Eczema Awareness Support and Education...Learn More
- What Is Eczema?
- For Adults
- For Parents
- For Kids
- Treating Eczema
- Topical Calcineurin Inhibitors
- A Closer Look At Topical Calcineurin Inhibitors
- A Closer Look At Topical Steroids
- Coal Tar Preparations
- Interactive Medicine Cabinet
- Treatment Progress Chart
A Closer Look At Topical Steroids
History of Topical Steroids in Canada
Topical steroid creams, also called cortisone creams, are applied directly to the skin. Topical steroids have been a traditional treatment for eczema for the last forty years. There are many different topical steroids which fall within one of seven classes, ranging from Class I (superpotent) to Class VII (low potency).
How Topical Steroids Work
Topical steroids are anti-inflammatory treatments to bring the itch of eczema under control. They should only be used under the supervision of a doctor and it is essential to use the appropriate strength and quantity as prescribed by your doctor. Only one cortisone cream can be bought from a pharmacist without a prescription. This is hydrocortisone and it is sold as a cream or ointment. It can be used to treat mild eczema.
The Role of the Skin Barrier
New insights into the difference between “healthy” skin and eczema-prone skin have focused on the skin barrier. The skin barrier appears to play a significant role in how effectively the skin functions, and why certain people get eczema while others do not. In healthy skin with a resilient skin barrier, allergens cannot penetrate deeper into the skin. Instead, bacteria and irritants are prevented from entering; the skin barrier also helps to protect proper levels of hydration in the skin. Research into the skin barrier has shown that there is a genetic predisposition to a weakened, defective skin barrier. This allows allergens to penetrate the skin. In addition, the defective skin barrier allows for increased interaction with environmental factors such as soap and detergent, house dust mites, hard water, infection and some topical pharmaceutical and cosmetic products. This can result in a worsening of eczema symptoms, and a further breakdown of the skin barrier.
Recent research into the skin barrier and how protecting it can help to prevent eczema ‘flare ups’ has resulted in new treatment strategies, which focus on preventing new flares as opposed to treating flares as they occur. This maintenance regimen involves the use of TCI or topical steroid treatments. Talk with your doctor; he or she has the most up to date information about eczema treatments. Discuss the different treatment options available to you to identify the best strategy for controlling your eczema.
Common Side Effects
When cortisone creams are correctly used under the supervision of a physician, they can be a safe and effective treatment for eczema.
However, certain side effects have been documented. Stretch marks, thinning skin, fragile skin, increased fine hair growth, and skin discolouration have all been reported.
These side effects are related to the potency of the cortisone cream, where it is being used on the body and the condition of the skin it is applied to. Cortisone creams have been shown to be less effective when used over a long period of time. There is also a risk that they could be absorbed into the blood through the skin. In rare instances, this could slow growth in children by suppressing the adrenal gland.
Generally, cortisone creams are only prescribed for short periods of time.
It is important not to confuse topical steroids with those steroids used illegally for body building or those used in the contraceptive pill; they are completely different.
Eczema Treatment Options
Eczema is traditionally treated with hydration of the skin (moisturizers), topical steroids for inflammation, oral antihistamines for control of itch, and antibiotics when there is infection. Eczema is difficult to treat because the condition is recurring, or chronic. Because of the recurrence of outbreaks, traditional treatments do not cure the condition and often have to be used for a prolonged period. Many of the treatments, including topical steroid treatments, produce various side effects, such as thinning of the skin and a change in skin pigmentation.
The newest class of treatments for eczema, called Topical Calcineuin Inhibitors or TCIs, stops the immune system from generating a ‘flare up’ response to irritants that cause eczema outbreaks. TCIs are chemically unrelated to steroidal treatments now in use, and are the first steroid-free treatment for eczema in forty years.