Topical Steroid Use in Children’s Eczema: A Panel Discussion

Topical steroids help reduce inflammation and control eczema flare-ups.

• They calm redness, swelling and itching in affected areas.
• They are prescribed for short periods during flare-ups to bring the condition under control.
• Used correctly, they make the skin more comfortable and allow it to heal.

Steroid creams should be used exactly as directed by a healthcare professional.

• Apply a thin layer to affected areas very sparingly, just enough to make the area look shiny.
• Avoid applying on normal skin.
• The correct strength and area of application will be chosen by your doctor or pharmacist.
• They should be used for short periods, usually between two and four weeks, and then stepped down in favour of maintenance treatments or as advised.

Steroids and moisturisers both play an important role, but they are used differently.

• Children need much more moisturiser than steroid cream to keep the skin hydrated.
• As a guide, about ten times more moisturiser should be used than potent steroid cream.
• A child with severe eczema may need around 250 grams of moisturiser per week.
• Steroid cream should be used sparingly, only on affected areas, and for the length of time advised.

Steroids work best when combined with regular use of moisturisers.

• Apply steroid cream at the time of day recommended by your doctor.
• Continue using emollients every day to maintain the skin barrier.
• Many people use steroid cream in the evening and moisturiser in the morning so both can work effectively.
• Moisturising should continue even after the skin looks clear.

Topical steroids come in three main strengths: mild, moderate and potent. The strength chosen depends on the child’s age, the part of the body being treated, and how severe the eczema is.

• Mild steroids are used on delicate areas such as the face, neck and skin folds.
• Moderate steroids are used on larger or thicker areas of skin, such as the arms and legs.
• Potent steroids are reserved for small areas of thickened or resistant skin and are used only under medical supervision.
• The strengths are not evenly spaced: moderate steroids are about twice as strong as mild ones, but potent steroids can be more than ten times stronger than mild creams.
• The percentage label printed on the product does not indicate how strong the steroid is, so always follow the advice of your doctor or pharmacist.

It is important to use the right amount of steroid cream for each area of the body.

• A fingertip unit (FTU) is the amount of cream that fits along an adult’s fingertip.
• One FTU covers an area of skin about the size of the adult’s hand.
• About three FTUs cover one arm.

Many parents worry about using steroid creams, but they are safe when used correctly.

• Steroid creams will not always thin the skin when used in the correct way.
• The key is to follow professional advice on strength, area and duration of use.
• Used properly, steroids reduce inflammation and prevent worsening of eczema.
• Regular review with a doctor or pharmacist helps ensure safe and effective treatment.