Applying Topical Treatments for Eczema

Topical Steroids

Topical steroids, also known as topical corticosteroids, are the most common treatment for eczema. Alongside emollient therapy, they are very effective at reducing the symptoms of itch, rash, swelling and redness in the skin. Topical corticosteroids are available in many different preparations including ointments, creams and lotions and vary in strength from very mild to very strong potency.

Your health care professional will prescribe the treatment based on your age, the severity of your eczema, and where the treatment is to be applied. For instance, you may require a stronger topical steroid on areas where the skin is very thick such as the palms of your hands and soles of your feet, and a milder topical steroid for areas where the skin is very thin, in areas such as your face, genital area and skin creases.

Application of topical steroids

Topical corticosteroids should be applied in a downwards direction to prevent a build-up of the cream or ointment in the hair follicles. Apply enough cream or ointment to cover the affected area until it glistens. The fingertip measurement is a useful guide to help you apply your topical steroid.

Fingertip measurement guide

A fingertip unit (FTU) is the amount of cream or ointment that just covers the end of an adult finger from the first bend in the finger to fingertip. This should be enough to cover an area of skin the size of two adult hands.

Take Care – topical steroids should not be applied to skin infections such as impetigo, cold sores or fungal infections unless advised by your doctor. When used as prescribed by your doctor or nurse in the correct strength and frequency of application, topical corticosteroids are a safe and effective treatment for eczema management alongside regular emollient therapy.

Antibiotic and antiviral therapies

Infection can be one of the most common reasons for eczema that doesn’t respond to treatment. Bacterial, fungal and viral infections can all aggravate the skin and lead to worsening eczema. Antibiotic and antiviral therapies can be very useful in managing infected eczema, with many topical treatments available. Antiseptic or antimicrobial preparations also may be recommended for bathing and showering to reduce or prevent infection.

It is recommended to only use these treatments for short periods to treat the infection, unless advised otherwise. This is to reduce the risk of developing resistance to these medications.

Topical Calcineurin Inhibiters

Topical calcineurin inhibiters are used for more difficult to treat eczema, where topical steroids have not been tolerated or where long term use of topical steroids is not suitable. Treatments include Pimecrolimus, a cream based treatment and Tacrolimus, an ointment based treatment.

Topical calcineurin inhibiters work by altering the immune system to block one of the chemicals that contributes to the flare of eczema. They are often used for delicate areas where the skin is thin such as the face and neck.

Topical JAK inhibiters

Topical Janus kinase inhibiters or JAK inhibiters are designed to target specific areas of the immune system and block the chemical messengers that activate inflammation and itch in eczema. These treatments are called biologic therapies and are available as injections, tablets, and topical creams. They are very new treatments and therefore require regular monitoring for any side effects. There are many topical treatments available for the treatment of eczema, but for these treatments to be effective it is essential to maintain a good skin care regime that involves regular cleansing and moisturising as well as the application of topical medicated treatments to help to manage the eczema and prevent infection.

Please remember to observe good hand hygiene and always wash your hands before and after applying topical treatments.

If you feel your eczema is worsening or not responding to the treatment prescribed, please speak with your doctor or nurse for further advice and support

For further support and advice please visit the Allergy UK website www.allergyuk.org or call our Helpline on 01322 619898

The production of this video has been made possible by Eli Lilly and Sanofi