Systemic Corticosteroids to Treat Eczema

Atopic dermatitis, commonly called eczema, is driven by inflammation. This inflammation is connected to an irregular immune response. People with eczema also have a disrupted skin barrier.^1,2

Corticosteroids, also called steroids, are commonly used to treat inflammatory disorders. They help regulate the immune system and control inflammation. Steroids can calm the immune system in the short term. However, they should be used cautiously.^3-6

Topical treatments are used first to treat eczema. These include steroids applied directly to the affected skin. For example, topical hydrocortisone is a commonly used topical steroid.^5,7

But if topical treatments do not control symptoms, systemic treatments may be tried next, although the expert panel does not recommend it. Systemic treatments travel through your bloodstream and have body-wide effects. Systemic steroids can quickly calm eczema by limiting the immune system’s ability to cause inflammation.^5,6

When are systemic corticosteroids recommended?

Part of the appeal of systemic steroids is that they can reduce symptoms quickly. However, they are recommended for treating eczema only in certain situations. And they typically are used for only a short period of time.^4-6

Systemic steroids may be used in children and adults with severe or fast-advancing symptoms, and:^4-6

• When there is a high need for short-term relief, such as a major life event or a very severe case
• When support is needed to move from one therapy to another
• When phototherapy (light therapy) is started
• When co-occurring health conditions, such as asthma flares, are present
• When nonsteroidal systemic therapies targeting the immune system, or its parts, are being started

Your doctor may recommend systemic steroids in other situations. Systemic steroids are not recommended for long-term use in eczema. They are also not recommended for occasional use due to their many potential and serious side effects.⁴

How do systemic corticosteroids work?

People with eczema have an abnormal immune response. This response is what causes the inflammation, soreness, and pain that come with eczema.¹

Systemic steroids suppress the immune system’s ability to cause inflammation. Inflammation is the result of complex processes involving many different parts of the immune system. Steroids can block or limit the body’s ability to make the chemicals, proteins, and immune cells involved in inflammation.³

Examples

The most commonly used systemic steroids for people with eczema include:⁴

• Prednisone (tablet)
• Prednisolone (liquid)
• Methylprednisone (intravenous)

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. The most common side effects of systemic steroids include:^3,4

• High blood pressure
• High blood sugar
• Inflammation of the stomach lining
• Weight gain
• Loss of bone density
• Increased risk of infection
• Emotional/psychiatric disturbances
• Decreased growth (in children)
• Slowed healing of wounds

Once systemic steroids are stopped, symptoms may return in a more severe form. This is called a rebound flare.^4,5

These are not all the possible side effects of systemic steroids. Talk to your doctor about what to expect when taking these drugs. You also should call your doctor if you have any changes that concern you when taking a systemic steroid.

Other things to know

Before beginning a systemic steroid, your doctor will screen you for:³

• Diabetes
• High blood pressure
• Certain heart conditions
• Psychiatric or mood disorders
• Bone health
• Upcoming vaccines (due to increased risk of infections)

Systemic steroids may be used for treating eczema only in some situations. It is important to weigh the risks versus benefits of systemic steroids before using them. If you have questions about systemic steroids, talk to your doctor. Make a list of questions or concerns, and bring it to your next appointment.^5,6

Before beginning treatment for eczema, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.