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Eczema Treatment

Eczema Treatment

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Updated May 19, 2014

Topical Steroids/Rashes
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Eczema Treatment: Steroid Creams

What are Topical Steroids?

Topical steroids are anti-inflammatory medications used to treat various skin conditions. These medications can reduce inflammation, itching, flaking and oozing when applied to the skin one or more times a day. There are a number of types of topical steroids available by prescription, as well as hydrocortisone acetate 1% cream, which is available over the counter without a prescription.

What Kinds of Allergic Diseases do Topical Steroids Treat?

Topical steroids are useful for the treatment of many kinds of allergic skin diseases and pruritus. These medications are also used for a number of non-allergic diseases, such as psoriasis, and along with an anti-fungal medication to treat itching associated with ringworm infections.

What Kinds of Topical Steroids are Available?

Topical steroids are available in a variety of medications, strengths and vehicles. Some medications are more potent (stronger given the same amount of medication), in higher concentrations, or are placed in a different "vehicle" (such as creams, lotions, ointments, etc.), which can affect how strong the topical steroid is.

What Is the Difference Between a Lotion, Cream and Ointment Topical Steroid?

The vehicle of the topical steroid influences the strength of the medication. Given the same topical steroid, the following list represents the strengths of the medication, from highest to lowest:
  • Ointment
  • Creams
  • Lotions
  • Solutions
  • Gels
  • Sprays

Which Types of Topical Steroids Can Be Used on Children?

Because children are more prone to the side effects of topical steroids, lower potency topical steroids should be used whenever possible. Recent studies suggest that two of the newer topical steroids, Cutivate (fluticasone propionate) and Elocon (mometasone furoate), may be safer for kids since less of the medication is absorbed into the body. In addition, Cutivate is the only topical steroid FDA-approved for children as young as 3 months of age.

Can I Use Topical Steroids on My Face?

The skin on the face is particularly susceptible to the side effects of topical steroids, and getting these medications into the eyes can result in glaucoma or cataract formation. Therefore, only the lowest potency topical steroids should be used on the face, with the smallest amount of medication and for the shortest amount of time possible.

Are There Areas on My Body Where I Shouldn’t Use Topical Steroids?

Some areas of the body are particularly sensitive to the effects of topical steroids and should only be used on these areas sparingly. Parts of the body with thin skin, such as the face, eyelids and genitals, are highly susceptible to the side effects of topical steroids. Only the lowest potency topical steroids should be used on these areas. Areas of skin folds, such as the armpits, groin, and under the breasts, absorb more topical steroid, so low potency topical steroids should be used with caution on these areas as well.

What Are the Possible Side Effects of Topical Steroids?

Side effects from topical steroids are most often seen on the ares of skin where the medication is applied. However, when topical steroids are used over large parts of the body, areas of increased absorption (see above), or for prolonged periods of time, the effects can affect the body as a whole.

Local side effects include:

  • Thinning of the skin
  • Pigment changes (lighter or darker skin)
  • Telangectasia (blood vessel) formation
  • Rosacea, perioral dermatitis and acne
  • Increased susceptibility to infections of the skin
  • Delayed wound healing ability
  • Irritation, redness, burning, stinging and peeling of the skin
  • Contact dermatitis resulting from the topical steroid itself
Body-wide effects of topical steroids, while rare, can include any or all of the symptoms of Cushing’s syndrome.

What Are Some Examples of Topical Steroids Classified by Potency?

Topical steroids are typically separated into 7 groups based on level of potency, with group 1 being the strongest and group 7 being the weakest. The following are examples of commonly used topical steroids from each group:
  • Group 1: Temovate (clobetasol) cream and ointment, Diprolene (betamethasone) cream and ointment
  • Group 2: Lidex (fluocinonide) in all forms, Topicort (desoximetasone) 0.25% cream, Elocon ointment
  • Group 3: Topicort 0.05% cream, Cutivate ointment
  • Group 4: Westcort (hydrocortisone valerate) ointment, Kenalog (triamcinolone) 0.1% cream, Elocon cream
  • Group 5: Cutivate cream, Westcort cream
  • Group 6: Desonate (desonide) cream
  • Group 7: Cortaid (hydrocortisone acetate) all forms and concentrations

Does Over-the-Counter Hydrocortisone Cream Work Well Enough, or Do I Need a Prescription?

It depends on the severity of the skin disease. For mild atopic dermatitis, for example, an over-the-counter low potency hydrocortisone cream will likely work just fine. If the eczema is severe, long-standing, or involving thick skin (such as the palms or soles), a stronger prescription topical steroid may be needed.

You should never use another person's prescription topical steroid, since you may not know what that medication was originally intended for. The topical steroid may be of a strong potency, and you would not want to use such a medication on certain parts of the body, such as the face or on skin folds.

Want to learn more? Find out about the various types of allergic skin diseases .

Sources:

Boguniewicz M, Leung DYM. Atopic Dermatitis. J Allergy Clin Immunol. 2006; 117(2):S475-80.

Atopic Dermatitis Practice Parameters. Ann Allergy Asthma Immunol. 2004;93:S1-21.

Chen TM, Aeling JL .Topical Steroids. In: Fitzpatrick JE, Morelli JG, eds. Dermatology Secrets. 3rd ed. Philadelphia: Mosby;2007:408-16.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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