What are the treatment options for eczema after hydrocortisone (corticosteroid)?

From the Guidelines

For eczema treatment after hydrocortisone, stepping up to a medium-potency topical steroid like triamcinolone 0.1% cream or considering topical calcineurin inhibitors (TCI) such as tacrolimus 0.03-0.1% or pimecrolimus 1% cream is recommended, as they are effective steroid-sparing agents for acute and maintenance therapy of atopic dermatitis (AD) 1. When considering treatment options, it's essential to note that moisturizers are front-line therapy for both acute and proactive treatment of AD, and their application after bathing is crucial 1.

Key Treatment Considerations

• Intensive moisturizing using fragrance-free emollients like CeraVe, Eucerin, or Vanicream applied at least 2-3 times daily, especially after bathing while skin is still damp, to help repair the skin barrier.
• Topical calcineurin inhibitors (TCI) like tacrolimus 0.03-0.1% or pimecrolimus 1% cream, which are effective for acute and maintenance therapy of AD, with the consideration of cutaneous side effects 1.
• Phototherapy, which is recommended for recalcitrant AD or after failure of first-line treatment with topical agents, with a preference toward narrow-band UVB 1.

Additional Treatment Options

• Oral antihistamines such as cetirizine 10mg daily can help manage itching.
• Avoiding triggers like harsh soaps, fragrances, and extreme temperatures.
• If infection is suspected (honey-colored crusts, increased redness, pain), seeking evaluation for possible antibiotics, as systemic antibiotics are recommended for patients with evidence of infection (S aureus) 1.

Systemic Options

• For widespread or severely uncontrolled eczema, systemic options like dupilumab injections or oral immunosuppressants such as cyclosporine, azathioprine, and methotrexate may be necessary under specialist care, as they are recommended for a subset of patients with severe AD refractory to topical treatments and phototherapy 1.

From the FDA Drug Label

ELIDEL Cream is for use after other prescription medicines have not worked for you or if your doctor recommends that other prescription medicines should not be used The treatment options for eczema after hydrocortisone (corticosteroid) include:

• Topical calcineurin inhibitors like pimecrolimus (ELIDEL Cream) It can be used on the skin for short periods, and if needed, treatment may be repeated with breaks in between 2

From the Research

Treatment Options for Eczema After Hydrocortisone (Corticosteroid)

• After the use of hydrocortisone, a corticosteroid, treatment options for eczema may include:
  • Tacrolimus: a topical immunomodulator that has been shown to be effective in treating moderate to severe atopic dermatitis, with over 90% improvement in disease severity in some patients 3
  • Pimecrolimus: a topical immunomodulator that has been shown to be effective in preventing flares and improving quality of life in patients with eczema, although it may be less effective than topical corticosteroids 4
  • Other topical corticosteroids: such as triamcinolone acetonide and betamethasone valerate, which may be more effective than pimecrolimus but also have a higher risk of adverse effects 4
• The choice of treatment option depends on the severity of the eczema, the patient's medical history, and the potential risks and benefits of each treatment 5, 6
• It is essential to note that topical corticosteroids, including hydrocortisone, should be used for limited periods and under the guidance of a healthcare professional to minimize the risk of adverse effects 7, 6

Considerations for Treatment

• The potency of the topical corticosteroid: higher potency corticosteroids may be more effective but also have a higher risk of adverse effects 5, 6
• The frequency and duration of application: applying topical corticosteroids once or twice daily for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 6
• The skin location and total surface area treated: topical corticosteroids should be used with caution on sensitive areas, such as the face and genitals 6
• Patient education: correct patient application is critical to successful use, and patients should be taught how to apply topical corticosteroids using the fingertip unit method 6