Used to treat:
All types of eczema
What You Should Know About Corticosteriods
Topical corticosteroids. Available both
over-the-counter and by prescription, topical (applied to the
skin) corticosteroids have been used since the 1950s to treat
eczema. Today, dermatologists use topical corticosteroids more
than any other medication to reduce the signs and symptoms of
eczema. Also known as “glucocorticoids” and “steroids,”
corticosteroids come in a variety of strengths, ranging from
mild to extremely potent. The strength prescribed depends on
the patient’s age and medical history, severity of the eczema,
where on the body the medication will be used, and the size of
the area(s) to be treated.
While many patients have concerns
about using corticosteroids due to potential side effects, the
likelihood of a side effect occurring is rare when
corticosteroids are used as prescribed. Side effects, such as
thinning skin, dilated blood vessels, stretch marks, and loss
of effectiveness, tend to occur when high-potency
corticosteroids are used over long periods of time.
Reserved for severe cases, this powerful medication can
relieve intense itching. It also may be prescribed to prevent
a serious flare of atopic dermatitis. While effective,
systemic corticosteroids are prescribed sparingly and rarely a
treatment option for children.
Systemic corticosteroids come in
different forms. The patient may be prescribed pills, a
liquid, or a shot. The shot is rarely given to children.
Due to potential side effects
caused by long-term use, a systemic corticosteroid is normally
prescribed for a limited time. In most cases, significant
improvement is seen within a few weeks. The remaining signs
and symptoms are usually successfully treated with topical
treatment and lifestyle modifications.
What it does: Corticosteroids
tend to rapidly and effectively reduce inflammation, which relieves
How to use topical corticosteroids:
These medications are applied in a thin layer to the skin as
prescribed and used for limited periods of time. To prevent
potential side effects, topical corticosteroids should not be
applied near the eyes. Cataracts and glaucoma have been linked to
such use. Care should be taken when applying this medication to body
folds and to skin that is diapered or bandaged.
To increase the effectiveness of a
topical corticosteroid, a dermatologist may recommend:
Soak and smear therapy. This technique has effectively
treated patients with severe atopic dermatitis, hand dermatitis, and
nummular dermatitis when other treatments failed. A study published
in 2005 reported that patients with severe eczema, who had not found
relief with other treatments, responded to soak and smear therapy.
These patients had tried prednisone (a potent systemic
corticosteroid), cyclosporine, and UVB phototherapy. Shortly after
beginning soak and smear, all 28 patients saw improvement, with 17
experiencing complete clearing. Most people saw clearing within
several days to two weeks.
While effective, soak and smear is
time-consuming. A two-part process, soak and smear requires the
patient to first soak the skin affected by eczema — or the entire
body — in warm (not hot) water for 20 minutes. Immediately after
soaking, a topical corticosteroid is smeared directly on the
affected skin while it is still wet. Applying the medication to the
wet skin allows the skin to retain much-needed moisture from the
water. It also enables the medication to penetrate the skin more
deeply. This process may be repeated daily for 4 days to 2 weeks.
therapy. Used to effectively re-hydrate and calm the skin,
wet wrap therapy may be prescribed for severe atopic dermatitis that
has not responded to other treatments. There are several ways to use
In general, wet wrap therapy involves
wrapping wet gauze bandages around the affected skin. Wet bandages
can be used on any area of the body that the patient will tolerate,
including the face. To lock in moisture, dry bandages are wrapped
over the wet ones. A dermatologist can provide instructions for the
wet wrap therapy that will be most appropriate for each patient.
Behavior modification. Research shows that adding behavior
modification to a treatment plan can increase the effectiveness of
topical corticosteroids as well as decrease the need for this
One technique that has proven especially effective for atopic
dermatitis is the “combined approach.” This approach requires
patients to learn behavior-modification techniques that can help
them avoid scratching. Next, they receive face-to-face instruction
on the proper use of topical therapy (e.g., corticosteroids,
moisturizer, and emollients).
When patients replace the scratching behavior with the learned
alternative behaviors and use their topical therapy as instructed,
the results have been dramatic. Without the habitual scratching —
people with atopic dermatitis may scratch their skin 500 to 1,000
times per day — and with proper use of topical therapy, even
patients with severe long-term atopic dermatitis have seen
significantly clearer skin.
How to use systemic corticosteroids:
Prescribed for a short time, a systemic corticosteroid may come in
pill or liquid form or be given as a shot.
Systemic corticosteroids should not be
prescribed repeatedly nor taken for long periods due to potential
Other key facts:
Avoid systemic corticosteroids while
pregnant or breast-feeding. Pregnant and breast-feeding women
should not take a systemic corticosteroid. These medications cross
the placenta, so they can reach the baby. When the child is in the
womb or breast-feeding, exposure to a systemic corticosteroid can
slow growth and development.
Children who may have been exposed to
systemic corticosteroids before birth (or while being breast-fed)
should be monitored. A woman who is pregnant or becomes pregnant
during a course of systemic or high-potency topical corticosteroid
therapy should discuss safety issues with her dermatologist or
Use only as prescribed. A
corticosteroid should be used only as prescribed. This medication
should not be used more frequently or for longer than directed.
Never share a corticosteroid.
This fact is especially important for parents to know. Since atopic
dermatitis tends to run in families, a parent with atopic dermatitis
may believe that using a corticosteroid already in the home will
help a child. This should never be done without consulting a
Treating Eczema During Pregnancy
Treating Eczema with Steroids
Gutman AB et al. “Soak and Smear: A Standard Technique
Revisited.” Archives of Dermatology. 2005 December;141(12
Staughton R. et al. “Psychologic approach to atopic skin disease.”
Journal of the American Academy of Dermatology. 2001. Jul;45(1 Suppl):S53-S54.
Wolkerstorfer A et al. “Efficacy and safety of wet-wrap dressings in
children with severe atopic
dermatitis: influence of corticosteroids dilution.” British Journal
of Dermatology. 2000
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developed by the American Academy of Dermatology
When dermatologists prescribe corticosteroids, they
monitor patients closely and draw on their extensive
medical knowledge to develop a treatment plan that
minimizes side effects.