What topical corticosteroid (steroid) is safe for facial use in adults with an atopic dermatitis (eczema) flare-up?

From the Guidelines

For adults experiencing eczema flare-ups on the face, the safest steroid cream to use is a medium potency topical corticosteroid, such as fluticasone propionate 0.05% cream, applied intermittently, twice a week, as maintenance therapy to reduce disease flares and relapse. This recommendation is based on high certainty evidence from a recent study published in the Journal of the American Academy of Dermatology 1. When active disease is present, twice daily application for a short period, such as up to 4 weeks, can be used to achieve treatment success.

Key points to consider when using steroid creams on the face for eczema flare-ups include:

• Limiting the use of steroid creams to the shortest duration necessary to control symptoms
• Avoiding the use of high potency steroids on the face due to the risk of atrophy and other adverse events
• Using a medium potency steroid, such as fluticasone propionate 0.05% cream, which has a more favorable adverse event profile for longer courses of treatment
• Applying a thin layer of the steroid cream to the affected areas, as directed
• Transitioning to regular moisturizing after the flare subsides and only using the steroid cream when symptoms return

It is essential to follow the recommended usage and maintenance therapy to minimize the risk of side effects, such as skin thinning, telangiectasia, or hypopigmentation, and to maintain the health and integrity of the facial skin. If symptoms do not improve within two weeks, it is crucial to consult a healthcare provider to reassess the treatment approach and rule out other conditions. The use of medium potency steroids, like fluticasone propionate 0.05% cream, as maintenance therapy, twice a week, can help reduce disease flares and relapse, as demonstrated in a study where patients were 7.0 times less likely to have an AD relapse 1.

From the FDA Drug Label

Hydrocortisone Butyrate Ointment, 0.1% is indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. The hydrocortisone butyrate cream is safe for the face when having eczema flare up in adults, as it is indicated for the relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses, which includes eczema.

• Key points:
  • It is for external use only
  • Avoid contact with the eyes
  • The treated skin area should not be bandaged or otherwise covered or wrapped as to be occlusive unless directed by the physician 2 2

From the Research

Steroid Creams for Eczema on the Face

When it comes to treating eczema flare-ups on the face in adults, the choice of steroid cream is crucial. The following points highlight the key considerations:

• Potency of Steroid Creams: Studies have shown that potent and moderate topical corticosteroids are probably more effective than mild topical corticosteroids in treating eczema, especially in cases of moderate or severe eczema 3.
• Specific Steroid Creams: Methylprednisolone aceponate has been found to be effective in treating eczema, including facial eczema, with rapid relief from itch and excellent local and systemic tolerability 4, 5.
• Application Frequency: Applying potent topical corticosteroids once a day probably does not decrease the number of participants achieving treatment success compared to twice daily application 3.
• Prevention of Relapse: Weekend (proactive) therapy with topical corticosteroids probably results in a large decrease in the likelihood of a relapse from 58% to 25% 3.
• Safety Considerations: Local adverse events, such as abnormal skin thinning, are more common with higher-potency topical corticosteroids, but the overall frequency is low 3.
• Alternative Treatments: Other treatments, such as calcineurin inhibitors, wet wrap therapy, anti-histamines, and vitamin D supplementation, may be considered in addition to or instead of steroid creams 6.

Key Findings

Some key findings from the studies include:

• Methylprednisolone aceponate is effective in treating eczema, including facial eczema, with rapid relief from itch and excellent local and systemic tolerability 4, 5.
• Potent and moderate topical corticosteroids are probably more effective than mild topical corticosteroids in treating eczema, especially in cases of moderate or severe eczema 3.
• Systemic corticosteroids should generally be avoided in the treatment of atopic dermatitis, but may be used rarely in severe cases under certain circumstances 7.