Overview of Topical Steroids for Treating Eczema

Soothing the Itch of Eczema is a Major Goal of Care

Topical Steroids/Rashes
Topical steroids are the preferred treatment for eczema. Bambu Productions Collection/Iconica/Getty Images

Topical steroids are useful for the treatment of many kinds of allergic skin diseases and pruritus, including atopic dermatitis (also called eczema). As an anti-inflammatory medication, topical steroids reduce itching, flaking, and oozing when applied to the skin one or more times a day. 

Generally speaking, a doctor will recommend a topical steroid for treating a child's (or adult's) eczema that cannot be controlled with skin moisturizers alone.

What Kinds of Topical Steroids are Available?

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.

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.

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. They can also be used once as opposed to twice a day. 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 in 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 used 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. For instance, parts of the body with thin skin, such as the face, eyelids, and genitals, are highly susceptible, and 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 areas of skin where the medication is applied.

Local side effects include:

  • Thinning of the skin
  • Pigment changes (lighter or darker skin)
  • Telangiectasia (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

When topical steroids are used over large parts of the body, areas of increased absorption (for example, the face or genitals), or for prolonged periods of time, the whole body may be affected. This is called a systemic effect, and while rare, can include any or all of the symptoms of Cushing’s syndrome.

Other factors that determine whether body-wide effects of topical steroids occur include the potency of the corticosteroid, as well as whether an occlusion dressing is applied over the steroid.

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) 0.05% cream and ointment, Diprolene (betamethasone) 0.05% cream and ointment
  • Group 2: Lidex (fluocinonide) 0.05% in all forms, Topicort (desoximetasone) 0.25% cream, gel, ointment, Elocon (mometasone furoate) 0.1% ointment
  • Group 3: Topicort (desoximetasone) 0.05% cream, Cutivate (fluticasone proprionate) 0.005% ointment
  • Group 4: Westcort (hydrocortisone valerate) 0.2% ointment, Kenalog (triamcinolone) 0.1% cream, Elocon (mometasone furoate) 0.1% cream
  • Group 5: Cutivate (fluticasone proprionate) 0.05% cream, Westcort (hydrocortisone valerate) 0.2% cream
  • Group 6: Desonate (desonide) 0.05% 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.

A Word From Verywell

One important tidbit is that you should never use another person's prescription topical steroid, as 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.

Sources:

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

Schneider L et al. Atopic dermatitis: a practice parameter update 2012. J Allergy Clin Immunol. 2013 Feb;131(2):295-9.e1-27.

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