What Over-the-Counter Treatments Are There For Atopic Dermatitis?

Over-the-counter (OTC) medications are those available for purchase without needing a prescription. There are several OTC topical corticosteroids that people with atopic dermatitis (AD) or other forms of eczema may use to relieve their symptoms, including itching, redness, and rash.

Topical corticosteroids are recommended as a treatment for AD flares. Corticosteroids are available in a range of potency, with more potent medications being available only by prescription. The topical corticosteroids that are available over-the-counter are milder. Topical corticosteroids that are available OTC range from 0.5% – 1.0% hydrocortisone. However, using OTC medications still has some risks. All medications, including those available OTC, may interact with other drugs, supplements, or foods. It’s important to tell your doctor about any and all medications you are using.1,2

How topical corticosteroids work

Corticosteroids, also called steroids, are similar to substances that naturally occur in the body. They are different than the steroid compounds that some athletes abuse. Corticosteroids decrease inflammation and reduce the activity of the immune system. In AD and other forms of eczema, the immune system responds abnormally, causing an abundance of chemicals that cause inflammation, redness, and swelling. Corticosteroids reduce the production of the chemicals that cause inflammation.3

Choosing an over-the-counter topical corticosteroid

OTC topical corticosteroids come in different preparations, including ointments, creams, and lotions. The preparation affects the potency of the product.

Ointments

Ointments provide more lubrication and are more potent than cream formulations. Ointments are occlusives, which contain a high level of lipid (oil) and create a hydrophobic film on the skin. Some people do not like ointments because they feel greasy. Because of their occlusive properties, ointments provide more lubrication and improve the absorption of corticosteroids.

Creams

Creams are a mixture of water and oil and are more readily absorbed into the skin. Cream corticosteroids are less potent than ointments of the same strength, and they frequently include preservatives, which may cause irritation to some people.

Lotions and gels

Lotions and gels are the least greasy and usually penetrate the skin easily. As the least occlusive preparation, they have the lowest potency and are less moisturizing. Topical corticosteroids in lotions and gels are usually beneficial for hairy areas of the skin or scalp.2,4

Dosing

OTC topical corticosteroids are for short-term relief and should be used as described on the packaging. Most preparations are recommended for once or twice daily application. These medications are most effective when applied after bathing. Although corticosteroid preparations provide lubrication, these products should not be used as a moisturizer. Topical corticosteroids should be applied only to affected areas of skin, and a moisturizer should be applied on top of the medication.1,4

Side effects of over-the-counter topical corticosteroids

To be available over-the-counter, medications have been approved by the U.S. Food and Drug Administration (FDA) as safe, however, OTC medications like topical corticosteroids still have risks. OTC topical corticosteroids should be used as directed and should not be used more than the label or your doctor recommends.

Common side effects of topical corticosteroids include thinning of the skin (atrophy), stretch marks, dilated blood vessels, or lightening or darkening of the skin. Side effects are rare with proper use of the medication and are more common with higher doses and prolonged usage.1

Emily Downward | June 2017
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