What topical cream is recommended for treating skin conditions like eczema or dermatitis?

Topical Corticosteroids Are the Mainstay Treatment for Eczema and Dermatitis

For adults with atopic dermatitis or eczema, topical corticosteroids are strongly recommended as first-line treatment, with the choice of potency guided by disease severity and anatomical location. 1

Treatment Algorithm by Disease Severity

Mild-to-Moderate Eczema/Dermatitis

• Start with medium-potency topical corticosteroids (e.g., hydrocortisone 1% for mild cases, or prednicarbate 0.02% cream for moderate cases) applied once or twice daily 1, 2
• Medium-potency steroids can be used for longer courses due to favorable adverse event profiles compared to high-potency agents 1
• Once daily application is as effective as twice daily for potent topical corticosteroids, so once daily dosing is sufficient 1, 3

Moderate-to-Severe Eczema/Dermatitis

• Use potent topical corticosteroids initially to rapidly control active disease 1
• Potent corticosteroids result in 70% treatment success versus 39% with mild-potency agents 3
• Very high-potency steroids should be reserved for short courses only due to atrophy risk 1

Anatomical Considerations

Critical: Use lower potency agents on thin-skinned areas including the face, neck, genitals, and body folds to minimize adverse effects 1, 2

• Face and intertriginous areas: Low-potency (hydrocortisone 1%) 4, 2
• Body and extremities: Medium to potent potency based on severity 1, 2
• Thick, lichenified areas: Potent to very potent potency 1

Maintenance Therapy to Prevent Flares

For patients achieving control, intermittent use of medium-potency topical corticosteroids twice weekly (weekend/proactive therapy) is strongly recommended to reduce disease flares and relapse 1

• Weekend proactive therapy decreases relapse likelihood from 58% to 25% 3
• This approach allows maintenance without continuous steroid exposure 3

Alternative First-Line Options for Mild-to-Moderate Disease

When corticosteroid adverse effects are a concern, particularly for facial or long-term use:

• Tacrolimus 0.03% or 0.1% ointment (strong recommendation, high-certainty evidence) 1
• Pimecrolimus 1% cream (strong recommendation, high-certainty evidence) 1
• Crisaborole ointment (strong recommendation, high-certainty evidence) 1
• Ruxolitinib cream (strong recommendation, moderate-certainty evidence) 1

Essential Adjunctive Measures

Moisturizers are strongly recommended for all patients with atopic dermatitis and should be applied liberally, ideally after bathing 1

• Emollients provide surface lipid film that retards evaporative water loss 1
• Use soap substitutes (dispersible creams) instead of traditional soaps which remove natural skin lipids 1
• Apply moisturizers at least once daily to the whole body 1

Duration of Treatment

• Super-high-potency corticosteroids: up to 3 weeks maximum 2
• High- or medium-potency corticosteroids: up to 12 weeks 2
• Low-potency corticosteroids: no specified time limit 2
• Stop corticosteroids for short periods when possible to minimize adverse effects 1

Common Pitfalls to Avoid

Do NOT use topical antihistamines (conditional recommendation against) 1

Do NOT routinely use topical antimicrobials or antiseptics unless there are clinical signs of secondary bacterial infection 1

Avoid alcohol-containing lotions or gels as they enhance skin dryness 1

Do not underdose: Use the fingertip unit method—one fingertip unit covers approximately 2% body surface area 2

Adverse Event Monitoring

• Abnormal skin thinning occurs in approximately 1% of patients, primarily with higher-potency agents 3
• Risk increases with prolonged use, large application areas, occlusion, and use on thin-skinned areas 2
• In children, use lower potencies and shorter durations 2
• Systemic absorption and pituitary-adrenal axis suppression are risks with very potent steroids, particularly in children 1