There are four strengths of the types of steroids used directly on the skin to treat eczema.
The four strengths are
Mild topical steroids are the weakest types of steroids. This is the strength most used, and most recommended to use. It is good for mild and moderate eczema.
An example of a mild treatment is Hydrocortisone 0.5-2.5%. Its active ingredient is Hydrocorisone.
You can buy Hydrocortisone cream 0.1-1% over the counter at a chemist. It comes in a 15g tube. You can buy branded cream or the chemist's own make.
They all contain the same basic ingredients, though some of the ingredients may be different. This might be something to look at if a certain treatment doesn’t work, or if an allergy occurs.
Other mild treatments available include
These types of steroids all contain Hydrocortisone, in different amounts. The % amount is the % of the cream containing the active ingredient.
These contain moderate strength steroids. They can be up to 25 times stronger than one of the mild types of steroids.
A moderate steroid is useful on arms and legs, where the skin is slightly thicker.
An example of a moderate treatment is Eumovate. Its active ingredient is Clobetasone butyrate 0.05% w/w.
You can buy Eumovate 0.05% w/w over the counter as a cream or ointment. It comes in a 15g tube.
I have used this cream when I have needed a slightly stronger treatment. It is very handy to be able to buy it at a chemist. Although I only use this as a short term solution.
If my eczema doesn’t improve I then go to my doctor. They may prescribe a stronger or different treatment. He is then able to monitor its use and the effect it has on my skin.
Some other moderate strength treatments available are
Potent topical steroids contain strong strength steroids. They can be up to 150 times stronger than a mild treatment.
They are used when mild and moderate types of steroids aren’t effective. They are often used on the palms of the hands and soles of the feet.
They are usually only available on prescription. This enables your doctor to monitor how the treatment is used, and how effective it is. They are also able to advise you on how much you should use, and how often to use it.
One example of a potent treatment is Betnovate. It's active ingredient is betamethasone valerate. It contains 0.122% w/w. It is available only on prescription. It comes in 15g, 30g and 100g tubes, and a 500g pot.
Some other potent treatments available are
Very potent topical steroids contain the highest strength steroids. They can be up to 600 times stronger than a mild treatment.
These are only used when eczema is proving hard to clear. They are only available on prescription. They are not recommended for use on thin areas of skin that absorb treatment quickly. Including the face, eyelids and genitals.
They are usually used for up to 2 weeks to help clear a severe flare up. When there is an improvement in the condition a weaker strength treatment will then be used.
One example of a very potent treatment is Dermovate. Its active ingredient is clobetasol propionate. It contains 0.05% w/w. It comes in 25g and 30g tubes, and a 100g tub, as cream and ointment.
Some of the other very potent topical steroid treatments available are
Different treatments contain different amounts of their active ingredient. Sometimes a mild treatment has a higher percentage of an active ingredient in than a very potent one. It does not make it stronger. It just has more of a weaker steroid in it.
The rest of the ingredients in a topical steroid tend to be the same as is in an emollient. They have a moisturising effect on the skin.
Although these types of steroids should not be used solely as a moisturiser. Another emollient should be used alongside. It helps to reduce the amount of steroid treatment needed.
When using a topical steroid and emollient together allow 30 minutes after putting one on before applying the other. It allows the first treatment applied to absorb into the skin properly.
In some topical corticosteroids other ingredients are added. These other ingredients help with other aspects of having eczema.
These ingredients are contained in other treatments than the ones mentioned.
I have been prescribed Fucibet when my eczema has become infected. It helps clear up the worse of the condition. When it has cleared enough I can then go back to a normal topical steroid until it is manageable with an emollient. I use an emollient throughout the whole treatment.
It is important to remember that with any topical steroid treatment you buy over the counter or are prescribed, you should always follow the directions of use.
They are an important part of the treatment of eczema but they shouldn’t be completely relied on.
Using them when needed, alongside emollients and avoiding irritants and allergens can help limit the number of outbreaks you have.