Eczema to psoriasis: how topical steroid creams can help

For people grappling with skin conditions, daily life can be profoundly challenging. Conditions like eczema and psoriasis are more than skin deep, often impacting daily activities and quality of life. Learning to control flare ups can help people regain control of their lives and prevent the discomfort that can be associated with these conditions.

The first step in treating a skin condition is to understand which one you have and its causes. Once you understand what might be causing the problem, you will be much closer to finding out how you can prevent or treat it.

Eczema – causes and symptoms

Eczema, also known as dermatitis, affects up to 20% of children, or one in five, and sometimes persists into adulthood. The most common type of eczema is atopic eczema, which often causes dry, itchy, and cracked skin.

Eczema may affect both small and large areas of the body, commonly appearing on the hands, inside of elbows, backs of the knees, face, or scalp. Eczema appears red on lighter skin tones, while on darker skin, it may present as dark brown, purple, or grey.

A medical professional will usually diagnose eczema if you are experiencing three or more of the following:

• Irritated, red skin in specific areas of the body
• History of skin irritation
• Dry skin for 12 months or more (in children)
• Asthma or hay fever, or an immediate relative who suffers from asthma or hay fever
• If the condition started in a child before they were 2 years old, and they are now over 4 years old (1)

It is not clear what causes atopic eczema; however, it is usually the result of allergies, which is why family history is considered when diagnosing the condition in young children. People with eczema may notice triggers, such as pets, washing detergents, weather, stress, or even food.

Psoriasis – causes and symptoms

Psoriasis, affecting roughly 2% of the population, is notably less common than eczema. The condition causes flaky patches of skin that develop into scales. On all skin colours, psoriasis can look pink or red, with white or silver scales. On black and brown skin, the patches can look dark brown or purple, and the scales might appear to be grey.  Usually, psoriasis affects the elbows, knees, lower back and scalp, although it can affect any part of the body.(2)

Like eczema, psoriasis is a chronic disease, which means that it is long-lasting. Unlike eczema, which usually first appears in childhood, psoriasis typically first appears in adulthood, often between the ages of 20 to 30, or 50 to 60.

Psoriasis occurs when someone makes too many skin cells, which causes the formation of scales. In most people, skin cells are replaced every 3 – 4 weeks; for people with psoriasis, their skin cells are produced every 3-7 days. Like eczema, the root cause of psoriasis is unknown, but it is thought to be linked to the immune system.

Psoriasis can be hereditary, and often a flare up can be the result of a specific event or trigger, such as injury, infections, or using some medicines.

Psoriasis is slightly harder to diagnose than eczema, and sometimes a medical professional might recommend that you see a dermatologist.

The role of topical steroid creams in treatment of eczema and psoriasis

While no cure exists for eczema or psoriasis, effective management is possible through tailored treatment plans.

Working out how to avoid triggers is a good start, as is the use of emollients (moisturising treatments), but steroid creams also play an important role in control.(3) They are effective in reducing swelling, redness, and itching when skin flares up.

Benefits of using topical steroid creams

Steroid creams play a vital role in controlling flare-ups of eczema or psoriasis. For many people who suffer from skin conditions, it is important to get the flare-up under control as soon as possible. Without the use of topical steroids, an outbreak can become severe, leading to unbearable itching and broken skin.

Types of topical steroids: potency and formulations

Topical corticosteroids are available in various forms, such as creams, lotions, tapes, ointments, and mousses. There are generally four potencies: mild, moderate, potent and very potent. Mild corticosteroids are often available over the counter, but stronger creams require a prescription.

Prescription creams include Fusidic Acid (an antimicrobial) and betamethasone (a steroid, brand name Betnovate); creams such as Fucibet contain a combination of both.

How to use topical steroid creams safely

While steroid products can be effective, they should be used with caution. Unless otherwise instructed by your prescriber, follow the instructions in the patient information leaflet. In general terms, it will be advised that you use the product once or twice a day for up to a week; occasionally longer term use will be recommended.

Potential side effects and how to manage them

Like all prescription drugs, when using corticosteroids, it is important that you follow medical advice. In most cases, if used as advised, there are minimal side effects of using steroid creams to treat eczema and psoriasis. The most common side effect is a stinging sensation when the cream is applied. However, rarer side effects include:  

• Spreading of a skin infection
• Folliculitis
• Thinning of the skin, which can lead to damage such as bruising
• Acne
• Rosacea
• Stretch marks
• Excessive hair growth in the affected area

The likelihood of these side effects increases with the usage and potency of topical corticosteroids.

Alternatives to topical steroid creams

Long-term use of topical steroid creams is not usually recommended. There are a range of alternative treatments which can help to treat or control psoriasis and eczema, leaving corticosteroids for extreme flare ups, rather than using them regularly.

Alternative treatments include vitamin D based creams, probiotics, or apple cider vinegar (ACV), and mindfulness and hypnosis, which can help reduce stress-related flare-ups.(4)

When to consult a Dermatologist

If you are struggling to control your eczema despite support from a medical professional, you might want to contact a dermatologist. A prescriber may recommend consulting a dermatologist to confirm a psoriasis diagnosis, and in some cases a biopsy might be taken.

Conclusion

When seeking treatment for a condition, particularly a chronic one like eczema or psoriasis, it is important that you arm yourself with trustworthy knowledge so you can make an informed decision about the best course of action for you.

It can help to keep a journal of flare-ups and treatment regimes so you can identify patterns and work to eliminate environmental factors that might exacerbate the condition. Prevention is, of course, better than cure, but if you do experience a flare-up it is important that you know which creams work for you, and have a supply to use as soon as you need them.

If you would like to discover the range of topical corticosteroids that could be used to treat eczema or psoriasis, add a product to your basket and complete an online consultation with one of our experienced prescribers.

References

1. nhs.uk [Internet]. [cited 2024 Jul]. Atopic eczema.
2. nhs.uk [Internet]. [cited 2024 Jul]. Psoriasis.
3. Developers B. National Eczema Society. 2020 [cited 2024 Jul]. Living with eczema.
4. British Skin Foundation [Internet]. [cited 2024 Jul]. What is Psychodermatology? with Dr Anjali Mahto.