Steroids. Why long-term usage of steroids is of concern, particularly for infants and babies?
Many topical eczema creams contain steroids or anti-histamines. Although steroids can allow for quick short-term healing, with prolonged usage, steroids can actually cause irration and weaken our skin's barrier. Skin may become thinner and even more sensitive; therefore more skin rashes or lesions may re-appear due to environmental triggers.
The major limiting factor for the topical use of corticosteroids, especially in the young and elderly is skin atrophy. Skin Atrophy is the thinning of the epidermis and changes in the connective tissue of the dermis. Skin tissue becomes wrinkled and shiny. The affected area may show visible telangiectasias, hypopigmentation, and prominence of underlying veins. Skin atrophy makes skin tissue predisposed to infection and lowers healing rate.
National eczema association has provided a comparison table regarding different strengths of steroids.
Aside from steroids, currently there are also two prescription non-steroid topical products, one is Elidel® (pimecrolimus). Elidel is a steroid-free cream for patients aged 2 years and older who have mild-to-moderate eczema. The other topical immunomodulator is Protopic® (tacrolimus). It is a steroid-free ointment for patients aged 2 years and older who have moderate-to-severe eczema. Protopic and Elidel suppress inflammation in a similar way to steroids, and is equally as effective as a mid-potency steroid. An important advantage of tacrolimus is that unlike steroids, it does not cause skin thinning, or other steroid related side-effects. However immunosuppresants should be used with caution. A small number of patients who used pimecrolimus cream or another similar medication developed skin cancer or lymphoma (cancer in a part of the immune system). Studies of transplant patients and laboratory animals and an understanding of the way pimecrolimus works suggest that there is possibility that people who use pimecrolimus cream have a greater risk of developing cancer. It's crucial to follow your physician's advice when prescribed topical immunomodulator.