Treatment with steroid-based corticosteroids can mean relief from the constant itching and accompanying red, scaly skin patches of eczema.
Yet, many patients and their families are fearful of using steroids due to potential side effects associated with the medications. This fear, or “steroid-phobia,” among patients can be lessened by working with a dermatologist who is trained in prescribing these medications, can monitor patients closely, and knows how to incorporate creative treatment strategies to minimize side effects.
Eczema, a chronic disease in which the skin becomes itchy and inflamed, affects about 15 million Americans. One of the most common forms of eczema is atopic dermatitis, or AD, which can occur on just about any body part. AD takes a physical and emotional toll because it can be painful and physically unattractive, causing skin redness, swelling, cracking, weeping, and scaling.
The majority of patients have a “mild” form of the disease, meaning the AD affects less than 20 percent of the body surface area. Still, left untreated, even the mild form can result in itching and rashes that become a significant and visible reminder of the disease. For people whose AD affects more than 20 percent of their bodies, the disease can be a physically painful problem.
Goals of Treatment
One of the most important goals of eczema treatment is to prevent the development of rashes by avoiding those things that trigger itching. In the mildest form of the disease, simple moisturizers and cold compresses may help relieve and prevent the dry, itchy skin of eczema. However, experts note, once skin inflammation occurs, prevention is less effective and anti-inflammatory agents, such as corticosteroids, become necessary to effectively manage the condition.
It has been shown time and time again that the key to the safe and effective use of these agents is to use them under the watchful eye of a dermatologist experienced in prescribing them. Despite the potential side effects, studies have shown that severe side effects are rare when dermatologists prescribe long-term continuous low-potency corticosteroid treatment for up to 10 years, or intermittent mid-potency topical treatment for moderate to severe eczema. It is important that dermatologists carefully monitor patients using corticosteroids for any period of time. Another essential element of successful treatment is that patients consistently take or apply their medications as prescribed by their dermatologists.
Topical Corticosteroids: Types and Uses
Corticosteroids, including nonprescription and prescription forms, are widely used in the treatment of eczema. This class of substances is related to a natural hormone that can diminish an inflammatory response. In particular, glucocorticosteroids (GCSs), which have been used since 1951 for a wide variety of inflammatory skin diseases, offer very effective anti-inflammatory properties.
For the treatment of mild to moderate inflammatory skin diseases, dermatologists usually first use topical GCS therapy, meaning patients apply the medication to their skin. These preparations include less potent nonprescription and more potent prescription forms. Topical types of the medication can be delivered to the skin in many different forms including as an ointment, lotion, cream, and foam.
The medications are classified according to their potency, or strength. Topical hydrocortisone, which is a low-potency GCS available in non-prescription and prescription forms, is used on areas of sensitive skin, such as the face or in the skin folds. Mid-potency GCSs, such as flurandrenolide and betamethasone dipropionate in lotion form, are prescribed by dermatologists and are appropriate for lesions on the torso. Prescription-only high-potency topical GCSs, such as fluocinonide, betamethasone dipropionate, in lotion, cream or ointment form, and clobetasol propionate, are reserved for short treatments of up to two weeks for stubborn lesions, as well as rashes on the palms of the hands or soles of the feet.
Dermatologists strive to use the mildest forms of topical medications possible in order to minimize potential side effects. However, they might use a higher-potency corticosteroid for a short period to address an acute situation; then continue with milder forms.
Dermatologists generally use the topical form of corticosteroids to treat atopic dermatitis rashes that do not have open or crusted sores. They might use the higher-strength preparations for tougher-to-treat thickened skin, and scaly or oozing rashes. The creams, lotions, ointments, or foams are usually applied one to two times a day, depending on the patient’s age and the strength of the preparation.
Corticosteroid treatments usually significantly clear intermittent rashes in two to three days. Dermatologists may use topical corticosteroids for only a short time — until the rash is cleared. In general, intermittent treatment with high potency topical corticosteroids will last seven to 10 days; while low- to mid-strength corticosteroid treatment can last two to three weeks.
Oral/Systemic Corticosteroids: Treatments of Last Resort
Dermatologists usually will not prescribe oral or injected (systemic) forms of corticosteroids unless the atopic dermatitis, or other chronic eczema, is severe or topical agents have not worked. Still, the oral medications have their places in treatment. For example, they are often effective in reducing inflammation and itching, and a high initial dose can eliminate rashes quickly. In addition to recalcitrant severe chronic disease, oral/systemic steroids may be indicated to treat widespread acute eczema, such as severe allergic contact dermatitis to poison ivy. Systemic corticosteroids include: methylprednisolone, hydrocortisone, prednisone, and prednisolone.
These medications are not recommended for use during pregnancy due to studies that show birth defects, such as cleft lip and cleft palate, may be associated with the use of systemic corticosteroids during pregnancy.
