Atopic Eczema - British Association of Dermatologists

Atopic Eczema and Steroid Creams

Steroid creams and ointments are an effective and safe method of treating flare ups in atopic eczema. It is true that they do not treat the cause of the condition (which is a mixture of genetics and many environmental factors) but at the moment, they still offer the safest and most effective means of restoring your child's quality of life.

Aren't steroids bad for the skin?

If used properly, no. Unfortunately, many of the stronger steroid creams were abused in the 1960's and 1970's, resulting in side effects such as thinning of the skin and prominent stretch marks developing. This abuse has given topical corticosteroid creams a bad name, especially when people mix up these creams with steroid tablets and anabolic steroids taken by athletes which are different from steroid creams. In the 10 years that we have been looking after children with eczema, we have not seen a single child with a side effect from steroid creams. Untreated eczema, on the other hand, does have very serious side effects in that it can damage and scar the skin and make your child's life very miserable.

What side effects can steroid creams have?

If strong steroid creams are used continuously for a long period, then the skin may begin to thin. This will usually go back to normal if the creams are stopped but some areas are particularly vulnerable such as face, armpits and napkin area. Some of the steroid cream are absorbed into the body's circulation and may partly suppress the body's natural defence mechanisms (adrenal glands). Again, this is extremely unlikely if you follow the golden rules summarised at the bottom of this page.

Should I use a steroid cream or a steroid ointment?

Generally speaking, dermatologists would prefer you to use an ointment because this stays on the skin for longer and helps the active ingredient work on your child's eczema. In addition, dryness is the hallmark of eczema and the greasy ointments help to counteract this problem. Some children cannot tolerate ointments and they prefer creams. Creams are white and contain a lot of water and are sometime easier to apply to very acute weeping eczema when compared with ointments.

Can I control my child's eczema with steroid creams only?

No. Steroid creams are only used to treat your child's eczema when the eczema is active and must be accompanied by a regular moisturiser (emollient) when the eczema is in a quieter period. Using the steroid cream twice daily for 10-14 days when the eczema is active is probably the best way of using these creams, and this should then be followed by a "holiday period" of emollients only. Sometimes, we recommend moving from a strong ointment for a few days through to a moderate ointment to be followed by a mild or very mild preparation to be used for longer periods, again in conjunction with emollients.

Six Golden Rules on Using Steroid Creams in Atopic Eczema

1 Use the weakest possible cream that maintains good control of your child's eczema.

2 Use ointments rather than creams if possible.

3 Use the preparations for short periods of 10-14 days at a time followed by emollient holidays.

4 Always use these creams/ointments along with your regular emollient but allow at least 1 hour before applying the emollient, otherwise this will dilute the effect of the steroid preparations.

5 If used sensibly, steroid creams/ointments do not cause side effects of the skin, whereas untreated eczema can have serious consequences.

6 Always remember to obtain more preparations from your doctor when your current tube is one quarter full and always take along your old tubes for your doctor to monitor the quantities that you are using.