Topical corticosteroids have been the primary prescribed eczema therapy for about 50 years; they are effective for both acute and chronic disease. Formulated in potencies ranging from extremely high strength to low over-the-counter strength, these medicines are available in a number of different formulations, including ointments, creams, lotions, solutions, gels, sprays, foam, oil and steroid-impregnated tape.
Ointments have the fewest additives and help retain moisture. Creams and lotions may be better tolerated in excessive heat or humidity, are easier to apply and are less greasy; they may, however, contribute to skin irritation and xerosis (abnormally dry skin) in some patients. Solutions and foams are useful for eczema of the scalp or other areas that have hair, although the alcohol in them can be irritating when used on inflamed or excoriated (scraped or abraded) skin.
While generic formulations are required to have the same active ingredients and concentration as the original product, many do not, and bioequivalence can vary significantly.
Adverse effects reported with topical corticosteroid therapy include local effects, such as skin atrophy (thinning), striae (stretch marks), telangiectasia (spider veins), perioral dermatitis (link to page) and acne-form eruptions as well as less frequent systemic effects, such as hypothalamic-pituitary-adrenal axis suppression and cataracts. Most adverse effects are associated with use of very strong topical steroids, although chronic use of less potent steroid preparations, especially on the face, groin or axillae, can lead to local side effects. Ingredients in topical steroid bases and rarely the corticosteroid molecule itself can cause an allergic contact dermatitis.