Topical Steroids for Infant Eczema: Pros and Cons

Topical steroids cause a bit of worry and confusion for parents. The choice to use them or not has caused arguments between the most understanding of couples. I have gone back and forth myself on whether to use a prescription steroid cream for eczema on my son.

Eli was prescribed hydrocortisone, a common corticosteroid cream when he was around four months old. It was not an easy choice to use the topical steroid cream on his face.

Reluctantly, I used them, but I wanted to stop using them when he didn’t show immediate signs of improvement. I want Eli to be itch free and happy, but I would never want to cause him unnecessary harm.

To learn more about his journey read my previous article. 

The choice is ultimately yours, but some information about what you are getting into can help. Remember you are not wrong when you are doing the best for your kids. People are going to judge you no matter what you chose so to Hades with them.

How to Decide to Use an Eczema Steroid Cream

To decide whether or not to use prescription steroid creams for eczema consider three factors:

• how severe the eczema is
• what your doctor suggests
• if the pros outweigh the cons

Here we’ll go over what steroids are and the pros and cons of using them. I will do my best to keep it simple. Lots of pros and cons lists are in medical terms, but that’s not our goal here.

I am going to break it down to you one parent to another based on facts without too much jargon. At the end I will list some articles and journals that have more information.

As always feel free to tell me what you think and leave a comment if something has changed and needs to be updated, it often does.

If you haven’t already read all about what my eczema guide, you may want to read that first. That will give you a better understanding of why you might need topical steroids for eczema.

What are Corticosteroids

Corticosteroids are hormones that are sometimes used to stop an eczema flare-up. They can be prescribed in the form of a cream from a low potency to a high potency.

In highly severe cases steroids can be prescribed orally, but we will focus on topical steroids for eczema today.

The topical steroids are the ones your pediatrician will prescribe to your infant first. The most mild on a scale of 1 to 7 is a hydrocortisone.

To get a corticosteroid cream list along with a pro and con worksheet enter your email here:

Topical steroids are not a cure and they can be used for flare-ups only for a short time. Unless otherwise instructed, they are not to be used any longer than a one week at a time. They are considered safe because they are naturally occurring in the body.

“Steroids are hormonal substances that are produced naturally in the body by the adrenal glands (which are just above each kidney) and by the reproductive organs. There are many different types of steroids and they have different effects on the body” 

Great Ormond Street Hospital for Children

Why your Doctor Will Prescribe Steroids

During a doctor visit your pediatrician will see the eczema and ask you questions about it. They will want to know how your baby is sleeping and if they are scratching.

Even if the doctor doesn’t ask, now is the time to speak up. Do not be afraid. Let the doctor know if your baby has been having hard nights. Every bit of information you give will help.

The doctor will prescribe a steroid for eczema if the doctor notices the eczema is severe. They will be prescribed because steroids reduce inflammation.

The severity of the eczema can be determined by inflammation, or the look of the skin and the behavior that goes along with it.

For example, severe eczema could be skin that is dry, red, itchy or darkened and accompanied by behavior like lack of sleep and constant scratching. Other factors could be timing, if the eczema has been there since your last visit.

Why your Doctor Won’t Always Prescribe Steroids

The doctor will not prescribe steroids right away if the eczema is not severe.

A light rash in one location or a rash that is showing signs of healing, may not be considered severe. If the rash is new and you are concerned the doctor may ask you to track the rash before giving you any medication.

You won’t be prescribed steroids unless the doctor thinks it’s necessary. If the doctor does decide to give you steroids for a skin rash, they will be a low potency steroid cream.

Even though Eli’s eczema was severe, when if his rash ever appeared mild the doctor would suggest using a more gentle topical treatment for eczema.

It’s so important that you follow doctor instruction when using steroids because misuse is the main reason side effects occur. Be extra careful when using steroid cream for baby eczema.

The Pros of Steroids for Eczema

The main pro of using a steroid ointment for eczema is clearing the flare-up.

Problems that come with baby eczema can dampen quality of life for your little one. The plan is often to wait for eczema to go away. While you are waiting you and your baby still need sleep. An itchy, crying, baby is unhappy, so something that can take the pain away, even temporarily, can be useful.

