What corticosteroid (cortisone) can be used on the skin for eczema in New Zealand?

From the Guidelines

In New Zealand, hydrocortisone (0.5% or 1%) is a commonly used corticosteroid for treating mild eczema on the skin, particularly on sensitive areas like the face, as it is essential to use the least potent preparation required to keep the eczema under control 1. When managing eczema, it's crucial to consider the age of the patient, the site to be treated, and the extent of the disease when prescribing topical corticosteroids 1. Some key points to consider when using corticosteroids for eczema include:

• Using the lowest effective strength, especially on thin skin areas
• Applying the medication thinly to affected areas once or twice daily
• Typically treating for 1-2 weeks for acute flares, with longer treatment needed for chronic cases
• Carefully monitoring the patient's response to the medication
• Using moisturizers alongside corticosteroids, applied after the medication has been absorbed
• Considering "weekend therapy" for maintenance after the initial flare is controlled It's also important to note that deterioration in previously stable eczema may be due to secondary bacterial infection or to development of a contact dermatitis, and attempts to eradicate the house dust mite are not currently recommended 1. The goal of treatment is to alleviate redness, itching, and swelling, while minimizing the risks associated with corticosteroid use, and hydrocortisone is a suitable option for mild eczema in New Zealand 1.

From the FDA Drug Label

Topical corticosteroids are indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. The corticosteroid betamethasone valerate can be used on the skin for eczema in New Zealand 2.

• Key points:
  • It is a topical corticosteroid.
  • It is used for the relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.
  • Eczema is a type of dermatosis that may respond to corticosteroid treatment.

From the Research

Topical Corticosteroids for Eczema in New Zealand

• Topical corticosteroids (TCS) are a core component of therapy for managing inflammation in atopic eczema, as stated in the study 3.
• The study 3 also mentions that TCS are often underutilised by many parents due to corticosteroid phobia and unfounded concerns about their adverse effects.
• However, the study 3 found that TCS use in paediatric eczema does not cause atrophy, hypopigmentation, hypertrichosis, osteoporosis, purpura, or telangiectasia when used appropriately as per guidelines.

Alternatives to Topical Corticosteroids

• Pimecrolimus cream 1% has been shown to effectively control atopic eczema when applied twice daily from the first signs or symptoms of eczema until clearance, as stated in the study 4.
• The study 4 also found that pimecrolimus cream 1% has a favourable safety profile, lacking topical corticosteroid-related side-effects such as skin atrophy.
• Tacrolimus is another alternative to topical corticosteroids, and the study 5 found that it is effective in treating atopic dermatitis, with over 90% improvement in disease severity in 75% of patients after 1-year treatment.

Comparison of Topical Corticosteroids

• The study 6 compared different potencies of topical corticosteroids and found that potent and moderate topical corticosteroids are probably more effective than mild topical corticosteroids, primarily in moderate or severe eczema.
• The study 6 also found that there is uncertain evidence to support any advantage of very potent over potent topical corticosteroids.
• The study 7 compared pimecrolimus with other topical comparators and found that pimecrolimus is less effective than moderate and potent corticosteroids and 0.1% tacrolimus.

Usage of Topical Corticosteroids in New Zealand

• The study 3 is an Australasian consensus statement, which includes New Zealand, and provides guidance on the use of topical corticosteroids in paediatric eczema.
• The study 3 recommends that TCS should be the cornerstone treatment of atopic eczema in children, and that they are very effective treatments for eczema when used appropriately.