Expert Advice – Steroid Use

Why do I need to use a steroid cream for my eczema?

Eczema is a chronic condition. That means it is not curable and has to be controlled. It is a condition where the skin is constantly inflamed. For over 50 years, topical steroids have been known to be highly effective in controlling this inflammation. There is no other medication that works as well or as efficiently. One of the main functions of skin is to maintain a barrier to the outside world. In eczema the barrier is damaged. Steroids rapidly repair the damaged skin barrier without irritating the skin.

How long should I use my steroid cream for?

You need to use your cream for as long as it takes to get your condition better and whenever it flares up again. There are no rigid time limits. The sooner you use it, the quicker it works and the less you need. It is always better to use a bit longer than not long enough.

What does ‘sparingly’ mean?

‘Sparingly’ is a meaningless term that has, unfortunately, been automatically printed out by the labeling software used by pharmacists for many years. It creates an impression that the creams are dangerous and should be minimized. If anything, the opposite is true. Creams should be used in adequate amounts to cover the entire area involved so that a film is obvious on the skin. The word ‘sparingly’ has recently been removed from medication labels.

How does using a steroid cream help me prevent getting an infection?

We have mentioned that the skin “barrier” is damaged in eczema. This barrier keeps invading organisms out. Inflamed skin is easily infected. Cortisone creams rapidly reduce inflammation and restore the barrier and this prevents infection. Well controlled eczema is much less often infected than active eczema.

Do I still need to use a moisturiser while I am using my steroid cream?

Definitely. Using a moisturizer is vital to restore the skin barrier. People with eczema have dry skin. Their skin does not retain moisture naturally and this needs to be replaced with substances that do. Your moisturizer is there to store water in the skin. Applying it over your cortisone creams gets you better more quickly and keeping it going when you are better helps to prevent flares.

What side effects should I be aware of while using a steroid cream?

steroid cream

Side effects are very uncommon. Blocked pores can occur from the use of any cream and these can become infected. We call this folliculitis and it may require antibiotics. Stinging may occur with creams however ointments which do not contain preservatives usually do not sting. Use of strong steroids on the face can cause a rash around the mouth. All of these side effects are not dangerous and are reversible. Steroids do not thin the skin if used normally. This only occurs if they are very incorrectly used or put on under plastic wrap. It is a popular myth that they do this but this is an exaggeration. In general, steroid creams are outstandingly safe.

Why is it important for management of my eczema to use different strength steroid creams?

Expert use of steroid creams involves matching the strength of the cream to the severity of the eczema and to the type of skin being treated. For instance the soles of the feet are completely different to the face. They will need a much stronger steroid because the skin there is thicker and much less sensitive. Age is not important in choice of steroid. A baby with severe eczema may need a stronger one than an adult with mild eczema.

Why should I visit a dermatologist to obtain the correct strength steroid cream?

Dermatologists are experts in skin disease and its management. They can correctly diagnose your condition, assess its severity and can anticipate and manage complicating factors such as infection, allergy to medications and skin sensitivity.

Dermatologists also have a complete understanding of steroids. They can devise a treatment regime that is exactly right for each individual and also give accurate up-to-the-minute advice on safety. Pharmacists often tell patients that they can only use steroids for a short time. However unlike pharmacists who have a good knowledge of drugs and their side effects but do not see outcomes of their use, dermatologists have a balanced knowledge of the accurate and safe use of drugs in practice. And unlike GP’s, they have very extensive experience with steroids. Their advice is therefore not over-cautious and they are in an excellent position to be able to provide patients with reassurance and the confidence to manage eczema effectively and safely.

This article was written by Gayle Fischer M.B.B.S. M.D. F.A.C.D., Associate Professor of Dermatology, Sydney Medical School