Here some pros for using a topical steroid :

• clear skin long enough to heal scars 
• relieves itch
• reduces redness

Steroids offer relief of the itch and redness, so that the skin has time to heal. It can clear the skin and stop your infant from scratching long enough to help.

Constant itching irritates the skin more and causes a rash or flare-up to last longer. The open wounds that come from scratching can also cause infections to develop.

Worrying About the Cons

Now we will go into the cons because it’s what is on everyone’s mind. So much so, that the term steroid phobia was coined, because some people are so scared of the side effects they won’t even consider them. Stop worrying and you will have done what no parent has ever been able to do.

If you can’t stop worrying, try the technique of considering what is the worst that could truly happen. Then let it go and ask yourself: how likely is it this will happen? Then think of the pros. How do you feel after you’ve considered all options. You should have your answer.

If you do not have your answer, go with your gut. Still no answer, go with your partners gut. No partner, go with your doctor or another teammates advice. No advice, however, will be better than your parental instinct.

The Cons of Steroids for Eczema

The biggest con is that corticosteroid creams can be absorbed by the skin and cause side effects.

Understand they are temporary. Topical steroids do not cure eczema. They are designed to be used for short periods of time.

Each topical steroid works differently for each child’s eczema. Knowing what they treat is important, so understand what topical steroid you are using and what form of eczema your child has.

Here are the side effects:

• skin thinning
• skin thickening
• redness
• steroid withdrawals
• discoloration

Inappropriate use of corticosteroid preparations in terms of any one of the following variables can cause both local and systemic adverse effects: quantity per application, frequency of application, duration of treatment, potency, vehicle used and site of application. Children are especially more prone to the systemic adverse effects of these drugs because their skin has poorly developed barrier function and a large surface area: weight ratio compared to adults. [2] Thus, there is higher potential for clinically significant absorption of the drug into the systemic circulation, which defeats the very purpose of topical therapy.

Indian Journal of Dermatology

This is why I am constantly repeating use cortiocosteroid creams according to your doctors instruction, so that these sorts of side effects are avoided. Children are always more susceptible to issues because they are tiny and cute with tender skin.

Despite side effects doctors still believe they are safe because issues begin because they are used too often or too long. Under proper supervision side effects can be stopped before they become problematic.

You can stop use before symptoms get out of control. Without proper supervision side effects can be missed. It can be difficult to see a child’s side effects when they are masked by eczema symptoms.

Topical Steroid Withdrawals

This particular side effect could be an article on its own because of the misunderstandings surrounding it.

Topical steroid withdrawal is a side effect that will show up in the form of swelling, redness, and burning. It’s rare in children, hard to diagnose, and caused by suddenly stopping topical steroids after overusing them. 

Topical corticosteroids withdrawal (sometimes called “topical steroid addiction” or “Red Skin Syndrome”) appears to be a clinical adverse effect that can occur when topical corticosteroids are inappropriately used or overused, then stopped.

National Eczema Association 

The side effects of steroid withdrawals are hard to determine because they mimic the symptoms of eczema. Without a professional opinion it would be difficult to say that the eczema is not the cause of the symptoms.

So it’s best to tell your doctor if you are choosing to stop using steroids so that you can watch the situation and avoid steroid withdrawal.

When taking Eli off steroids I worried that he had topical steroid withdrawal. I based this assumption on the symptoms I read about. However it turned out, he did not have topical steroid withdrawals.

He was beginning to get worse when I used the steroids on his face. I talked to my doctor and stopped use of the steroids. His answer was to prescribe a different corticosteroid, which I did not use for a long while.

What I didn’t realize about withdrawal at the time, was that the symptoms begin after you stop using steroids not while you are using them.

Partners on Opposite Sides of the Argument

Using a prescripton steroid creams is a devisive topic.

If you and your partner are not on the same page try talking it out with your doctor. Try to get an understanding of how steroids work. Let your doctor explain why they have prescribed the medicine and then you can try to reach a compromise about use.

