Steroids are powerful and amazing medications. Our body naturally produces steroids that plays a big role in bringing down inflammation as well as other functions (1). Steroids that are pharmaceutically manufactured have been used for eczema since the 1950’s. (2) There’s a lot of fear and concerns about steroids. This is totally understandable as I was in your shoes as well. I was very concerned about the possible side effects of such powerful medications for my little children. In this article, I will discuss how steroids help eczema and whether steroids are really appropriate for eczema.
What are topical steroids?
Topical steroids are medications that bring down inflammation when applied to the skin. They come in different vehicles (method of transporting steroids) such as creams, lotions, gels, ointments, solutions, tapes and bandages (3). Steroids are commonly used for eczema (atopic dermatitis) in addition to other skin conditions such as psoriasis, vitiligo, phimosis, acute radiation dermatitis, and lichen sclerosis. (4) There are many other conditions steroids can be used for.
What are the types of topical steroids available?
Potency: Topical steroids are available depending on how potent or “strong” the steroid is. For example, hydrocortisone is a low potency steroid that is available over the counter. It usually doesn’t require a prescription. On the other hand, betamethasone is more potent. This requires a prescription. (5).
Vehicles: Vehicle refers to how steroids are delivered. Creams can be used for most areas of the skin whereas ointments are indicated for more dry or scaly skin. Liquid solutions are good for hairy areas like the scalp.
When and how are topical steroids used?
Steroids are helpful when there is a lot of inflammation on the skin. When the skin is very red, this is a sign of inflammation. Steroids can be applied to the area of redness to bring the redness down. If the inflammation continues, it will be very itchy for your child. As your child continues to scratch, the skin can bleed and become infected. To prevent this, steroids can be helpful. Read about the itch scratch cycle.
Always talk to your physician before starting steroids. They will guide in how much and how often to use topical steroids. Usually, a fingertip unit guides the amount of topical steroid to be applied on the skin site. (6)
Are there risks of using topical steroids?
As with any medication, topical steroids have POTENTIAL side effects. I emphasize the word potential because if steroids are used appropriately and as prescribed by a medical provider, then you will most likely not have these side effects. The problem happens when people lose track of steroid use and keep using it everyday for several weeks or longer. That’s why you’ll see doctors prescribe these medications only for a few weeks, not long term. Some side effects include skin thinning, stretch marks, easy bruising or tearing of skin, enlarged blood vessels appearing as red marks etc. (7) This is not to scare you from steroids, but to make you aware of potential side effects. In general, using steroids for periods of time when your child’s eczema flares can be very helpful, but it is not for long term, everyday use.
Can steroids cause skin color changes?
Melanocytes are the cells give our skin color. Steroids cause skin to become pale because it suppress melanocyte cells, which gives skin color. This change is usually reversible after stopping steroids. (8)
How can steroids help eczema?
When the skin becomes very inflamed and red, it can be very uncomfortable for your child. It is important to control inflammation before it gets out of hand. It can lead the itch-scratch cycle (link to article). If this is left uncontrolled, your child’s skin can bleed and become infected from scratching. Long term use of steroids is not a good idea and this is where steroids get a bad rap. Long term management of eczema involve good moisturizers and good gut health. Again, steroids can be great when the skin is acutely inflamed.
Do topical steroids stunt a child’s development?
There is no evidence to support that topical steroids can affect a child’s growth who has eczema. It is true that steroids can affect a child’s growth. In those cases, children were given high doses of steroids, which is not the case in children with eczema. Again, this is why I mention that steroids can help with an eczema flare. For long term use, eczema must be treated from the inside (gut) and then outside (skin). (9)
Can topical steroids worsen Eczema?
There is no evidence stating that topical steroids cause eczema to get worse. (10) If steroids are not used appropriately (wrong steroid, wrong vehicle, wrong dose) or under the guidance of physician, then there is always a chance of steroids making eczema worse.
Will using moisturizers eliminate the need for topical steroids?
Moisturizers are topical cream, oils, lotions that are applied on the skin to keep it hydrated and prevent them from drying. This is definitely true if the skin is not inflamed. On the other hand, if there is an exacerbation of eczema, then topical steroids can help. Hence a combination of topical steroids and moisturizers works very well for eczema. Most important, make sure your child’s gut has the right things to heal skin.
How fast does steroid cream work on eczema?
Topical steroids can work quickly in a matter of hours to days. It is important to discuss with your physician to avoid the side effects discussed. Again, they should not be used long term. Once the inflammation disappears, steroids are not needed. (11)
Topical steroids are an important tool to control eczema. It should not be used for long term. It should be used if there is uncontrollable inflammation of the skin. Always discuss with your medical provider before starting steroids. Eczema is treated from the inside (gut) and outside (skin). I hope this article answers your question, “how do steroids help eczema?”.