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Prescription Steroid Creams for Eczema

Posted on October 05, 2021
Medically reviewed by
Kevin Berman, M.D., Ph.D.
Article written by
Amy Isler, RN

Topical corticosteroids, also called steroids, are a common and effective treatment for reducing inflammation during eczema (atopic dermatitis) flare-ups. There are more than 30 types of topical steroids, and they come in many different potencies and formulations including creams, lotions, gels, aerosols, and shampoos.

Depending on the severity of your eczema symptoms, your age, and the area of skin that needs to be treated, your dermatologist or doctor may prescribe a higher potency and dose of a topical corticosteroid to get your eczema under control. Although these treatments are highly effective, it is important to administer these medications according to package and physician instructions, as high-potency steroids can cause negative side effects.

In this article, we will cover the different potencies of topical corticosteroids including the brand and generic names as well as their potential side effects.

Low-Potency Corticosteroids

Low-potency corticosteroids are topical creams you can buy over the counter and should be applied according to package instructions. The most common topical corticosteroid is hydrocortisone.

Low-potency corticosteroids are recommended for eczema on sensitive body areas such as the face, genitals, and under the arms.

Hydrocortisone

Cortaid (hydrocortisone topical 1 percent and 2.5 percent) is the least potent topical corticosteroid and is sold over the counter. It helps reduce discoloration, irritation, and inflammation caused by mild to moderate eczema symptoms. Hydrocortisone cream is typically applied twice daily until symptoms subside.

Alclometasone Dipropionate

Aclovate (alclometasone) is a low-potent topical corticosteroid (0.05 percent) that is obtained by prescription. It is slightly more potent than hydrocortisone and should not be used on sensitive areas of the skin. Note that it should not be used on children if they are younger than 1 year of age. Alcovate is typically applied twice daily until symptoms subside.

Learn more about over-the-counter treatment options for eczema.

Medium-Potency Corticosteroids

Medium-potency topical corticosteroids are prescribed for people with more severe cases of eczema and dermatitis. They can only be obtained by a prescription and should not be used for longer than two weeks at a time to avoid side effects (notably thinning of the skin). Medium-potency corticosteroids include:

High-Potency Corticosteroids

Dermatologists typically reserve high- and ultra-high-potency topical corticosteroids for cases of eczema that don’t respond to lower-potency treatments. They can also be more effective on affected areas of the body that have thicker skin such as the palms of the hands and soles of the feet. High-potency corticosteroids include:

  • Clobex (clobetasol propionate 0.05 percent) — Considered ultra-high potency
  • Diprosone (betamethasone dipropionate), 0.05 percent
  • Lidex (fluocinonide), 0.05 percent

A MyEczemaTeam member shared their experience with taking an ultra-high-potency steroid: “I have been using clobetasol for a few years. I go on it for two weeks, then off of it for two weeks. It does calm it down.”

Side Effects of Topical Corticosteroids

Steroids, even those that are administered topically, can cause adverse side effects if they are not taken according to package instructions or if they are taken over long periods of time. The most common side effect is skin atrophy or skin thinning, which can be permanent. The steroid can also be absorbed into the bloodstream and have systemic side effects, such as raising blood sugar.

Low-Potency Side Effects

Low-potency topical corticosteroids have more mild side effects compared to the medium- and high-potency options. Keep in mind the following side effects when using over-the-counter topical corticosteroids for eczema relief:

  • Itching
  • Burning
  • Skin-color change
  • Acne
  • Dry skin
  • Skin thinning

Higher-Potency Side Effects

The higher the steroid potency is, the less time you should be using it. There is also a greater risk for negative side effects such as:

  • Skin atrophy
  • Telangiectasia (blood vessels look like spider webs)
  • Rosacea
  • Infections
  • Stretch marks (striae)
  • High blood sugar levels
  • Acne lesions
  • Topical steroid withdrawal (rebound phenomenon)

A MyEczemaTeam member wrote about their daughter’s experience with topical steroids and withdrawal symptoms, “I stumbled on an article about topical steroid withdrawal. After reading about the differences between topical steroid withdrawal and eczema, I’m convinced a large part of her skin condition is caused by the steroid creams prescribed. We’ve quit all the steroid creams and things got way worse, but I see healing happening, too.”

Applying the Correct Dose

Dermatologists use the fingertip unit (FTU) to help gauge how much topical corticosteroid should be applied to the affected area of the body. A person's age and the size of the surface area will determine the FTU dosing.

One FTU is the length of the tip of the adult finger to the first crease and is typically about 0.5 grams.

You Are Not Alone

MyEczemaTeam is the social network for people with eczema and their loved ones. You can find support at MyEczemaTeam, where more than 39,000 people with eczema gather to share advice and talk about their experiences living with this skin condition.

Do you use prescription corticosteroids to treat your eczema symptoms? Have you had any side effects from using them over a long period of time? Share your experience in the comments below or on MyEczemaTeam. Your story may help others.

Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Amy Isler, RN is a registered nurse with over six years of experience as a credentialed school nurse. Learn more about her here.

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