As a rule, a topical steroid course is used when one or more patches of an eczema flare-up. The purpose of treatment is to clear the red patches and then to avoid the steroid treatment.

It is common practice to use the lowest-strength topical steroid, which clears the flare-up. So, for example, hydrocortisone 1 per cent is sometimes used, particularly when treating children. This also works well. If there is no improvement after 3-7 days, a more potent topical steroid is administered. For severe flare-ups, a potent topical steroid can be allocated from the outset.

Often two or more preparations with different strengths are used at the same time. For example, a mild steroid for the face and a moderately strong steroid for eczema on the arms or legs’ thicker skin. A very strong topA powerful is also required for eczema on the palms and soles of adults’ feet because these areas have thick skin.

You should use topical steroids before the flare-up is entirely gone and then avoid using them. In 0some instances, a course of medication for 7-14 days is enough to clear a flare-up of eczema. In certain cases, a longer course is required.

Many people with eczema need a course of topical steroids now and then to clear a flare-up. The frequency of flare-ups and the number of times a course of topical steroids is required differ significantly from person to person.

Once you finish a topical steroid course, continue to use moisturisers (emollients) every day to help avoid a further flare-up.

Short bursts of high-strength steroid as an alternative

For adults, a short course (usually three days) of a powerful topical steroid can be an option to treat a mild-to-moderate flare-up of eczema. A potent topical steroid also works quicker than a mild one. (This is in comparison to the conventional practice of using the lowest strength wherever possible. However, studies have shown that using high power for a short time can be more convenient and is believed to be safe.)

Short-duration treatment to avoid flare-ups (weekend therapy)

Some people have regular flare-ups of eczema. For example, a flare-up can subside well with topical steroid therapy. Then, within a few weeks, a flare-up returns. In this case, one alternative that might help is to apply steroid eczema cream on the usual sites of flare-ups for two days a week. This is also called weekend counselling. This attempts to avoid a flare-up from happening. In the long run, it may mean that the overall amount of topical steroid used is less than if each flare-up were handled as and when it happened. You should need to discuss this choice with your doctor.

How do I apply topical steroids?

Topical steroids are usually used once a day (sometimes twice a day – the doctor will advise) (sometimes twice a day – your doctor will recommend). Gently rub a small amount (see ‘Having the dosage right – the fingertip machine’, below) on to areas of skin that are inflamed. (This is different from moisturisers (emollients) which should be spread liberally all over.) Gently massage the cream or ointment onto the skin until it has vanished. Then wash your hands (unless your hands are in the treated area) (unless your hands are in the treated area).