Medication
Corticosteroids

Used to treat:

All types of eczema

What it does: Corticosteroids tend to rapidly and effectively reduce inflammation, which relieves itching.

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

• Wet wrap therapy

• Behavior modification

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.

Wet wrap 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 this therapy.

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 medication.

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 side effects.

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 obstetrician.

• 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 dermatologist.

More Information
Treating Eczema During Pregnancy

Treating Eczema with Steroids

References:
Gutman AB et al. “Soak and Smear: A Standard Technique Revisited.” Archives of Dermatology. 2005 December;141(12 ):1556-1559.

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
November;143(5)999-1004.

All content solely developed by the American Academy of Dermatology