Take a realistic look at how severe the eczema is and how long it can take to get through the current flare-up.

Try to understand it can be difficult to compromise when you are passionate about what is best for your child. Remember that your partner feels just as passionately about your child as you do.

Try to treat this as a problem you both have to tackle with no wrong or right answer.

Create a plan for what to do with steroids and what to do without steroids. Begin one plan and if it’s not working change the plan.

When you are figuring out what works for your child the plan will change many times. Be honest about what you can handle and about what your child can handle.

My Sons Journey with Topical Steroids

Eli has gone from hydrocortisone to Mometasone. Mometasone is so potent we couldn’t use it on his face.

With infants a lower dosage is better, so your doctor will always start you with the least amount of strength that they can.

However it is best to use the right strength from the start, so you don’t prolong the problems. We never made it to an oral steroid which can be an option. By that time we decided not to use steroids.

I began using a non steroid ointment after seeing an allergist. We got to the root of the problem which led us to the ability to stop the topical steroid use.

Eli had severe eczema, but our doctor still recommended us not to use the steroid cream on sensitive areas.

He had a bad experience with steroids early on. The steroids seemed to clear his eczema right away. But soon they stopped working and when I tried to use them his eczema became worse.

His skin began to thin to the point of constant breakage. Then I learned about the cons of using steroids and found another way. I was able to use them to the point where they worked well and identify when not to use them.

After a long journey of understanding the root cause of Eli’s eczema, we were able to find a plan I was comfortable with that worked for him. 

In the End

We have been through a lot when it comes to steroid use: Using them, phobia of them, not using them, even thinking he had withdrawals. We’ve been through it all and you will go through it all too if you have not already.

It’s okay to change your mind a dozen times and to worry that is natural. Your doctor will upset you, but you have to be open and talk to them. The wormhole of the internet will freak you out, but you have got this. You are a great person and a great parent.

No matter what you decide there is a plan for it. When you end up winging it because that plan didn’t work know that you are not alone. We have been there and so many others have too. When it doesn’t work try again tomorrow. Happy Parenting.

Enter your email to receive a printable list of steroids. in order of their severity. The corticosteroid includes a notes section so you can write down instructions from your doctor on how to use topical steroids properly. Add your own pros and cons based on your child’s eczema. 

References

“Eczema: Steroids and Other Topical Medications.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, 23 Feb. 2017, www.ncbi.nlm.nih.gov/books/NBK424899/.
Furue, M., et al. “Clinical Dose and Adverse Effects of Topical Steroids in Daily Management of Atopic Dermatitis.” The Canadian Journal of Chemical Engineering, Wiley-Blackwell, 14 Jan. 2003, onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-2133.2003.04934.x.
Furue, Masutaka, et al. “Dosage and Adverse Effects of Topical Tacrolimus and Steroids in Daily Management of Atopic Dermatitis.” The Canadian Journal of Chemical Engineering, Wiley-Blackwell, 22 July 2014, onlinelibrary.wiley.com/doi/abs/10.1111/j.1346-8138.2004.tb00673.x.
NHS Choices, NHS, www.gosh.nhs.uk/medical-information-0/medicines-information/short-term-steroid-treatment.
“NEA Task Force Weighs in on Topical Steroid Addiction & Withdrawal.” National Eczema Association, 9 Feb. 2018, nationaleczema.org/warnings-for-topical-steroids-eczema/.
Salomon, Sheryl Huggins. “Do You Need a Topical Steroid to Help Control Your Eczema?” Stroke Center - EverydayHealth.com, Ziff Davis, LLC, 7 May 2018, www.everydayhealth.com/eczema/treatment/what-are-topical-steroids-you-need-manage-eczema/.
Saraswat A. Topical corticosteroid use in children: Adverse effects and how to minimize them. Indian J Dermatol Venereol Leprol [serial online] 2010 [cited 2018 Nov 28];76:225-8. Available from: http://www.ijdvl.com/text.asp?2010/76/3/225/62959

What have you decided to do about steroids? Have you or your child ever used them? Let me know in the comments below and don’t forget to sign up to get your free steroid guide today.