Topical corticosteroids (TCSs) are used to suppress inflammation, which often considerably reduces itching. Treatment should start as soon as a flare-up is recognised and continue until 48 hours after the inflammation has subsided. The skin may not be back to normal, but it will have stopped looking angry and sore.

A moderate or potent TCS is usually needed to bring a flare-up under control; it is better to use a higher potency agent for a short time than a low potency one over a long period.

Some parents are reluctant to use TCSs on their child’s skin because of so-called ‘steroid phobia’, but if TCSs are used for a short period of time and their use ‘stepped down’, there is no risk of skin thinning. Parents may also be concerned about the warning on the information leaflet that says it should not be used on broken skin, as most patches of eczema have small breaks in the skin with visible blood flecks. It is safe to apply a TCS to such skin, but not to large raw areas. 

OTC topical corticosteroids

OTC hydrocortisone creams and ointments can be sold for flare-ups of eczema in children over 10 years of age. Patients who have not previously been diagnosed with atopic eczema, or who have widespread and/or severe eczema, should be referred to a GP. Hydrocortisone 1% cream and ointment can be sold for use in children under 10 years of age on medical advice (i.e. recommended by a GP who has not provided a prescription).

Clobetasone butyrate 0.05% cream (moderate potency) may be sold for the short-term treatment and control of small patches of atopic eczema in adults and children over 12 years of age.