Printer Friendly Version

Use Of Steroid Creams and Ointments

• Steroid cream or ointment is the main treatment for the itch of eczema.
• Creams are usually less potent than the same steroid in an ointment form.
• Ointments work better on areas of the body with thicker skin, such as the palms and soles.
• Ointments are more effective in African-American children.

Steroid creams and ointments come in different strengths or potencies:

Group 1: ultra-high potency: Diprolene ,Ultravate (0.05% cream/ointment)
Group 2: high-potency: Elocon 0.1% ointment and Lidex 0.05% ointment
Group 3: high-potency: Lidex 0.05% cream, Halog ointment, Kenalog 0.1% ointment, Cutivate ointment
Group 4: mid-potency: Westcort ointment (hydrocortisone valerate), Elocon cream, Synalar 0.025% ointment
Group 5: mid-potency: Westcort cream (hydrocortisone valerate), Cutivate cream, Synalar 0.025% cream
Group 6: low-potency: Aclovate 0.05% cream/ointment
Group 7: low-potency: Hydrocortisone 1.0% cream / ointment (over-the-counter) Hydrocortisone 2.5% cream / ointment

At the first sign of a flare-up of your child’s eczema, begin treatment with a low potency steroid. Most children with mild eczema will respond to treatment with low potency steroids (Group 7). If treatment is started right away, this may prevent progression of the eczema.

Hydrocortisone 1% cream and ointment are Group 7 steroids and are over the counter. They are very safe and can be used up to four times per day in all age children.

If your child’s eczema does not respond to Group 7 steroids, progressively higher potency steroids can be used. The higher group steroids should only be used long enough to get the eczema under control. If this requires more then 2-3 weeks, please call our office. You should then use a low potency steroid to treat the eczema until the rash is completely resolved.

Ultra-high potency steroids are rarely needed in children. High-potency steroids (Group 2 and 3) can be used to treat more severe eczema (under a doctor’s advice) until the rash has shown improvement.

When you travel with your child, always take the steroid cream/ointment with you. Do not let your supply run low. Get the prescription refilled when your supply runs low.


Non-Steroid Treatments

Elidel 1% cream (pimecrolimus) and Protopic 0.03% (2-15 years of age) / 0.1% ointment (tacrolimus) are the first steroid-free prescriptions for treatment of eczema. They have been shown to reduce the incidence of eczema flares and the need for topical corticosteroids. As a skin-selective inflammatory cytokine inhibitor, Elidel and Protopic work by selectively targeting those cells in the skin that trigger eczema

Elidel and Protopic should be started at the first sign of a flare-up and continued until the eczema clears up. If eczema symptoms return, treatment can be restarted (if symptoms persist for more than six weeks, call our office).

The most common side effect on the skin was a mild to moderate, temporary feeling of warmth or burning. This side effect was temporary, mostly seen at the beginning of treatment. Headache is another reported side effect.

One big advantage of Elidel and Protopic over higher potency steroids is that when used long term, these medicines do not cause damage to the skin (thinning).


How Do I Use These Medicines

• Wash your hands before using.
• Apply a thin layer (pea sized amount) to all skin areas of eczema. Try to cover the affected areas completely.
• Apply twice a day, about 12 hours apart.
• Before applying after a bath or shower, be sure skin is completely dry.
• Do not cover the skin being treated with bandages, dressings or wraps. However, you can wear normal clothing.
• Do not bathe, shower or swim right after applying. This could wash off the medicine.
• If you are a parent applying this medicine, or if you are a patient who is not treating your hands, wash your hands with soap and water after applying. This should remove any medicine left on the hands.
• Use only on your skin. Do not use in the mouth.

• Your child should have one bath a day for 10 minutes.
• Water-soaked skin is far less itchy.
• Eczema is very sensitive to some soaps, especially bubble bath.
• Use a mild soap like Lever 2000, Dove, and New Ivory.
• Any shampoo may irritate your child’s eczema.

• Apply the oil directly to your child’s skin while the skin is still wet.
• Wrap a towel around your child until the oil is absorbed and your child is dry.
• The bath oil can also be placed in the bath.
• After the Alpha Keri bath oil is absorbed into the skin, you can apply the steroid cream prescribed for your child.
• Generic is less expensive and as effective.

• Apply a lubricating cream or ointment 1-3 times daily (more during the winter).
• Ointments (Aquaphor) provide more lubrication for very dry skin and thicker areas of skin (palms/soles)
• Steroids, non-steroids and lubricating creams/ointments can be used together.

• Aquaphor ointment
• Acid Mantle cream
• Eucerin cream
• Lubriderm cream
• Keri lotion cream
• Pen Kera cream

• At the first sign of any itching, apply the steroid cream/ointment to the area that is affected.
• Keep your child's fingernails cut short.
• Keep your child's hands clean to avoid an infection from developing when scratching the eczema.

• Can be given every 4 hours as needed to help control itching.
• Dose: ¼ - ½ teaspoon per 10 pounds of body weight. In the case of a 20 pound child, the dose would be ½ to 1 teaspoon.

• Can be used if Benadryl does not control the itching.
• Dose: same as Benadryl.

• Wool fibers and clothes made of other scratchy, rough materials make eczema worse.
• Cotton clothes should be worn as much as possible.
• Avoid triggers that cause eczema to flare up, such as: excessive heat, sweating, excessive cold, dry air (use a humidifier), chlorine, harsh chemicals, and soaps.
• Never use bubble bath.
• Keep your child off the grass during grass-pollen season (May and June).
• Keep your child away from anyone with fever blisters since the herpes virus can cause a serious skin infection in children with eczema.
• Breast-feeding has been shown to lessen the severity of eczema.
• Avoid cow's milk products, soy, eggs, peanut butter, wheat, and fish during your infant's first year.

• The rash becomes severe (raw and bleeding in several places).
• The rash looks infected (red streaks, pus, yellow scabs).
• The rash has not improved after 7 days of treatment.
• You have other concerns or questions.

Printer Friendly Version