Flare control creams

Yes. They are safe to use on broken skin.

Broken or cracked skin is common in eczema, and steroid creams are one of the best ways to help skin get back to normal.

Information sheets that come with steroid creams sometimes say that they cannot be used on damaged or broken skin. This is because steroids are more easily absorbed into the body through broken skin. But if any is absorbed, it is such a small amount that it is extremely unlikely to have any effect on the body and is a much smaller amount of steroid than your child would receive by mouth for a bad flare-up. It is better to get control of the eczema earlier with the steroid cream, even if skin is broken.

Her eczema became terrible and eventually the nurse convinced me to try the steroid ointment instead of cream. It was amazing – it didn’t sting and the eczema cleared up within days.Tanya

No. When used correctly, steroid creams do not thin the skin.

People often worry that steroid creams will thin their child’s skin.

You may have heard about the serious side-effects of steroid creams in the 1960s and 1970s. Back then, steroid creams were new, and less was known about how best to use them. Because these creams were so good at treating eczema, many people were wrongly given very strong steroid creams to use non-stop over long periods (like every day for a year). This made the skin ‘thin’.

Doctors now know much more about steroid creams and how to use them safely without thinning the skin.

Steroid creams can sting at first, but this will go away quickly.

Some children don’t like having creams put on. Lots of people find that steroid creams sting when they are first put on the skin. This may happen if your child’s skin is dry, cracked, or broken because of eczema.

Steroid creams will usually only sting for the first few days. This will stop when you get control of your child’s eczema and their skin gets better. You can find tips about how to help distract your child from the stinging in the ‘making treatment times easier‘ section which you can find in the menu bar above.

If the stinging doesn’t go away after a few days, then you may want to tell your child’s doctor. It may be that your child is having a reaction to an ingredient in the cream. You may need to try a different steroid cream. An ointment may be better as they are less likely to sting.

The nurse told me that it might sting and to keep going, so we did and after a few days it went away.Jack

No. Steroid creams do not change the colour of your child’s skin.

Your child’s skin is more likely to change colour in patches (become lighter or darker) if eczema is under-treated. Eczema flare-ups make the skin itchy and sore, which can change the colour. This can make the skin have darker or lighter patches where eczema is.

Steroid creams can lower the chance of the skin changing colour by helping you get control of eczema. These patches of lighter or darker skin will go away once you get control of eczema, but it can sometimes take a long time for the skin to go back to normal.

Sometimes people think these patches are scars. It is very unusual for eczema to scar. When people with eczema get scars it is usually because of severe scratching. You can find out more about how to deal with this in the ‘beat the itch’ section, which you can find in the ‘itch, stress and sleep‘ menu above.

She used to have lighter patches of skin on the inside of her elbows but now that we have the eczema under control that has faded.Aisha

Your child’s doctor or nurse practitioner will prescribe the correct strength (potency) and amount to help you get control of their eczema.

What they give you will depend on how itchy and sore your child’s skin is, and whether the eczema has made their skin ‘thick’. When the skin is thick, a stronger steroid cream can help bring the skin back to normal.

You may need to step up or step down between different strengths of steroid creams as you get control of your child’s eczema.

Some parts of the body are more sensitive than others. These are the face, armpits, genitals, and bottom. Only put strong steroid creams on these areas if the doctor or nurse has told you to do this. You can find out about different strength steroid creams later in ‘finding the right flare control (steroid) cream’.

In the past, when steroids weren’t used safely, some skin did get thinner, but this usually went back to normal when the steroids were stopped. On the other hand, eczema damages the skin if you do not treat it and can make your child’s life very difficult.

No, there is no evidence that steroid creams make eczema worse long-term. 

Many families worry about how steroid creams will affect the course of their child’s eczema. Some families also worry that treatments might make it worse.

There is no evidence that steroid creams – or, indeed, any other treatment for eczema – wchange how long eczema lasts, or amkes it worse in the long-term.

What steroid creams do is help you to get control of eczema.

In other words, they don’t make children grow out of eczema any slower or quicker.

No. Steroid creams are not thought to affect growth and development if used as recommended as recommended.

Very little cream is absorbed into the body. Most stays on the surface of the skin.

More can be absorbed when using stronger creams. This can happen if the creams are being used in very large amounts all over the body, or on very sensitive parts of the body. Sensitive parts of the body are the face, armpits, genitals, and bottom.

Most people will need to use flare control creams once a day when they get a flare-up. It is best to keep using the flare control cream until the skin feels smooth and is itch free. Sometimes eczema can still be under the skin even when it looks OK. Using the cream until the skin feels smooth and itch free will help make sure you treat all of it.

Maintenance therapy (sometimes called ‘Weekend Therapy’) means using flare control creams one to two days a week on the areas that often get eczema. This can be any 2 days in the week and is usually spaced apart. E.g. Monday and Thursday. This can help stop these areas havine as many flare-ups. So you child will need less flare control cream in the long-run.

Mantenance therapy is used when eczema is already under control but at risk of flare-up. If you think your child’s eczema is severe and they often get flare-ups, then you could discuss mainenance therapy with your child’s doctor nurse.

When using mainenance therapy, you still need to use flare control creams once every day if your child has a flare-up.

He really hated the creams. He kept crying when I put it on. I went to the doctor and he gave me an ointment. That was much better.James

Steroid creams come in four different strengths (potencies). These are:

Mild | Moderate | Strong (potent) | Very strong (very potent)

The strength of a steroid cream depends on how it was made. Different types of steroids are made of different chemical building blocks, making some stronger than others. This means that you can’t tell how strong a steroid cream is by looking at what % of steroid the cream has in it.

Your doctor or nurse practitioner will prescribe the right strength of cream to help you get control of your child’s eczema. Mild eczema is usually treated with a mild treatment cream or ointment. Moderate or severe eczema, or eczema that is not getting better, will need a stronger cream or ointment.

If you are not sure how strong your child’s steroid cream is, speak to their pharmacist, doctor, or nurse.

Mild eczema is usually treated with a mild steroid cream, such as hydrocortisone. Moderate or severe eczema, or eczema that is not getting better, will need a stronger cream.

Skin on the face, armpits, genitals, and bottom are more sensitive. Only mild or moderate steroid creams should be used on these areas unless you have been told something else by your child’s doctor. This might happen if your child’s eczema is quite bad in these areas, and needs a stronger treatment to get it under control.

On the other hand, thick skin areas such as the palms, soles of the feet and scalp will need moderate to strong steroid creams for them to work.

Your child’s doctor will prescribe the correct strength (potency) of steroid cream to help you get control of your child’s eczema. You may be given more than one steroid cream to treat eczema in different areas of the body. Make sure that you are clear which to use where. If in doubt, talk to your child’s pharmacist or contact your doctor or nurse.

You should always use the mildest steroid cream that will treat your child’s eczema flare. As you get control of your child’s eczema, you may need to step down between different strengths of steroid creams until your child’s eczema is back under control.

If your child’s eczema is not getting better then you may need to change to a stronger steroid cream.

If you think you need to change to a different strength steroid cream you should speak to your child’s doctor to make sure that you get the right strength. It is very important you only use the cream on the person it has been prescribed for. Different steroid creams are usually given to babies, children, and adults.

There are three other flare control creams available in Australia.

• Tacrolimus (compounded cream)
• Elidel (pimecrolimus)
• Staquis (crisaborole)

These are sometimes used for ears of sensitive skin, like the centre of the face or eyelids. Your doctor will decide if these are an appropriate addition to your chil’s eczema care plan.