Flare control creams

Steroid creams are the most common type of flare control creams.

The steroids in these creams are like the ones produced naturally by the body. They are very good at treating eczema flare-ups by reducing itching, and helping soreness and swelling. This helps the skin heal much quicker. They are not the same as the steroids sometimes taken by athletes or bodybuilders. These are called ‘anabolic steroids’. They have a very different use. They build muscle and are not used to treat eczema.

When I get a flare-up, I put the steroid cream on and it clears it right up.

Tom

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 you 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.

My eczema was awful. 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.

Will

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

People often worry that steroid creams will thin their 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.

Lots of people find that steroid creams sting when they are first put on the skin. This may happen if your 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 eczema and your skin gets better.

If the stinging doesn’t go away after a few days, then you may want to tell your doctor. It may be that you are 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 I did and after a few days it went away.

Josef

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

Your 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.

I used to have lighter patches of skin on my arm but now that I have my eczema under control they have disappeared.

Sophie

Your doctor or nurse will prescribe the correct strength (potency) and amount to help you get control of your eczema.

What they give you will depend on how itchy and sore your skin is, and whether the eczema has made your 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 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 your 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.

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

Many people with eczema worry about how steroid creams will affect the course of their eczema. Some people also worry that treatments might make it worse.

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

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

It is good to remember that eczema damages the skin if you do not treat it.

No. Steroid creams are not thought to affect growth and development if used as recommended for a few days or weeks at a time.

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.

For this reason, steroid creams are only used for a few days or weeks. If you need to use them every day for more than 4 weeks, it would be good to speak to your doctor or nurse.

It is best to start using flare control creams as soon as you spot a flare-up. This will help you get control quickly. It will help stop the flare getting worse, and will make it go away faster.

Top tip!

It’s a good idea to always keep spare flare control cream in the house. This means that you can quickly treat any flare-ups as soon as they start. This will help you get control sooner.

A flare-up is where the skin is more sore or itchy than usual. In lighter skin, an eczema flare-up may make the skin look red. Click on the pictures to make them bigger.

In darker skin, an eczema flare-up may make the skin look grey, purple, or brown.

For some people with eczema, their flares can be treated with Pharmacist Only medicines. These treatments do not need a prescription, but you must speak with the pharmacist first before you can buy them.

The pharmacist will be able to confirm if these medicines are suitable for your needs. You will only be able to buy these medicines in small amounts.

We recommend also speaking with your doctor or nurse to understand if these medicines are right for you.

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 is itch free will help make sure you treat all of it.

I was getting flare-ups all the time, so the doctor told me to do maintenance therapy – using a steroid cream a couple of times a week. It’s been much better since then.

Aditya

You can leave a gap between putting on flare control creams and moisturising creams, but it is not essential

The important thing is to ensure you apply both the flare control creams and moisturising creams generously.

Do put the flare control cream on before the moisturiser to get the best effect.

Some people choose to put flare control creams on in the morning and moisturising creams on in the evening before they go to bed.

Other people prefer to apply them at set times during the day. Some people like to put moisturising creams on straight after a bath or shower and then put flare control creams on later. Whatever works for you!

I just set alarms for the different creams to remind me to put them on so I don’t forget!’

Lauren

Steroid creams come in ointments, creams, or lotions. Your doctor or nurse may prescribe an ointment when your eczema is dry or because ointments stay on the skin for longer. They are transparent and gel like. Because they are greasy they will help to add moisture to your skin.

Some people don’t like the feel of ointments. They may prefer ‘creams’. Creams are white and contain a lot of water. They are light and cooling. They can feel easier to put on, but sometimes people feel that creams ‘sting’ more than ointments on broken skin. There are also special steroid gels or lotions that can be used to treat eczema on the scalp. These can help if you get an itchy scalp, particularly at night.

The important thing is finding a treatment that is right for you. Sometimes the same steroid cream is available as different types, so it might be worth asking your doctor or nurse if you like a certain type more than others.

I really hated the creams. They stung when I put them on. I went to the doctor and she gave me an ointment. That was much better.

Oliver

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 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 steroid cream is, speak to your 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 doctor. This might happen if your 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 doctor will prescribe the correct strength (potency) of steroid cream to help you get control of your 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 pharmacist or contact your doctor or nurse.

When should I change to a different strength of steroid cream?

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

If your 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 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.

You can find information on how to read the labels on the packaging of your treatments in the ‘other resources’ section which you can get to from the menu bar above.

There are three other flare control creams available in Australia.

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

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