Topical Corticosteroids for Atopic Dermatitis

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Topical Corticosteroids for Atopic Dermatitis

Examples

Several corticosteroid creams and ointments are available for controlling atopic dermatitis symptoms. These products are classified according to potency, ranging from group I (the most potent) through group VIII (the least potent). They are prescribed according to the type of rash you have.

Non-prescription

Generic NameBrand Name
hydrocortisoneAveeno Anti-Itch, Claritin Skin Itch Relief, Cortate 0.5%

Prescription, low strength

Generic NameBrand Name
hydrocortisoneCortate 1%, Hyderm, Prevex, Sarna HC Lotion 1%

Prescription, medium strength

Generic NameBrand Name
betamethasoneDiprosone
fluticasoneCutivate
hydrocortisoneHydroval
triamcinoloneAristocort

Prescription, high strength

Generic NameBrand Name
betamethasoneDiprosone
fluocinonideLidex
triamcinoloneAristocort

Prescription, very high strength

Generic NameBrand Name
betamethasoneDiprolene
clobetasolClobex

Corticosteroid preparations are applied to the skin 1 to 4 times a day, depending on the strength of the preparation and your age. These medicines may be available as creams, lotions, or ointments.

How It Works

Corticosteroids are similar to natural substances the body produces. In atopic dermatitis, corticosteroids reduce inflammation, itching, and thickening of the skin (lichenification).

Why It Is Used

Topical corticosteroids are prescribed for atopic dermatitis rashes. High-strength preparations can be used on thickened skin. Avoid using high-strength topical corticosteroids on the face.

How Well It Works

Topical corticosteroids, in combination with aggressive moisturizing, are the most commonly used and effective treatment for atopic dermatitis. For most people, using a topical corticosteroid for 2 to 3 days significantly clears the rash. Thickened skin requires longer treatment.

To gain the best results from topical corticosteroid treatment, apply moisturizer after each corticosteroid treatment and at least one other time during the day.

In some cases, wrapping the area with a bandage, called an occlusive dressing, may improve atopic dermatitis. But high-strength corticosteroids combined with an occlusive dressing can increase the risk of skin thinning and other side effects.

Side Effects

Side effects include the following:

  • A burning sensation, itching, irritation, dryness, or redness may develop in the area where the medicine is applied.
  • With long-term use, high-strength topical corticosteroids cause temporary thinning of the skin, making it more easily irritated. But when used carefully and mostly in low-strength doses, topical corticosteroids can be used for up to 10 years without severe side effects.
  • Corticosteroids can be absorbed through the skin and cause problems throughout the body. Side effects include headache, indigestion, increased appetite, restlessness, and increased risk of infection. If your skin rash gets worse or if you have blurred vision, increased urination, excessive thirst, or mood changes, see your doctor.

Side effects are associated with long-term use of corticosteroids. You and your doctor must watch for side effects and weigh them against the potential benefit of corticosteroid treatment.

The face is especially sensitive to thinning of the skin. Using topical corticosteroids on the face can result in enlarged blood vessels (telangiectasias), bruising, acne, and stretch marks (striae).

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

  • Avoid stronger corticosteroids on the sensitive skin of the face, armpits, and genital area.
  • When treatment with topical corticosteroids begins, your doctor may prescribe medicines in a "pulse" pattern. For example, you may use corticosteroids for 2 weeks. Then you stop using them for 2 weeks. Then, you apply corticosteroids for another 2 weeks. This pulse-pattern prescription may help keep the medicine from becoming less effective over time.
  • An ointment form provides the best moisturizing effect for the skin. But ointments may be uncomfortable in warm and humid conditions because they don't allow the skin to breathe well. In these cases, creams or gels may be a better choice.
  • Topical corticosteroids may be alternated with coal tar preparations if there is concern about corticosteroid exposure. But this medicine should not be used on skin that is very irritated, because it can make your skin problem worse. Examples of coal tar preparations include Targel and Exorex.
  • When using a topical corticosteroid for longer periods of time, it is important to phase out its use gradually over 2 to 4 weeks, replacing it with a moisturizer or a coal tar product.

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Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Alexander H. Murray, MD, FRCPC - Dermatology
Last Revised June 18, 2010

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.