areas like eyelids, use low-potency hydrocortisone (0.5%-1%) applied thinly once or twice daily for 7-14 days.
- Avoid overuse to prevent side effects like skin thinning, but use steroid ointments adequately, as untreated inflammation can cause pigmentation changes.
- Consider "pulse dosing" (applying steroids 2 days per week) during remission phases to maintain control and minimise side effects.
- Continue intensive moisturizing with creams from tubs after steroid treatment to maintain skin barrier function and hydration.
Regular bathing in warm water followed by moisturizing is also recommended to support the skin barrier during eczema treatment. Always follow the specific instructions provided by your healthcare provider tailored to your condition.
It's important to note that while topical steroids are generally safe for children to use, as long as the person applying the medication follows the instructions of a healthcare professional carefully, they may exacerbate symptoms of certain conditions, such as hypertension, diabetes, widespread infections, mental health conditions, low bone density, heart failure, and eczema itself.
Topical steroid withdrawal (TSW) can occur in the days or weeks after stopping their use, and it appears to affect people who use them for a prolonged period, use medium or high potency steroids, or apply them to more sensitive areas. Possible side effects of topical steroids include thinner-looking skin, skin discoloration, enlarged blood vessels, stretch marks, bruising, breakouts resembling rosacea or acne, slower growth in children, and TSW.
There are other treatments for eczema in addition to topical steroids, such as moisturizing after bathing, prescription medicines, alternative and complementary treatments, and phototherapy. TSW can have a severe effect on sleep, mental health, and quality of life, and it often takes more than 3 months for TSW to resolve, but sometimes it takes years.
In conclusion, topical steroids can be an effective treatment for eczema when used correctly. Always consult with a healthcare professional for personalised advice and guidance on using topical steroids for eczema treatment.
- Topical steroids, a popular treatment for eczema, are offered in various forms like creams, ointments, lotions, gels, and foams, with varying strengths.
- Applying these treatments requires following guidelines for effectiveness and minimizing potential side effects, such as applying a "cream cheese" layer gently, using once or twice daily, and continuing the treatment until skin improves before switching to moisturizers.
- Appropriate preparation choices include creams for moist areas, ointments for dry or thickened skin, and lotions for hairy areas like the scalp, and avoid using them on rosacea or acne, or sensitive areas like the face, eyelids, or groin.
- Regular bathing in warm water and moisturizing support the skin barrier during eczema treatment, and emollients or moisturizers should be used 20 to 30 minutes prior to applying steroids to enhance absorption.
- Healthcare professionals should be consulted for personalized advice on the use of topical steroids, especially for children, to avoid exacerbating symptoms of certain medical conditions like hypertension, diabetes, and eczema itself.
- It is crucial to be cautious of potential side effects from overuse of topical steroids, such as thinner-looking skin, skin discoloration, enlarged blood vessels, stretch marks, bruising, breakouts resembling rosacea or acne, slower growth in children, and topical steroid withdrawal (TSW).
