Proper use of hydrocortisone and other steroid creams.

     Hydrocortisone and other steroid creams are used for itching and rashes with inflammation (eczema, seborrheic dermatitis, poison ivy, etc.). The 1/2 and 1% hydrocortisone creams are available over the counter. The stronger steroid creams are only available by prescription.
     Although these creams can be very helpful, they also have some side effects. They can thin the skin, lighten the pigment of the skin, and make the blood vessels under and in the skin look more prominent. The tricky thing about lightening the pigment is that the conditions that we treat with steroid creams also cause the same thing: eczema and poison ivy patches often cause so much irritation to the skin that the pigment of the skin looks lighter. The good news about this lighter pigment is that it tends to improve as the months go by once the eczema or poison ivy are gone. However, make sure to use a good sun block with titanium dioxide and zinc dioxide to help protect from sun damage when out in the sun. The pale areas have a harder time recovering their pigment if allowed to become sun burned.
     So how should you safely use these creams? One rule to follow is to use the weakest cream that works. That means that if improvement is seen with over the counter hydrocortisone cream, use that instead of moving to something stronger. Remember we are looking for improvement after using the creams over 3-5 days. Even if eczema comes back after you stop using it after 3-7 days of hydrocortisone, we still think of the hydrocortisone cream has successfully helping.
     If the rash looks much better after 3-7 days of a steroid cream, stop using it for a while and see how the rash does without it. Eczema will likely need another round of a few days to a week of the steroid cream periodically, but poison ivy rashes will likely improve and you will not need to re-use the cream soon. Ideally, for every number of days you used these creams, you should avoid them for the same length of time. For instance, to help your child's eczema if you normally will do the steroid cream for 5 days in a row, follow that with at least 5 days without the steroid cream before using it again.
     If an over the counter hydrocortisone cream is not helping, we will want to see the rash. We can decide whether a prescription strength cream is needed. This can done at a walk-in visit during walk-in hours, a scheduled ill visit, or a well check.