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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).

Nonprescription

Generic Name Brand Name
hydrocortisone Aveeno Anti-Itch, Bactine, Cortaid, Dermolate

Prescription, low strength

Generic Name Brand Name
hydrocortisone Synacort

Prescription, medium strength

Generic Name Brand Name
betamethasone  
flurandrenolide Cordran
fluticasone Cutivate
hydrocortisone Westcort
triamcinolone Kenalog

Prescription, high strength

Generic Name Brand Name
betamethasone  
fluocinonide Lidex
triamcinolone Kenalog

Prescription, very high strength

Generic Name Brand Name
betamethasone Diprolene
clobetasol Temovate

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

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

  • Hives.
  • A worsening of the rash.
  • A burning sensation, itching, irritation, dryness, or redness where you applied the medicine.
  • Blurred vision.
  • Increased urination.
  • Excessive thirst.
  • Mood changes.

Common side effects of this medicine include:

  • Headache.
  • Indigestion.
  • Increased appetite.
  • Restlessness.
  • Increased risk of infection.

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).

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 many years without severe side effects.

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 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 5% coal tar in a hydro-alcoholic gel (such as Estar) or 5% liquor carbonis detergens in a cream base.
  • 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, a topical calcineurin inhibitor, or a coal tar product.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

Women who use this medicine during pregnancy have a slightly higher chance of having a baby with birth defects. If you are pregnant or planning to get pregnant, you and your doctor must weigh the risks of using this medicine against the risks of not treating your condition.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Credits

By Healthwise Staff
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer Amy McMichael, MD - Dermatology
Last Revised April 17, 2012

Last Revised: April 17, 2012

Author: Healthwise Staff

Medical Review: Adam Husney, MD - Family Medicine & Amy McMichael, MD - Dermatology

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