June 2, 2000 -- Neil Glazer, a 39-year-old Philadelphia lawyer, has had eczema all his life. That means itchy, irritated, red skin in patches on his body. Sometimes the rash goes away, but then it comes back again. Having tried "a zillion" treatments, Glazer often avoids one of the most common -- the stigmatized corticosteroid creams to be applied to the skin for any number of skin-related ailments.
Glazer and his doctor admire the work of Andrew Weil, MD, author of 8 Weeks to Optimum Health, who practices integrative medicine. Weil urges people with eczema to avoid corticosteroid creams and use natural remedies instead. But sometimes, Glazer says, nothing else will work. "I make a point of using moisturizers often and getting lots of essential fatty acids in my diet. Sometimes I go for a year or two without needing anything more," he says. "But when the eczema really starts to break out, nothing brings it under control like topical corticosteroids."
Glazer is not the only patient with concerns about using corticosteroid creams and ointments for eczema. A recent study in the British Journal of Dermatology showed as many as 73% of patients with eczema are afraid of corticosteroid creams and ointments. About 25% refuse to use them.
"Weak steroids such as hydrocortisone are very safe to use," says Carolyn Charman, BMBCh, lead author of the study. "They certainly are very unlikely to have negative effects on a child's growth and development, which seems to be a major concern for some people." Even the strongest corticosteroid creams are safe to use in short courses under the guidance of a dermatologist, adds Charman, who is a dermatology research fellow at Queens Medical Centre in Nottingham, England. "Patients need to understand that topical corticosteroids are very different from steroids in tablet form."
Primary care physicians and dermatologists often prescribe corticosteroid creams and ointments for atopic eczema and other skin ailments. "Many studies have shown they have a good effect," Charman says. "Eighty percent to 90% of patients improve dramatically within a relatively short time."
Mild corticosteroid creams are quite safe when used in an appropriate way, says Amy Paller, MD, professor of pediatrics and dermatology at Northwestern University Medical School. "That means limiting use to twice daily, and only applying a thin layer of the cream. Patients also need to be particularly careful when using these creams on the face or in fold areas, since there could be increased absorption in those areas and possible local side effects such as thinning of the skin. There are at least a dozen creams available that are medium strength or less and have a very low risk." Paller is also head of the division of pediatric dermatology at Children's Memorial Hospital in Chicago.