Skin care and treatment plans for eczema can be time-consuming and complicated. MyEczemaTeam members often discuss the ongoing challenges of managing eczema symptoms with both over-the-counter (OTC) or prescription topical steroids and moisturizers. But does it matter which one you apply first?
One member wrote, “For topical care, I use SheaMoisture African Black Soap Lotion or Hemp Seed Oil Lotion. When my eczema was really bad, the only thing that would help was the steroid cream. If you are itching really badly, just rinse with cool/cold water and pat dry very gently. Let the skin air out for a bit, the fresh air is healing. Then apply the Shea Moisture lotion.”
“I am back to using a topical steroid,” another member said. “I also still use SmartLotion at times, and of course, moisturizers.”
Someone else said, “I normally have to use a cream such as Zero Cream and apply it all over dry skin and then wait for 15 to 20 minutes (normally when the cream has all soaked in). Then I apply a steroid cream over my bad eczema patches.”
If you’re not getting the results you want from using a topical steroid with a moisturizer or emollient, it may be because you’re not applying your steroid treatment properly. When and how you apply the steroid is essential to reaping its full benefits. Here’s why.
Topical steroids are commonly used for short-term treatment of eczema flare-ups to quickly reduce inflammation and allow skin to start healing. Steroids are naturally occurring hormones in the body that help regulate the immune system. Synthetic (human-made) steroid medications are used for a wide range of health conditions that cause inflammation. Topical corticosteroids — or glucocorticoids — are synthetic topical steroids used to treat numerous inflammatory skin conditions, including eczema.
Eczema results from the immune system being overly reactive to triggers that can irritate and inflame skin. Topical steroids have anti-inflammatory and immunosuppressive properties. They are also anti-mitotic, which means they stop cells from dividing too much and making too many cells when there’s inflammation.
As topical steroids are absorbed into the skin, they cause vasoconstriction — narrowing of the blood vessels in the skin. This restricts pro-inflammatory agents in the immune system from entering the skin. By reducing inflammation, topical steroids can help control eczema symptoms such as a discolored rash (which can vary in color depending on skin tone) and itchy, dry, and painful skin.
Health experts consider consistent moisturizing a mainstay of eczema treatment for protecting and strengthening the skin barrier. Using moisturizers with other topical therapies, such as topical steroids, is important in that it can help prevent itchy skin and dryness and aid with the absorption of topical medications such as steroids. International guidelines for the treatment of eczema suggest that people with atopic dermatitis (the most common form of eczema) should moisturize their skin twice a day.
Here are some tips on how to properly combine moisturizing with a topical steroid to be sure you’re using a steroid safely and effectively.
There is no clear consensus as to whether topical steroids or moisturizers should be applied first. However, the National Eczema Association suggests that any prescription topical should be applied before moisturizing.
On the other hand, Oxford University Hospitals NHS Foundation Trust recommends applying a topical steroid after either bathing or moisturizing to be sure that your skin is moist.
Current dermatology research indicates that the order in which you apply a topical steroid or moisturizer probably doesn’t matter — though it does note that corticosteroids work better when they’re applied to wet skin.
Most medical experts agree that regardless of the order in which you apply a topical steroid and a moisturizer, you should wait at least 10 minutes between applications. If possible, it’s good to wait 20 to 30 minutes between applying a steroid and applying a moisturizer.
One reason for waiting between applications is that a topical steroid can become diluted — and may lose potency and effectiveness — if it mixes with a moisturizer that hasn’t been fully absorbed into the skin.
Additionally, mixing moisturizer and a steroid while you’re still wet can spread the steroid to skin that does not need treatment. Exposing healthy skin to a steroid increases your risk of side effects. Steroids should be applied only to affected areas of skin that need treatment, while moisturizer should be applied to large areas of the body.
Talk to your dermatologist in detail about the proper dosage if you’re using a topical steroid for your eczema. In many cases, a thin layer of a topical steroid is applied only once a day. Appropriate dosage is measured in fingertip units, the amount of cream that squeezes out of the tube onto the end of your finger. Speak with your doctor for additional guidance.
Most topical steroids are prescription medications, other than low-dose hydrocortisone topicals, which are available as OTC ointments and creams. Topical steroids come in different potencies and forms, such as creams, ointments, or foams. Always use a topical steroid exactly as directed by your doctor. Using a steroid longer than your doctor recommends can increase your risk for side effects. Topical steroids usually aren’t used over long periods of time.
Be sure to discuss topical steroid side effects in detail with your dermatologist. Too much of a topical steroid can increase the risk of side effects such as:
Researchers have found that strong steroids in particular aren’t more effective if they are applied more than once a day.
Protecting your skin from sun exposure is an important part of skin care. If you’re using a topical steroid and moisturizer, you should generally apply sunscreen last. Just as you should give a topical steroid or moisturizer at least 10 minutes to absorb into your skin, you should do the same before applying sunscreen.
Some sunscreens are mineral-based — a combination of mineral and chemical sunscreen, such as zinc oxide sunscreen — and they work by reflecting sunlight. Applying these sunscreens last allows them to retain their full reflective effectiveness. Chemical sunscreen can lose its effectiveness over time, and waiting to apply sunscreen after applying a topical steroid and moisturizer helps ensure longer effectiveness when you’re outside. Sunscreen should be reapplied every two hours.
Even when using sunscreen, it’s important to avoid direct sunlight as much as possible with protective clothing and by staying in the shade. Always use sunscreen with an SPF of at least 30.
If you have questions about applying a topical steroid with a moisturizer, talk to your doctor. Your health care team can give you specific directions and tips to help you maintain your skin care and treatment plan. Always ask for medical advice before making any changes to your treatment schedule.
On MyEczemaTeam, the social network for people with eczema and their loved ones, more than 49,000 members come together to ask questions, give advice, and share their stories with others who understand life with eczema.
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