Eczema

Eczema treatments: using steroids

Steroids help control eczema by reducing inflammation (redness, swelling). People tended to say they only use steroid creams/ointments when their eczema is flared-up. Although Anissa and Laura had heard that topical steroids shouldn’t be put on broken skin, the only time when steroid creams shouldn’t be used is if the if the eczema is infected.There were concerns about steroids but people also found it worked and made their eczema less red and itchy.

The steroids young people had used for their eczema varied in terms of:
  • main steroid type/ingredients – for example, hydrocortisone or clobetasone (Eumovate, Trimovate) or betamethasone butyrate (Betnovate)
  • form (cream/ointment, tablet, injection, eye drops)
  • potency (the strength of the steroid) and concentration (some steroids are available in diluted strengths)
  • for different body parts
Everyone we talked to had used topical steroids (rubbed onto the skin, usually creams or ointments). Aman used a steroid ointment, which is thicker than cream, but found it ‘sat’ on his skin and made him itchier. Georgia, Aman and Vicky have also taken steroid tablets. Aadam uses steroid eye drops and has had steroid injections into his eyelids to help with keratoconjunctivitis (an eczema-related eye condition). People who had only used steroid creams/ointments said they prefer having something they can put on the skin and didn’t like the idea of steroid tablets to swallow. Some people had a particular type of steroid or brand of cream that they found worked best for them, but couldn’t always get hold of it.
Managing eczema can involve trying topical steroids of different types and strengths. Some people weren’t too sure which steroid ingredients they had tried in their creams or whether they were strong. They thought that their doctors prescribed them increasingly strong steroids over time. Sometimes it was seen as necessary because their steroid cream seemed less effective over time and they wanted a stronger one to help their eczema. Anissa says the strength of her steroid creams have gone “up and up and up” over the years. It was unusual for people to go back to weaker steroid creams. An exception was Vicky whose current doctors are more reluctant about giving her the strong steroids she had as a child. Maham thinks topical steroid can be like “fire-fighting”, offering only temporary relief before the eczema returned.
Some people have several steroid creams for various parts of the body. Shams dermatologist “customised” his creams for different areas of skin. Aisha had a steroid ointment for the eczema on her scalp but stopped using it because it was painful and gave her headaches. There was uncertainty about using steroid creams on/near the face or other delicate skin areas such as the vulva (the skin around the vagina). Some people had weaker steroids for the face, especially eyelids, while others had been told to never use steroids there. Sarah was refused a steroid cream by a pharmacist on the suspicion that she would use it on her face. Lizzie was careful not to accidentally touch her eyes or handle food until after she’d washed her hands when she’d put steroid creams on.
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Worries about using steroid creams

People were aware of the risks of steroid creams, which include thinning of the skin (skin atrophy) and making eczema worse in the long run. Some people thought that overuse of steroids had made their skin more fragile and damaged their immune system. Aisha gets a lot of colds and thinks this is because steroids have “worn sort of my natural defence down”. Vicky says she was given strong steroids as a child before doctors were as aware of the risks.
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Some people worried that doctors gave out stronger steroid creams than necessary. Anissa would like doctors to be clear that you should always use an emollient even if a steroid is needed. Some people we talked to tended to put steroid cream on first and then their emollient on top or not any emollient at all. Other people found that doctors wouldn’t prescribe them strong enough steroid creams to treat their eczema. This could be very frustrating. Aisha says that it was only when her dad argued with the GP that she was prescribed a suitable steroid cream.
Some people worried they used too much steroid cream. The advice from doctors is to use it sparingly (after letting emollient soak in) and for short periods of time. It’s especially tempting to “slather” and “plaster” it on when you are in pain or feel self-conscious though. Aadam occasionally puts steroid cream on his face because he wants “to conceal it, even with the risk.” He sometimes uses more steroid cream and eye drops when he’s feeling stressed to try to prevent flare-ups. Others also said they sometimes used their steroid creams more often than their doctors advised, in the hope of their eczema healing quicker.

Sarah, Aisha and Georgia have researched ‘topical steroid withdrawal’: when your body has got too used to steroids (addicted) and you have ‘rebound flares’ when you stop taking it.
Some people experienced side effects which included burning or stinging when they applied steroid creams. Ointments can help this problem as they are less likely to cause stinging. Georgia’s skin sometimes became more red, inflamed and warm after using steroid creams. Ele had to instantly wash off one steroid cream she tried and now avoids using it. Molly doesn’t like how steroid creams smell and feel (greasy) which can get on her hair.

People weighed up risks and benefits for steroid treatment. Gary wants his eczema treatment to “be as natural and as healthy as possible”, but accepts he may sometimes need steroid creams. Sarah’s approach during university exams was to “do what you’ve gotta do to get it maintained through that period of stress and then afterwards you can maybe try to be a bit more holistic about it”.

Help and advice from others about steroids for eczema

Like with emollients, people sometimes had help with applying steroid cream when they were younger, in pain or couldn’t easily see the body part affected. Some parents reminded the person to use the steroids when needed, others were more ‘hands off’ and tended to let the young person get on with using the emollients and steroid creams.

A few people knew that they could buy weak steroid creams from pharmacies and only visited their doctors if they needed something stronger or wanted one specific to them.

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