Topical corticosteroidsTopical steroids are used in addition to moisturisers emollients for treating eczema. Topical steroids reduce skin inflammation. A short course will usually clear a flare-up of eczema. Side-effects are unlikely to occur with short courses. The terms eczema and dermatitis mean much the same.
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Topical steroids are used in addition to moisturisers emollients for treating eczema. Topical steroids reduce skin inflammation. A short course will usually clear a flare-up of eczema.
Side-effects are unlikely to occur with short courses. The terms eczema and dermatitis mean much the same. That is, an inflammation of the skin. It causes red, itchy skin which may also blister. See separate leaflet called Atopic Eczema and one called Contact Dermatitis which provide a general overview of the conditions.
Topical steroids are creams, ointments and lotions which contain steroid medicines. Topical steroids work by reducing inflammation in the skin. They are used for various skin conditions including eczema.
Steroid medicines that reduce inflammation are sometimes called corticosteroids. They are very different to the anabolic steroids which are used by some bodybuilders and athletes. 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. 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. 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.
This often works well. If there is no improvement after days, 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 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 vary greatly from person to person. After you finish a course of topical steroid, continue to use moisturisers emollients every day to help prevent a further flare-up.
See separate leaflet called Moisturisers Emollients for Eczema for more details. For adults, a short course usually three days of a strong topical steroid may be an option 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.
Some people have frequent flare-ups of eczema. For example, a flare-up may subside well with topical steroid therapy. But then, within a few weeks, a flare-up returns. In this situation, one option that might help is to apply steroid cream on the usual sites of flare-ups for two days every week.
This is often called weekend therapy. This aims to prevent a flare-up from occurring. In the long run, it can mean that the total amount of topical steroid used is less than if each flare-up were treated as and when it occurred.
You may wish to discuss this option with your doctor. Topical steroids are usually applied once a day sometimes twice a day - your doctor will advise. Rub a small amount see 'Getting the dose right - the fingertip unit', below on to areas of skin which are inflamed.
This is different to moisturisers 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. The amount of topical steroid that you should apply is commonly measured by fingertip units FTUs. One FTU is the amount of topical steroid that is squeezed out from a standard tube along an adult's fingertip. This assumes the tube has a standard 5 mm nozzle.
A fingertip is from the very end of the finger to the first crease in the finger. One FTU is enough to treat an area of skin twice the size of the flat of an adult's hand with the fingers together. Two FTUs are about the same as 1 g of topical steroid.
For example, say you treat an area of skin the size of eight adult hands. You will need four FTUs for each dose. This is 2 g per dose. If the dose is once a day, then a 30 g tube should last for about 15 days of treatment. An FTU of cream or ointment is measured on an adult index finger before being rubbed on to a child. Again, one FTU is used to treat an area of skin on a child, equivalent to twice the size of the flat of an adult's hand with the fingers together.
You can gauge the amount of topical steroid to use by using your adult hand to measure the amount of skin affected on the child. From this you can work out the amount of topical steroid to use. Most people with eczema will also use emollients. Emollients are different to topical steroids and should be used and applied in a different way. When using the two treatments, apply the emollient first.
Then wait minutes before applying a topical steroid. That is, the emollient should be allowed to sink in be absorbed before a topical steroid is applied. The skin should be moist or slightly tacky but not slippery, when applying the steroid. Short courses of topical steroids fewer than four weeks are usually safe and usually cause no problems.
Problems may develop if topical steroids are used for long periods, or if short courses of stronger steroids are repeated often. The main concern is if strong steroids are used on a long-term basis. Side-effects from mild topical steroids are uncommon. Side-effects from topical steroids can either be local or systemic. Local means just affecting that bit of skin and systemic means affecting the whole person.
If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at www. The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines or any other healthcare products may have caused.
If you wish to report a side-effect, you will need to provide basic information about:. A common mistake is to be too cautious about topical steroids. Some parents undertreat their children's eczema because of an unfounded fear of topical steroids. They may not apply the steroid as often as prescribed, or at the strength needed to clear the flare-up.
This may actually lead to using more steroid in the long term, as the inflamed skin may never completely clear. So, you may end up applying a topical steroid on and off perhaps every few days for quite some time. The child may be distressed or uncomfortable for this period if the inflammation does not clear properly. A flare-up is more likely to clear fully if topical steroids are used correctly.
Only use topical steroids for eczema as directed by your doctor. Some people continue to use topical steroids each day in the long term after the eczema has cleared to 'keep the eczema away'. This is not normally needed. Some people with severe eczema may require continuous steroid treatment.
However, this should be under the close supervision of a doctor. All people with eczema should use moisturisers emollients every day to help prevent further flare-ups of eczema. Did you find this information useful? Thomsen SF ; Atopic dermatitis: I've always dealt with eczema, almost exclusively on my hands.