From the Guidelines
Steroid treatment should be considered for extreme eczema only when other treatments have failed, and the decision to use systemic steroids should never be taken lightly. For severe cases, potent topical corticosteroids like betamethasone valerate 0.1% or fluocinonide 0.05% are typically recommended, applied thinly to affected areas twice daily for 1-2 weeks 1. The following key points should be considered when treating extreme eczema:
- Use the lowest effective potency of topical corticosteroids to minimize side effects
- Follow a "weekend therapy" maintenance approach (applying steroids only on weekends after initial control) to reduce the risk of adverse effects
- Incorporate emollients like petroleum jelly or ceramide-containing moisturizers applied at least twice daily to help manage the condition
- For extremely severe or widespread eczema, oral prednisone may be prescribed, usually starting at 40-60mg daily with a gradual taper over 2-3 weeks, but this should be done with caution and under close medical supervision 2
- In treatment-resistant cases, alternative therapies such as phototherapy or systemic therapies like immunosuppressants, corticosteroids, antimetabolites, or Janus kinase (JAK) inhibitors may be considered 1
- The decision to initiate these more advanced therapies should be made using shared decision-making between patients and clinicians, taking into account the severity of eczema, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1.
From the FDA Drug Label
Topical corticosteroids such as clobetasol propionate are effective in the treatment of corticosteroid-responsive dermatoses primarily because of their anti-inflammatory, antipruritic, and vasoconstrictive actions. Clobetasol propionate, a corticosteroid, has been shown to have topical (dermatologic) and systemic pharmacologic and metabolic effects characteristic of this class of drugs The clobetasol propionate steroid treatment can be used for extreme eczema due to its anti-inflammatory and immunosuppressive effects.
- It is effective in treating corticosteroid-responsive dermatoses.
- However, it is essential to use it with caution and under medical supervision due to potential side effects, such as HPA axis suppression and systemic toxicity 3, 4.
- Patients should be evaluated periodically for evidence of HPA axis suppression.
- The treatment should be used for the shortest duration possible to achieve the desired therapeutic effect 4.
From the Research
Steroid Treatment for Extreme Eczema
- The use of topical corticosteroids, such as clobetasol propionate, has significantly enhanced the treatment of patients with dermatoses like eczema 5.
- Clobetasol propionate emollient cream is well tolerated and effective in courses of up to 4 weeks for the treatment of patients with atopic dermatitis 5.
- Topical corticosteroids are often used in combination with other treatments, such as phototherapy, for the management of eczema 6, 7, 8, 9.
Phototherapy as a Treatment Option
- Phototherapy is a second-line treatment for moderate to severe atopic dermatitis that effectively decreases cutaneous inflammation with minimal or no systemic side effects 6, 7, 8, 9.
- Different forms of phototherapy, including narrowband ultraviolet B (NB-UVB), ultraviolet A1 (UVA1), and broadband ultraviolet B (BB-UVB), have been shown to be effective in treating eczema 6, 7, 8, 9.
- Phototherapy can be used as monotherapy or in combination with systemic drugs, such as corticosteroids, for the treatment of eczema 6, 8.
Safety and Efficacy of Phototherapy
- Phototherapy is generally considered to be safe and well tolerated, with a low but established percentage of short-term and long-term adverse effects 6, 7, 8.
- The most common adverse effects of phototherapy include photodamage, xerosis, erythema, actinic keratosis, sunburn, and tenderness 6, 8.
- The efficacy of phototherapy in treating eczema has been established in adults and children, as well as for acute and chronic cases 6, 7, 8.