The concern is understandable. But when topical steroids are used the right way, they are safe, effective, and often the fastest route to calmer skin.

Key points

• • Used as directed, topical steroids are safe and effective for most people with eczema.
  • Using too little, or stopping too early, is a common reason eczema keeps flaring.
  • A fingertip unit is a simple way to measure the right amount.
  • Different strengths suit different parts of the body, so use each cream only where it was prescribed.

Why do steroid creams have such a bad reputation?

Much of the fear comes from older advice, stories online, and confusion between topical steroids and the anabolic steroids some people misuse for muscle building. They are completely different medicines. Topical steroids are anti inflammatory creams and ointments that calm the redness, itch and swelling of eczema at the source.

Side effects such as skin thinning, stretch marks or easy bruising are real, but they are uncommon when creams are used at the right strength, on the right area and for the right length of time. They are mostly linked to strong steroids being used on delicate skin for long periods without review.

What happens if I use too little?

Under treating eczema is a much more common problem than over treating it. A thin smear, or stopping as soon as the skin looks slightly better, often leaves inflammation simmering underneath. The eczema flares again, and over months you may end up using more steroid in total than if you had treated it properly the first time.

Long running, uncontrolled eczema also carries its own risks, including skin infections, broken sleep and thickened skin from constant scratching.

How much should I use, and for how long?

The fingertip unit is a simple guide. It is the amount of cream or ointment squeezed from the tube along the last segment of an adult's index finger, from the tip to the first crease. One fingertip unit covers an area about the size of two adult hands.

Apply it to all areas of active eczema, usually once or twice a day as prescribed. Keep going until the skin feels smooth, not just less red, then stop or step down as your doctor advised. For areas that flare repeatedly, your doctor may suggest applying it twice a week to those spots even when they look clear, to prevent flares before they start.

Does strength matter?

Yes. Topical steroids come in different strengths. Milder ones suit thin, sensitive skin such as the face, eyelids, neck and skin folds. Stronger ones are used on thicker skin, such as the hands, feet or stubborn patches on the body.

That is why it matters to use each cream only where it was prescribed, and not to share creams with family members. If you have been given more than one, a simple note of which cream goes where can prevent mix ups.

What about moisturiser?

Moisturiser is essential alongside topical steroids, not a replacement for them. Apply it generously every day, including when your skin is clear. On days you use a steroid cream, apply the steroid first and the moisturiser afterwards, leaving a short gap between them if your doctor recommends it.

When should I see my doctor?

Make an appointment if your eczema is not improving after one to two weeks of using your steroid as directed, if you need steroid creams almost constantly to keep it under control, or if you are worried about side effects. Skin that is weeping, crusting, very painful or accompanied by a fever may be infected and needs prompt review.

If topical steroids are not enough, there are other options, including non steroid creams and, for moderate to severe eczema, tablets and injectable treatments prescribed by a dermatologist.

How Ace can help

If you have several creams of different strengths, it is easy to lose track of which goes where. Ace pharmacists can label and explain each one clearly, show you how to measure a fingertip unit, and talk through any worries about side effects so you can treat your eczema with confidence. Get started with Ace.

References

Australasian Society of Clinical Immunology and Allergy. Eczema (atopic dermatitis) frequently asked questions.

Australasian Society of Clinical Immunology and Allergy. Eczema (atopic dermatitis).

Eczema Association of Australasia. Topical steroids information sheet.

This article is for general information only and does not constitute medical advice. Always use topical steroids as directed by your doctor or pharmacist.