Do You Need a Topical Steroid to Help Control Eczema?

Do You Need a Topical Steroid to Help Control Eczema?
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Updated on March 24, 2025
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Your eczema has flared up, and you can’t find any relief — even though you’re keeping your skin clean and moisturized and avoiding the irritants that can trigger symptoms of the skin condition. What’s next?

One option your doctor may recommend is a topical corticosteroid, commonly known as a steroid. The medication can ease the redness, itching, and inflammation so your skin can begin to heal.

“Topical steroids are the first line of treatment after you’ve addressed proper skin care using moisturizers, taking warm baths, avoiding irritants and triggers for a flare-up, and treating infections,” says Luz Fonacier, MD, an allergist at NYU Langone Health in Garden City, New York. “If, in spite of these actions, you still have eczema, then we move into low-potency topical steroids.”

What Are Topical Steroids?

Topical steroids, also called topical corticosteroids, are synthetic drugs that closely resemble cortisol — a naturally occurring hormone that is released in response to stress and infection and that helps regulate blood pressure and blood sugar. Corticosteroids work by reducing inflammation and calming your immune system.

Depending on the strength and type of medication, corticosteroids are available over the counter or via a prescription.

There are different types of topical formulations of corticosteroids, including ointments, lotions, and creams.

Ointments

Topical steroid ointments are thin, wet formulations that are designed to be easily absorbed by dry skin. If your eczema is very dry, your provider may prescribe a steroid ointment.

Lotions and Creams

Topical steroid lotions and creams are thicker formulations that may be applied to less dry areas of skin. Creams are designed to be light and cooling, and may be a good choice for moist or “wet” eczema. Lotions are a good choice for hairy areas of your body.

How Topical Steroids Can Relieve Eczema

Eczema (also known as atopic dermatitis) is not one specific condition, but a group of inflammatory skin conditions that can produce rash-like swelling, scaly or thick patches of skin, dry and cracked skin, and itchiness. It can appear anywhere on the body.

Topical steroids can reduce the inflammation that's causing your eczema symptoms. They work by slowing down the production of chemicals your body naturally makes that can increase inflammation.

Researchers have found that high-strength topical steroids were among the most effective treatments for improving both patient-reported symptoms and signs of eczema reported by providers.

Topical steroids are classified by strength on a scale of 1 to 7, with 1 being the strongest (“super potent”) and 7 being the weakest (least potent).

The potency of the topical steroid your doctor recommends will be based on several factors, including:

  • Eczema Severity If your symptoms become more severe, your doctor may swap a mild- or moderate-strength topical steroid for a stronger one.
  • Body Area Areas of thicker skin, such as your palms or scalp, can be treated with more potent topical steroids. For thinner skin, such as on your face or genital area, less potent steroids are usually a better choice.
  • Area Size If a larger area of skin is affected, your doctor may recommend a less potent topical steroid, since more of it will get absorbed into your skin.
  • Other Treatments If you apply a bandage or other covering as part of your treatment, a less potent topical steroid may be a better choice since the covering helps your skin absorb it.
When you apply a topical steroid for eczema, put it only on the affected area of skin, and only as often as your doctor recommends. You can put on a moisturizer 30 minutes after applying the steroid.

It’s more effective to apply the medication to wet skin, such as right after a shower, than to dry skin. Additionally you can put a bandage or wet wrap over the area in order to ensure maximum absorption of the medication.

How to Know When to Use Topical Steroids and at Which Strength

If you’re having difficulty managing eczema symptoms, your doctor may prescribe a low-strength topical steroid. If your symptoms still don’t improve, your doctor may then prescribe a stronger topical steroid, says Dr. Fonacier.

A nonsteroidal topical medication, such as crisaborole (Eucrisa), pimecrolimus (Elidel), roflumilast (Zoryve), tapinarof (Vtama), may be added as well.

Once your eczema is under control, reduce or stop using the topical steroid according to your doctor’s instructions.

With topical steroids, “the goal is to try to use as little medication as possible, for as short a period of time as possible, to get people comfortable and to get the eczema under control,” says Peter Lio, MD, a dermatologist at Northwestern Medicine in Chicago.

For more severe eczema, Dr. Lio says, the goal is to minimize drug exposure over the long term, which can mean using a higher-potency topical steroid for a shorter period of time than would be needed with a lower-potency steroid. “We probably do more damage to the skin by using even a mild steroid for a long period of time than we do by using a more powerful one to nip it in the bud and then be done with it,” he explains.

Questions to Ask Your Doctor

  • Could a topical steroid help with my eczema?
  • What formulations of topical steroids could be a good fit for my eczema symptoms?
  • How long until I know if the topical steroid I’m using is effective at treating my eczema?
  • If a topical steroid doesn’t control my eczema symptoms, should I consider a different medication with a higher potency?
  • How often should I apply a topical steroid for my eczema?
  • What side effects should I look out for when using a topical steroid?
  • Should I stop using a topical steroid if I experience a reaction or side effects?
  • When and how should I taper off, or stop using, a topical steroid for my eczema?

