Derm Deep Dive: Navigating Eczema Treatment With Topical Corticosteroids

Understanding the Risks, Benefits, and Alternative Options 

It can take just a single eczema flare-up to leave someone desperate for relief and treatment. Topical corticosteroids are commonly used to provide that relief; however, like any medication, it’s important to know what topical corticosteroids are, what they do, and the potential risks or side effects. 

For National Eczema Awareness Month, this Derm Deep Dive has all the details about topical corticosteroids for eczema so you can feel informed and confident about your eczema treatment plan.  

Topical Corticosteroids Have Long Been Used to Treat Eczema 

Corticosteroids include pills, inhalers, injections, and topicals, and help reduce inflammation in the body. Corticosteroids first came on the scene in the 1950s – a revolutionary treatment for eczema at the time. Today they are one of the most commonly prescribed treatments for eczema flare-ups. 

The popularity of corticosteroids is easy to understand for anyone who has experienced eczema. The National Eczema Association reports that 68% of adults and 74% of children with eczema experience at least one flare-up each month, and for some, daily. And flare-ups can cause far more symptoms than dry or irritated skin. Patients often experience intense itching, redness, inflammation, or discomfort that can interfere with everyday life.  

Dive Deeper:  

Topical corticosteroids are applied directly to the skin and help suppress the body’s inflammatory response to reduce eczema symptoms. They’re offered in a variety of strengths, from low-potency formulations to highly potent medications, but stronger doesn’t always mean better; your treatment depends on the severity of your eczema and where it’s located.  

And while corticosteroids can provide significant relief from eczema symptoms, potential side effects and safety concerns can make patients hesitant to use them. It’s just as important to understand what you’re using as it is how you’re using it. 

The Possible Side Effects of Topical Corticosteroids 

The American Academy of Dermatology states that side effects from topical corticosteroids are rare when a dermatologist manages treatment and the medication is used as directed; however, side effects can occur and depend on the potency, amount, frequency, location of use, and duration of treatment.  

Side effects can include: 

• Easy bruising 

• Stretch marks 

• Changes in skin pigmentation 

• Breakouts similar to acne or rosacea 

• Skin thinning 

• Visible blood vessels 

Skin thinning is the most common side effect, especially in adults, and is often preceded by wrinkled or weakened skin.  

Encouragingly, a PubMed study in 2023 identifies “no evidence of harm” when topical corticosteroids are used as recommended to treat flare-ups, and supports the belief that intermittent use yields fewer side effects.  

Is Topical Steroid Withdrawal a Concern? 

Withdrawal symptoms, also called Topical Steroid Withdrawal Syndrome, typically occur only if the high potency medication is used for an inappropriate and prolonged time. The National Eczema Association lists primary symptoms as burning, stinging, and bright red skin, which can appear days or weeks after ending the use of topical corticosteroids. 

Because eczema is a chronic inflammatory condition, symptoms can return when treatment is stopped. While it’s more likely your symptoms are an indication the underlying eczema has returned, they could signify eczema withdrawal. If you experience any concerning symptoms after discontinuing corticosteroid use, contact your dermatologist right away.  

The National Eczema Association acknowledges that instructions for topical corticosteroid use can be confusing for patients, which increases the chances of the medication being used incorrectly. Studies about topical corticosteroids draw a line between incorrect use and the increased likelihood of side effects and withdrawal, underlining the importance of working closely with your dermatologist and following a treatment plan.  

Can You Minimize The Risk of Side Effects From Topical Corticosteroids? 

Following your dermatologist’s treatment plan is the most effective way to minimize the risk of any potential side effects. Recommendations for responsible topical corticosteroid use can include: 

• Using the Lowest Necessary Potency: Stronger or potent formulations are primarily used on thicker skin like the limbs, palms, or soles of the feet, while mild potency options are more ideal for the face or skin folds. Make sure you are using the correct potency for the affected area. 
• Following a Twice-Daily Application: Most dermatologists will recommend applying a topical steroid twice a day, then taper to once-daily. 
• Trying a “Short Bursts” Approach: Use the medication for a short duration – typically one to two weeks or until your active rash and intense itchiness subside.  
• Applying Carefully to Sensitive Areas: The face, neck, groin, and skin folds are more sensitive and typically don’t require high-potency medication or high-frequency applications. 
• Moisturizing Regularly: Eczema treatment isn’t all about medication. Moisturizers help support the skin barrier and can be an important part of an eczema treatment.  

The right treatment plan will increase the likelihood you’ll be able to manage your eczema and experience some relief from your symptoms.  

Alternatives to Topical Corticosteroids for Eczema Treatment 

We know consistent moisturizing is a foundation of successful eczema treatment. But if moisturizers aren’t cutting it and you are looking for alternatives to topical corticosteroid use, there are a number of options to consider.  