Yet, many patients and their families are fearful of using steroids due to potential side effects associated with the medications. This fear, or “steroid-phobia,” among patients can be lessened by working with a dermatologist who is trained in prescribing these medications, can monitor patients closely, and knows how to incorporate creative treatment strategies to minimize side effects.
Eczema, a chronic disease in which the skin becomes itchy and inflamed, affects about 15 million Americans. One of the most common forms of eczema is atopic dermatitis, or AD, which can occur on just about any body part. AD takes a physical and emotional toll because it can be painful and physically unattractive, causing skin redness, swelling, cracking, weeping, and scaling.
The majority of patients have a “mild” form of the disease, meaning the AD affects less than 20 percent of the body surface area. Still, left untreated, even the mild form can result in itching and rashes that become a significant and visible reminder of the disease. For people whose AD affects more than 20 percent of their bodies, the disease can be a physically painful problem.
Goals of Treatment
One of the most important goals of eczema treatment is to prevent the development of rashes by avoiding those things that trigger itching. In the mildest form of the disease, simple moisturizers and cold compresses may help relieve and prevent the dry, itchy skin of eczema. However, experts note, once skin inflammation occurs, prevention is less effective and anti-inflammatory agents, such as corticosteroids, become necessary to effectively manage the condition.
It has been shown time and time again that the key to the safe and effective use of these agents is to use them under the watchful eye of a dermatologist experienced in prescribing them. Despite the potential side effects, studies have shown that severe side effects are rare when dermatologists prescribe long-term continuous low-potency corticosteroid treatment for up to 10 years, or intermittent mid-potency topical treatment for moderate to severe eczema. It is important that dermatologists carefully monitor patients using corticosteroids for any period of time. Another essential element of successful treatment is that patients consistently take or apply their medications as prescribed by their dermatologists.
Topical Corticosteroids: Types and Uses
Corticosteroids, including nonprescription and prescription forms, are widely used in the treatment of eczema. This class of substances is related to a natural hormone that can diminish an inflammatory response. In particular, glucocorticosteroids (GCSs), which have been used since 1951 for a wide variety of inflammatory skin diseases, offer very effective anti-inflammatory properties.
For the treatment of mild to moderate inflammatory skin diseases, dermatologists usually first use topical GCS therapy, meaning patients apply the medication to their skin. These preparations include less potent nonprescription and more potent prescription forms. Topical types of the medication can be delivered to the skin in many different forms including as an ointment, lotion, cream, and foam.
The medications are classified according to their potency, or strength. Topical hydrocortisone, which is a low-potency GCS available in non-prescription and prescription forms, is used on areas of sensitive skin, such as the face or in the skin folds. Mid-potency GCSs, such as flurandrenolide and betamethasone dipropionate in lotion form, are prescribed by dermatologists and are appropriate for lesions on the torso. Prescription-only high-potency topical GCSs, such as fluocinonide, betamethasone dipropionate, in lotion, cream or ointment form, and clobetasol propionate, are reserved for short treatments of up to two weeks for stubborn lesions, as well as rashes on the palms of the hands or soles of the feet.
Dermatologists strive to use the mildest forms of topical medications possible in order to minimize potential side effects. However, they might use a higher-potency corticosteroid for a short period to address an acute situation; then continue with milder forms.
Dermatologists generally use the topical form of corticosteroids to treat atopic dermatitis rashes that do not have open or crusted sores. They might use the higher-strength preparations for tougher-to-treat thickened skin, and scaly or oozing rashes. The creams, lotions, ointments, or foams are usually applied one to two times a day, depending on the patient’s age and the strength of the preparation.
Corticosteroid treatments usually significantly clear intermittent rashes in two to three days. Dermatologists may use topical corticosteroids for only a short time — until the rash is cleared. In general, intermittent treatment with high potency topical corticosteroids will last seven to 10 days; while low- to mid-strength corticosteroid treatment can last two to three weeks.
Oral/Systemic Corticosteroids: Treatments of Last Resort
Dermatologists usually will not prescribe oral or injected (systemic) forms of corticosteroids unless the atopic dermatitis, or other chronic eczema, is severe or topical agents have not worked. Still, the oral medications have their places in treatment. For example, they are often effective in reducing inflammation and itching, and a high initial dose can eliminate rashes quickly. In addition to recalcitrant severe chronic disease, oral/systemic steroids may be indicated to treat widespread acute eczema, such as severe allergic contact dermatitis to poison ivy. Systemic corticosteroids include: methylprednisolone, hydrocortisone, prednisone, and prednisolone.
These medications are not recommended for use during pregnancy due to studies that show birth defects, such as cleft lip and cleft palate, may be associated with the use of systemic corticosteroids during pregnancy.
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