There are a wide range of prescription eczema creams available. Here the Caidr team will break them down into the different groups of medications that are available, and within those groups, there are many more different types of medications.
Emollients are moisturising treatments applied directly to the skin to soothe and hydrate the skin. They cover the skin with a protective film to trap moisture, protect the skin and dampen down inflammation. Emollients are often used to help manage dry, itchy or scaly skin conditions such as eczema. They can come as cream, ointments, lotions, gels and sprays. Some emollients can also be used as soap substitutes in the bath or shower. All emollients are safe for babies, the elderly and women who are pregnant or breastfeeding. Emollients can be purchased over-the-counter, but your doctor will happily prescribe large volumes for you on prescription which will work out cheaper if you need large volumes. Ointments are greasier but may be more effective than creams, which are more easily absorbed. Creams, lotions and gels have a higher water content, but preservatives to make sure bacteria doesn't grow, and this can make eczema worse if you are sensitive. If you have a long-standing skin condition such as eczema or psoriasis, you should be using emollients as maintenance to keep your skin in good condition. If your condition flares up, this is when you may need a steroid prescribed, but you should still continue with emollients twice daily or more throughout treatment. Just wait 20 minutes or so after applying the steroid cream, so that it can be fully absorbed, before applying your emollient.
Topical formulations of steroids are used to treat skin inflammation due to eczema for a short period. Although 1% hydrocortisone can be purchased over-the-counter, this is the mildest steroid and anything stronger will require a prescription from your doctor. They mostly come as creams, but your doctor may sometimes prescribe an ointment, depending on your condition and preference. Doctors use a steroid ladder for prescribing steroids to patients, often starting with the mildest steroid that's appropriate for your condition, but they can move up the ladder to a more potent (stronger) one if it's not effectively clearing your condition. Topical steroids reduce inflammation in the skin, have immunosuppressive properties and vasoconstrictive properties. In adults, your doctor may start with a prescription-only moderate-strength steroid and work upwards but it all depends on the severity of the skin inflammation. Milder concentrations are used on the face and in children, as steroids are absorbed more readily so concentrations can build up. Steroid creams usually sting when they are first put on irritated or broken skin, but it should ease after a few seconds, and is part of your disease process rather than an allergy. If burning persists or your skin appears even more irritated, do discuss this with your doctor. You should apply steroids thinly and enough to make the skin shiny. Only apply them to affected areas, and only for the recommended amount of time. They carry a risk of side effects if used for a prolonged period, such as skin thinning or discolouration, but they are safe if you only use them when needed and you take regular breaks – such as two weeks of treatment, then one week off – or as your doctor advises. Most steroids reduce redness, soreness and itchiness within a few days of use, then you continue with your emollient to keep eczema at bay.
There are other treatment options if your eczema has not managed to be controlled adequately with emollients and steroid creams prescribed by your doctor. If a strong steroid had been tried but your condition is still severe, your doctor may refer you to a dermatologist, a doctor that specialises in skin conditions. They may prescribe strong steroid creams in different regime to keep eczema at bay, and they may consider if allergies or infection is adding to the problem. They have other therapies available, such a light therapy or medications to suppress your immune system, but these are reserved for only the most severe of cases.
Breaks in the skin can allow pathogens to take advantage. If you have a bacterial skin infection, it makes your eczema worse. Indications of an infection are your usual eczema treatment, like a steroid cream, isn't having the same effect, or the skin looks red and weeping or crusty. You should see your doctor, and they may take a skin swab and prescribe antibiotics. Antibiotic cream is not usually enough, so they are likely to be in tablet form, or liquid for children. Infected eczema usually needs both a steroid cream and antibiotics to get better, and emollients throughout and afterwards to help skin repair.