Prescribing topical steroids to manage flares

To manage eczema flares, your patients may need more than emollient therapy alone and guidelines recommend the use of topical steroids^1,4, which come as creams and ointments, in a range of strengths (mild, moderate, potent and very potent).

Product7,8			Severity of eczema
Brand	Generic	Potency	Mild	Moderate	Severe
Dioderm	Hydrocortisone 0.1%	Mild
Mildison Lipocream	Hydrocortisone 0.1%	Mild
Synalar 1 in 10	Fluocinolone acetonide 0.0025%	Mild
Betnovate RD	Betamethasone valerate 0.025%	Moderate
Eumovate	Clobetasone butyrate 0.05%	Moderate
Haelan	Fludroxycortide 0.0125%	Moderate
Modrasone	Alclometasone dipropionate 0.05%	Moderate
Synalar 1 in 4	Fluocinolone acetonide 0.00625%	Moderate
Ultralanum	Fluocortolone 0.25%	Moderate
Betnovate	Betamethasone valerate 0.1%	Potent
Cutivate	Fluticasone propionate 0.05%	Potent
Diprosone	Betamethasone dipropionate 0.05%	Potent
Elocon	Mometasone furoate 0.1%	Potent
Locoid	Hydrocortisone butyrate 0.1%	Potent
Metosyn	Fluocinonide 0.05%	Potent
Nerisone	Diflucortolone valerate 0.1%	Potent
Synalar	Fluocinolone acetonide 0.025%	Potent
Dermovate	Clobetasol propionate 0.0525%	Very potent			Adults only

A full list of topical steroids can be found on the British National Formulary (BNF) website⁷

When prescribing a topical steroid, it is preferable to choose one with a once-daily application to improve adherence. A step-wise approach should be used – starting with the correct potency based on the severity of the eczema, then ⁹:

• Stepping down as the severity decreases
• Or stepping up to twice-daily application or a more potent steroid, if no improvement is seen

The location of the eczema should also be considered in the prescribing decision; for example, treatment of eczema on delicate areas of skin, such as the face, should only be with a mild steroid.¹

Additional treatment options » « Choosing the right emollient

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