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Steroid creams for eczema unlikely to thin children's skin

A new study provides reassuring news for parents, finding no evidence that regularly using a steroid cream for eczema will thin a child's skin.

BMJ Group News

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Eczema is a common condition among children, causing inflamed, red, itchy, and flaky skin. Steroid creams and ointments (called topical steroids) are an effective treatment, relieving itching and irritation, and helping the skin to heal. Usually, a child will use a strong cream during a flare-up, and then a mild or medium-strength cream to keep symptoms under control.

Although these creams work well, parents are often uneasy about using them long term. In particular, parents (and some healthcare providers) worry that these creams will cause a child's skin to thin with regular use, making it more likely to split and scar.

Although thinning skin is a known side effect of topical steroids, it has been linked mainly to inappropriate use and extreme test conditions, such as sealing a potent steroid on the skin under a plastic dressing. It's less clear whether routine use of a steroid cream, as directed, might also cause this problem.

In the new study, researchers recruited 70 children who'd been using a topical steroid for an average of 10.6 months. They also recruited 22 children who'd never used steroids and did not have eczema, to act as a control group.

The parents of children using the steroids were all trained in how to use steroid creams to get the maximum control of their children’s eczema, ensuring they were using enough cream, and using it regularly.

After at least three months, the children’s skin was assessed. Using a mini-microscope called a dermascope, two researchers separately examined four patches on each child's skin, to check for any thinning.

What does the new study say?

The researchers found no signs of thinning skin, regardless of whether the children were using steroids. They say this shows that using steroid cream sufficiently to keep eczema completely under control does not cause skin thinning.

How reliable is the research?

This was a well-conducted study that used a reliable method to check for thinning skin.

However, to completely rule out this risk, a study would need to be much larger and look at steroid use over a longer period of time. Ideally, it would also randomly assign the children to use either a topical steroid or a dummy (placebo) cream, and then follow them over time. However, this type of study is unlikely to be done, as it would be unfair to deny some children a treatment that has been shown to work.

Where does the study come from?

The study was conducted by researchers in Sydney, Australia, and it was published in Pediatric Dermatology, a journal owned by Wiley Periodicals Inc.

What does this mean for me?

If your child has eczema, this study suggests that steroid creams won't thin their skin with regular use. This is good news, as these treatments can work well to relieve symptoms and prevent flare-ups. However, we still need more research to completely rule out skin thinning over the long term

What should I do now?

Talk to your doctor if you have any questions or concerns about your child's skin or treatment. Besides steroids, there are several other treatments you might try for eczema, including moisturisers and other types of medicated creams.

Published on April 21, 2011

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