Topical steroids in eczema

Topical steroids are the mainstay of eczema treatment and are used intermittently during flare-ups of the disease (1).

The treatment regimens may vary according to the severity of the disease but the mildest potency preparation is usually recommended by the clinicians for treatment (1).

When prescribing topical steroid treatment the clinician must consider:

• strength of topical steroid
• duration of use of topical steroid
• vehicle used with topical steroid
• site of eczema/dermatitis
• age of patient

Emollients are prescribed together with topical corticosteroids (1,2,3).

SIGN state (3)

• patients with atopic eczema should be advised to apply topical corticosteroids once daily
  • if there is an inadequate response to once daily application, the frequency should be increased to twice daily
• twice weekly maintenance therapy with a topical corticosteroid should be considered in patients with moderate to severe atopic eczema experiencing frequent relapses (4)
• topical corticosteroids should be used with caution in the periocular region

Reference:

• (1) National Institute for Health and Clinical Excellence (NICE) 2004. Frequency of application of topical corticosteroids for atopic eczema
• (2) NICE (December 2007).Atopic eczema in children Management of atopic eczema in children from birth up to the age of 12 years.
• (3) SIGN (March 2011). Management of atopic eczema in primary care.