1. Topical Calcineurin Inhibitors (TCIs) 

TCIs are prescription medications designed to treat eczema in individuals who either haven’t seen results from topical corticosteroids or cannot use them. TCIs can be applied directly to the skin and work by stopping the activity of certain cells in the immune system.  

2. Janus Kinase (JAK) Inhibitors 

These oral or topical medications are not steroids. They prevent the protein cytokines in the skin from attaching to certain receptors in the body that cause immune system overactivity. JAKs are ideal for individuals who haven’t had success with other treatments. Some side effects can be serious, so it’s important to speak with your dermatologist about JAKs and potential risk factors. 

3. Injectable Medications 

Non-steroid injections can be effective at treating eczema flare-ups. They contain biologics that target specific pathways involved in the immune response.  

4. Phototherapy 

Using controlled doses of ultraviolet light, dermatologists can help reduce inflammation in patients who aren’t responding to topical treatments. A Cochrane Library study found that phototherapy effectively reduced itching and visible symptoms in patients with eczema.  

5. Other Non-Steroidal Topical Treatments 

There are numerous prescription medications like criaborole, roflumilast, ruxolitinib, and tapinarof, which are prescribed depending on the specific diagnosis, severity, and patient’s age. These topical treatments can be highly effective at treating mild-to-moderate eczema symptoms.  

When Should I see a Dermatologist About My Eczema? 

You should see a dermatologist as soon as you have concerns about your skin health, especially if at-home moisturizing or other treatments aren’t reducing your symptoms.  

Working with a dermatologist is an important first step in eczema management. They can help you understand whether eczema is causing your symptoms or whether you have another skin condition – and which treatment will work best.  

Dive Deeper: Psoriasis Vs. Eczema – Identifying, Treating, & Managing Each Condition 

If you are prescribed a topical corticosteroid, your dermatologist will also help you navigate what can be a complex treatment plan. You should get the following information from your dermatologist before beginning any eczema treatment plan: 

• Which potency is appropriate 

• Where and how often the medication should be applied 

• How long your treatment should last 

• When you may need to transition from a corticosteroid to another treatment 

• Whether an alternative treatment could work better for you 

Eczema remains a primary skin issue for Americans, and seeking treatment is often the only way to find effective relief. At Optima Dermatology, our board-certified providers are experts in skin issues and will help you navigate your treatment whether it is topical corticosteroids or an alternative option – so you can take control of your eczema and get back to your life.  

Schedule an appointment today with one of our expert providers, and get the eczema treatment help you need, and deserve.  

Frequently Asked Questions About Topical Corticosteroids 

Are topical corticosteroids safe for treating eczema? 

Yes. Topical corticosteroids are considered an effective first-line treatment for many eczema flares and can be safe when used as directed. The risk of side effects depends on factors such as the steroid’s potency, how often it is applied, how long it is used, and where it is applied. Your dermatologist can help determine the appropriate medication and treatment duration for your skin. 

Can topical corticosteroids make eczema worse? 

Topical corticosteroids are generally used to reduce eczema-related inflammation and itching rather than make eczema worse. However, symptoms can return after treatment is stopped because eczema is a chronic condition. If your eczema repeatedly worsens after stopping a topical corticosteroid, talk with your dermatologist to determine whether you are experiencing a typical flare, a medication-related reaction, or another skin condition. 

What are the side effects of using topical corticosteroids for eczema? 

Potential side effects include skin thinning, easy bruising, visible blood vessels, stretch marks, pigmentation changes, and acne-like or rosacea-like breakouts. The risk is generally higher with potent steroids, prolonged use, and application to thin or sensitive areas of skin. Following your dermatologist’s instructions can help minimize these risks. 

What is topical corticosteroid withdrawal, and how do I know if I have it? 

Topical corticosteroid withdrawal (TSW) is a reported reaction that can occur after reducing or stopping prolonged use of topical corticosteroids, particularly potent steroids used inappropriately. Symptoms may include intense redness, burning, itching, or swelling. However, these symptoms can overlap with an eczema flare, so it is important to see a dermatologist for an accurate evaluation rather than assuming that symptoms are caused by TSW. 

What can I use for eczema instead of topical corticosteroids? 

Several non-steroidal options may be available, including topical calcineurin inhibitors such as tacrolimus and pimecrolimus, topical PDE-4 inhibitors such as crisaborole and roflumilast, topical JAK inhibitors such as ruxolitinib, and other prescription treatments. Moisturizers, trigger management, phototherapy, biologic medications, and oral treatments may also be appropriate depending on the severity of your eczema. A dermatologist can help determine which options are best for you. 

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