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.
Charman and other researchers in the department of dermatology at Queens Medical Centre asked 200 patients or parents of patients with atopic eczema to fill out a questionnaire about their attitudes toward corticosteroid creams. They found almost three-quarters of the responders worried about using corticosteroid creams on their own or their child's skin. The most common concerns were the risk of skin thinning, which was feared by almost 35% of those surveyed. Twenty-four percent feared long-term effects in general, and almost 10% were afraid of possible effects on a child's growth and development.
Quite a few patients had mistaken ideas about the strength of various creams. For example, about 75% of the patients had used hydrocortisone cream, which is one of the weakest corticosteroid creams available. However, 34% thought it was strong, and 20% didn't know; only 46% correctly identified it as weak.
"We hope general practitioners and family physicians will spend a little more time explaining the different strengths of corticosteroid creams available," Charman says. "The weaker creams are very unlikely to cause any problems. Strong ones are more likely to cause problems such as skin thinning, but they certainly would not have any effects on growth and development."
- A new study shows that 73% of patients are afraid of using topical corticosteroid creams for treatment of eczema and other skin conditions, though these fears may be unfounded.
- Weak corticosteroids, such as hydrocortisone, are very safe to use and are unlikely to have an effect on skin thinning or a child's growth; even stronger corticosteroids are unlikely to have negative effects with short-term use.
- Corticosteroid creams and ointments are very effective, and doctors should take time to educate patients about the low risk of side effects.