Topical steroids are used in addition to emollients (moisturisers) for treating eczema. Topical steroids reduce skin inflammation. A short course of topical steroids will usually clear a flare-up of eczema. Side-effects are unlikely to occur with short courses of topical steroids.
What are topical steroids and how do they work?
Topical steroids are creams, ointments and lotions which contain steroid drugs. Topical steroids work by reducing inflammation in the skin. They are used for various skin conditions including eczema. (Steroid drugs that reduce inflammation are sometimes called corticosteroids. They are very different to the anabolic steroids which are used by some body-builders and athletes.)
What types of topical steroids are there?
There are many types and brands of topical steroid. However, they are generally grouped into four categories depending on their strength - mild, moderately potent, potent, and very potent. There are various brands and types in each category. For example, hydrocortisone cream 1% is a commonly used steroid cream and is classed as a mild topical steroid.
The greater the strength (potency), the more effect it has on reducing inflammation, but the greater the risk of side-effects with continued use.
Creams are usually best to treat moist or weeping areas of skin. Ointments are usually best to treat areas of skin which are dry or thickened. Lotions may be useful to treat hairy areas such as the scalp.
When and how are topical steroids used?
As a rule, a course of topical steroid is used when one or more patches of eczema flare up. The aim of treatment is to clear the flare-up, and then to stop the steroid treatment.
It is common practice to use the lowest strength topical steroid which clears the flare-up. So, for example, hydrocortisone 1% is often used, especially when treating children. This often works well. If there is no improvement after 3-7 days then a stronger topical steroid is usually then prescribed. For severe flare-ups a stronger topical steroid may be prescribed from the outset.
Sometimes two or more preparations of different strengths are used at the same time. For example, a mild steroid for the face, and a moderately strong steroid for patches of eczema on the thicker skin of the arms or legs. A very strong topical steroid is often needed for eczema on the palms and soles of the feet of adults because these areas have thick skin.
You should use topical steroids until the flare-up has completely gone, and then stop it. In many cases, a course of treatment for 7-14 days is enough to clear a flare-up of eczema. In some cases, a longer course is needed.
Many people with eczema require a course of topical steroids every 'now and then' to clear a flare-up. The frequency of flare-ups, and the number of times a course of topical steroids is needed varies greatly from case to case.
Short bursts of high strength as an alternative
For adults with eczema a short course (usually three days) of a strong topical steroid is often used to treat a mild to moderate flare-up of eczema. A strong topical steroid often works quicker than a mild one. (This is in contrast to the traditional method of using the lowest strength wherever possible. However, studies have shown that using a high strength for a short period can be more convenient and is thought to be safe.)
How do I apply topical steroids?
Topical steroids are usually applied once a day (sometimes twice a day - your doctor will advise). Rub a small amount (measured by fingertip units - see below) onto areas of skin which are inflamed. (This is different to emollients which should be applied liberally all over.) Gently rub the cream or ointment into the skin until it has disappeared. Then wash your hands (unless your hands are the treated area).
Getting the dose right - the fingertip unit
