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Jul 18, 2023

Skin Health

Eczema

Choosing the Right Corticosteroid for Your Eczema

What is Eczema?

Eczema is a very common skin condition characterized by patches of dry, red, and itchy skin. These patches can come and go throughout your life in the same and/or different areas. Eczema often starts in childhood and can continue into adulthood. Some people find that it bothers them less as they get older.

The main cause of eczema is a change in the skin's normal barrier function. This leads to increased loss of moisture, which causes the dry and inflamed symptoms of eczema. The exact reasons for these changes are not fully understood, but there are likely several factors involved. Eczema tends to run in families, suggesting a genetic component. However, certain triggers in the environment, like fragrances or drying agents, can also contribute to the development of this condition.

Eczema Across Different Life Stages

The nature and location of eczema patches can vary depending on a person's age. This is partly influenced by changes in mobility as we grow older. Eczema tends to manifest in areas that are prone to dryness and friction, which can be different depending on our age and level of activity.

Babies and toddlers

In young children, eczema commonly appears on the face and scalp, particularly on the cheeks. The patches may have a scaly and red appearance, and if the baby scratches their face, they can become more inflamed and start oozing fluid. This can be problematic as the patches are extremely itchy, and young children often rub their faces against bedding or carpet to relieve the itch.

Children

As children become more mobile, eczema tends to develop in the folds of their elbows and knees. It can also occur on the neck, wrists, and ankles. Older children typically experience red, itchy, and scaly patches, and their skin may thicken as a protective response to scratching.

Teens and adults

Eczema is slightly less common in adults. In adults, eczema patches often appear very dry and itchy, and may be lighter or darker than the surrounding skin. The most common areas for adult eczema are the hands and around the eyes. It can also occur on the neck, feet, or in the bends of the elbows or knees.

Given the variations in the appearance of eczema across different age groups, the treatment approaches may also differ slightly.

Eczema Treatment Options

The management of eczema involves two main approaches: prevention and medication. Preventing eczema flares primarily revolves around maintaining proper skin hydration. This is crucial for reducing the frequency of flare-ups.

Prevention
  • Use fragrance-free moisturizers in generous amounts
  • Take lukewarm baths or showers once or twice a day (avoid hot water)
  • Avoid alcohol-containing products, as they can dry out the skin
  • Opt for non-soap, fragrance-free cleansers
  • Wash clothes with mild detergents that do not contain softeners or bleach

Medications

The primary focus is on symptom management and clearing up the affected patches. The main treatment option for eczema is topical corticosteroids, which effectively reduce itching and inflammation. Topical corticosteroids are available in different potencies, ranging from low to ultra-high. The choice of potency depends on the thickness and location of the affected skin.

Low Potency Corticosteroids
  • What: hydrocortisone 1%, 2%, 2.5%, desonide 0.05%
  • Who: young children and individuals of any age
  • Where: thin skin areas such as the face, neck, scalp, and genitals
  • When: mild eczema, often the initial choice for corticosteroid treatment
  • OTC or RX: Over-the-counter (OTC)
Medium Potency Corticosteroids
  • What: betamethasone valerate 0.05%, 0.1%, fluocinolone acetonide 0.01%, prednicarbate 0.1%, fluticasone propionate 0.05%
  • Who: individuals of any age
  • Where: mild to moderate eczema on various body surfaces. Particularly useful for: eczema in the bends of the elbows and knees, as well as the groin and armpits
  • When: low potency corticosteroids have not provided sufficient relief or for slightly more severe eczema in young individuals
  • OTC or RX: Prescription required
High Potency Corticosteroids
  • What: betamethasone dipropionate 0.025%, mometasone furoate 0.1%, desoximetasone 0.05%, amcinonide 0.1%
  • Who: typically used in adults, not recommended for young children
  • Where: areas with thicker skin, such as palms of hands and soles of feet
  • Caution: should not be used over large surface areas
  • When: dealing with severe eczema patches that have resulted in skin thickening
  • How long: limited to a few days
  • OTC or RX: Prescription required
Ultra-High Potency Corticosteroids
  • What: clobetasol propionate 0.05%, halobetasol propionate 0.05%, betamethasone dipropionate ointment 0.05%
  • Who: very strong and highly absorbed, should be avoided in young children but can be used in older children and adults.
  • Where: areas with thicker skin, such as palms of hands and soles of feet
  • Caution: should not be used over large surface areas
  • When: other corticosteroids have not produced desired improvement, reserved for severe eczema patches with excessive skin thickening
  • How long: limited to a few days
  • OTC or RX: Prescription required

Shop Online for Eczema Treatment Options

References:

  1. Eczema types: Atopic dermatitis overview. American Academy of Dermatology. (2022, November 28). Retrieved May 26, 2023, from https://www.aad.org
  2. U.S. Department of Health and Human Services. (2022). Atopic Dermatitis: Diagnosis, Treatment, and Steps to Take. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Retrieved May 26, 2023, from https://www.niams.nih.gov
  3. Topical steroids factsheet. National Eczema Society. (2019, June). Retrieved May 26, 2023, from https://eczema.org
  4. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Eczema: Steroids and other topical medications. 2017 Feb 23. Available from: https://www.ncbi.nlm.nih.gov/books/NBK424899/

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