Side Effects and Complications of Topical Steroid Use

There are a variety of complications that can arise from topical steroid use or overuse. That’s why these medications should not be used continuously (daily or multiple times a day) for more than two to four weeks, particularly when they are of higher potency.

 After this, use of topical steroids should be tapered down to twice a week.

Changes to Skin Appearance

Common side effects of topical steroids include skin thinning (atrophy), stretch marks (striae), small broken blood vessels (telangiectasia), and rashes resembling acne or rosacea at the site where the medication has been applied.

“In skin that’s rapidly expanding — in, for instance, teenagers who are rapidly growing in their legs and arms, or a breastfeeding woman whose skin is rapidly contracting and expanding all day to accommodate the breast milk — all these areas are higher risk for developing striae,” says Jenny Murase, MD, a dermatologist at Sutter Health in Mountain View, California.

Dr. Murase advises caution when using higher-potency topical steroids to help prevent complications. “Use the topical [steroid] judiciously in areas where there’s an expansion of skin, or in the armpits and the groin,” she says.

Overuse of moderate- to higher-potency topical steroids, and then abrupt stoppage of this use, can lead to “topical steroid withdrawal syndrome,” which can result in burning, stinging, swelling, skin sensitivity, pimple-like bumps and pustules, or bright red skin in people with a light complexion.

 Research shows that such symptoms are associated most closely with inappropriate use of topical steroids daily for more than a year, and typically appear within days to weeks after a person stops the treatment.

An Increased Risk for Certain Health Conditions

There are also possible systemic (body-wide) side effects of topical steroids, particularly with long-term use. Systemic side effects, which can be similar to those caused by oral steroid medication, may include cataracts, glaucoma, delayed growth in children, and hormone disruption.

One research review found that topical steroid use was linked to a higher risk of type 2 diabetes, regardless of the potency of the medication. The longer a topical steroid was used, and the more the medication was used over time, the stronger the link to diabetes was. But the authors noted that more research is needed to understand the link between topical steroids and type 2 diabetes.

Why You Should Try to Avoid ‘Steroid Phobia’

It’s important to understand the potential side effects of topical steroids, especially with overuse. But don’t let a fear of side effects stop you from taking advantage of topical steroids to help control your eczema.

“One of the reasons that eczema is poorly treated is steroid phobia,” says Fonacier, which is mostly driven by fear of complications. To avoid or minimize complications, particularly with long-term use of topical steroids, make sure you’re being monitored by a medical professional who can identify any problems before they worsen. Be sure to let your doctor know of any concerns so they can be addressed promptly and effectively.

If your eczema symptoms persist or serious side effects develop, ask your doctor to look at other treatment options, says Fonacier. Topical steroids are highly effective, but they aren’t the only effective treatment for eczema.

The Takeaway

  • Topical steroids are an effective treatment for eczema, and are available in a range of formulations with varying potency.
  • Use a topical steroid as directed for the shortest duration needed to resolve your symptoms, then taper off the medication.
  • Look out for side effects at the site where you apply a topical steroid, and let your doctor know about any concerns.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Corticosteroids (Glucocorticoids). Cleveland Clinic. October 21, 2024.
  2. Topical Steroids. National Eczema Society.
  3. Atopic Dermatitis (Eczema). Mayo Clinic. May 15, 2024.
  4. Lax SJ et al. Topical Anti‐Inflammatory Treatments for Eczema: A Cochrane Systematic Review and Network Meta‐Analysis. Clinical & Experimental Allergy. September 2, 2024.
  5. Prescription Topicals. National Eczema Association.
  6. Eczema: Learn More – Steroids and other topical medications. Informed Health Online. February 11, 2021.
  7. Education Announcement: Use of Topical Steroids For Eczema. National Eczema Association. July 17, 2021.
  8. Hajar T et al. A systematic review of topical corticosteroid withdrawal ("steroid addiction") in patients with atopic dermatitis and other dermatoses. Journal of the American Academy of Dermatology. March 2015.
  9. Phan K et al. Topical Corticosteroids and Risk of Diabetes Mellitus: Systematic Review and Meta-analysis. Journal of Dermatological Treatment. August 25, 2019.
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Susan Bard, MD

Medical Reviewer

Susan Bard, MD, is a clinical instructor in the department of dermatology at Weill Cornell Medicine and an adjunct clinical instructor in the department of dermatology at Mount Sinai in New York City. Her professional interests include Mohs micrographic surgery, cosmetic and laser procedures, and immunodermatology.

She is a procedural dermatologist with the American Board of Dermatology and a fellow of the American College of Mohs Surgery.

Dr. Bard has written numerous book chapters and articles for many prominent peer-reviewed journals, and authored the textbook The Laser Treatment of Vascular Lesions.

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