What is the appropriate use of topical corticosteroid (steroid) cream for dermatitis (rash)?

From the Guidelines

Topical corticosteroid creams should be used with caution for dermatitis, starting with low-potency options like hydrocortisone 1% for mild to moderate cases, and limiting use to 1-2 weeks to minimize risks of skin atrophy, striae, and other adverse effects. When using steroid creams, it is essential to clean the area before application, use only the amount needed to cover the rash thinly, and wash your hands afterward [ 1 ]. The most common local skin adverse effects of topical corticosteroid use include skin atrophy, striae, folliculitis, telangiectasia, and purpura, which can be more pronounced in areas like the face and intertriginous areas [ 1 ].

Key Considerations for Topical Corticosteroid Use

• For mild to moderate rashes, start with a low-potency steroid cream like hydrocortisone 1%, which is available over-the-counter.
• Apply a thin layer to the affected area 1-2 times daily for up to 7 days.
• For more severe or persistent rashes, medium-potency options like triamcinolone 0.1% or high-potency options like betamethasone 0.05% may be needed, but these require a prescription.
• Limit use to 1-2 weeks to avoid side effects like skin thinning, discoloration, or increased susceptibility to infection.
• Steroid creams work by reducing inflammation, which decreases redness, itching, and swelling [ 1 ].

Monitoring and Supervision

Regular clinical review is necessary, and no unsupervised repeat prescriptions should be made [ 1 ]. The use of potent or very potent preparations should be under dermatological supervision. It is also recommended to have periods each year when alternative treatment is employed to minimize the risks associated with long-term topical corticosteroid use [ 1 ]. If the rash doesn't improve after a week, worsens, shows signs of infection, or affects sensitive areas, consult a healthcare provider for proper diagnosis and treatment.

From the FDA Drug Label

Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema psoriasis poison ivy, oak, sumac insect bites detergents jewelry cosmetics soaps seborrheic dermatitis Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily Warnings For external use only

The appropriate use of topical corticosteroid (steroid) cream for dermatitis (rash) is to:

• Temporarily relieve itching associated with minor skin irritations, inflammation, and rashes
• Apply to the affected area not more than 3 to 4 times daily for adults and children 2 years of age and older
• Consult a doctor for use in children under 2 years of age or under 12 years of age for external anal and genital itching
• Use for external purposes only and avoid contact with eyes 2, 2, 2

From the Research

Appropriate Use of Topical Corticosteroid Cream for Dermatitis

• The use of topical corticosteroid cream for dermatitis should be carefully considered, as it can lead to allergy or dependence 3.
• Topical corticosteroids can be effective in treating seborrheic dermatitis, with studies comparing the efficacy of sertaconazole 2% cream and hydrocortisone 1% cream showing similar results 4, 5.
• However, long-term use of topical corticosteroids can lead to skin atrophy and telangiectasia, highlighting the need for caution and monitoring 6.
• Alternative treatments, such as sertaconazole 2% cream, may be considered as a safer option for treating atopic dermatitis, with studies showing similar efficacy to hydrocortisone 1% ointment 7.

Considerations for Treatment

• The choice of topical corticosteroid cream should be based on the severity of the dermatitis and the individual patient's response to treatment 3.
• Patients with a history of leg ulcers, stasis dermatitis, atopic dermatitis, or contact dermatitis may be at higher risk of developing allergy or dependence on topical corticosteroids 3.
• Regular monitoring and follow-up are essential to assess the effectiveness of treatment and minimize the risk of adverse effects 6, 7, 5.

Alternative Treatments

• Sertaconazole 2% cream has been shown to be a effective alternative to topical corticosteroids for treating seborrheic dermatitis and atopic dermatitis, with fewer adverse events 4, 7, 5.
• Pimecrolimus 1% cream may also be considered as a safer option for treating atopic dermatitis, particularly in sensitive skin areas like the face 6.