The general rule is to use the weakest steroid for the shortest period required to get the skin under control. Steroids are very good for settling down the immune activity in the skin and reducing inflammation, but they do come with side effects. They can lead to thinning of the skin, which in turn make the skin more prone to flares, bruising, tearing, stretch marks and enlarged blood vessels under the surface of the skin called telangiectasia. Depending on the location and strength of the steroid there may be some systemic absorption of the steroid. The risks of using steroids need to be balanced against the risk of poorly controlled eczema.

The thicker the skin, the stronger the steroid required. Only weak steroids used very cautiously should be applied to areas of thin skin such as the face, around the eyes and in the genital region. It is best to completely avoid steroids in these areas in children.

The steroid ladder from weakest to most potent:

• Mild: Hydrocortisone 0.5%, 1% and 2.5%
• Moderate: Eumovate (clobetasone butyrate 0.05%)
• Potent: Betnovate (betamethasone 0.1%)
• Very potent: Dermovate (clobetasol propionate 0.05%)