Are you suffering from Steroid-Phobia?

Eczema on baby’s face

You may be fearful of using steroids, as many parents (myself included) are. The fear could partly arise due to the negative news on steroid abuse by athletes and partly due to its side effects. If you have googled steroids, you will find numerous websites ‘promising’ treating eczema without using steroids. When Marcie’s doctor put her on oral steroid, I had a lot of reservations and fear and remembered scaring myself to death googling all the side effects.

But after going through resisting steroid use to using mild steroid lotion & cream and a 3-week oral steroid course for Marcie, I like to encourage you not to fear using steroids but instead use it under the instruction of your doctor, preferably a specialist.

How much steroid is ok?

Where there is no inflammation, just dry skin that’s itchy – I’d recommend using lots of moisturizer. Keeping the skin cool helps to relief the itch, so try turning the air-conditioner colder. (I sometimes give Marcie a cold drink bottle to hold and its works!)

Where there is inflammation and the skin is reddish and itchy – I’d clean the skin with cool liquid chlorhexidine (antiseptic) and apply mild steroid lotion or cream. For areas with delicate skin such as the face, I’d apply a 0.5% hydrocortisone and for other areas like the knees or elbows or hands, I’d apply a 1% elomet cream. Marcie’s doctor’s instructions were not to apply more than twice a day. So far, I have only needed to apply 2 to 3 days in a row, not exceeding twice a day, and the skin will go back to normal.

You can refer to this chart extracted from patient.co.uk for how much to apply, measured using fingertip units (ftu):

For a 3-6 month old child

  • Entire face and neck – 1 FTU
  • An entire arm and hand – 1 FTU
  • An entire leg and foot – 1.5 FTUs
  • The entire front of chest and abdomen – 1 FTU
  • The entire back including buttocks – 1.5 FTUs

For a 1-2 year old child

  • Entire face and neck – 1.5 FTUs
  • An entire arm and hand – 1.5 FTUs
  • An entire leg and foot – 2 FTUs
  • The entire front of chest and abdomen – 2 FTUs
  • The entire back including buttocks – 3 FTUs

What happened to Marcie after taking oral steroid?

You may be wondering why I’m encouraging parents to be open to using steroids when I initially did not even apply steroid on Marcie. It was very difficult to get the eczema under control and her eczema will suddenly just flare and affect her whole body. However, a one-time 3 weeks reducing dosage of oral steroid, prednisolone, really helped to keep the eczema manageable.  Marcie’s rashes disappeared within the first 2 days of the oral steroid, but gradually came back as the dosage is reduced. I worried a lot after reading the side effects of steroids such as thinning of skin, acne and damage of blood vessels. I am very glad that I chose to trust Marcie’s doctor and persisted with the 3 weeks course despite being fearful everyday. After the 3 weeks course, Marcie’s doctor said he will not give Marcie any treatment that is not 100% safe and will not give her another oral steroid course because that will not be safe. I read later that stopping an oral steroid course halfway causes more harm than following through and makes it more difficult for the doctor to decide on the next step.

After the oral steroid course, there are still rashes on and off, triggered by hot weather, sweat but never affecting her whole body with no reason. This makes it a lot easier to manage and Marcie has been a much happier baby since.

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Last update was on: 25 June, 2018 5:56 pm
15 Comments
  1. […] but also due to its cost, I use when her rashes are affecting her badly (on top of using mild steroid). On a daily basis, liberal amounts of QV body lotion is slathered on Marcie and her infant care […]

  2. […] written on above topics, here on moisturizing tips by Dr Bridgett, here on steroid potency, here on finger tip units, here on wet-wrap and here on bleach […]

  3. Hi Raymond,

    I’ve applied 1% before but just for a day/2 max. I know 1% Elomet is ok on the neck (as prescribed before), so probably ok for the face too 🙂 check w doc if going to keep applying yeah..

    Take care,
    Mei

  4. hi mei,

    was 0.5% hydrocortisone for the face instructed by doc? i wonder if 1% is ok.

  5. […] Marcie Mom: Good day, Prof Hugo. I must thank you again for helping Marcie with her eczema. I noticed that it got much better after the one-time oral steroid course you prescribed (read more in this post). […]

  6. […] it’s important to dispel any misperception of steroid when the risk of under-treatment due to steroid phobia is […]

  7. […] asked Dr Jim and his answers below for you! Marcie Mom: My baby’s eczema improved after a one time oral steroid at 7 month old, another mom told me her baby got worse. What’s her option now? Dr Jim Sears: […]

  8. […] and partner with our child’s doctor. This is particularly the case if you’re prescribed oral steroid, you have to trust your doctor and follow through, giving up halfway makes it more difficult to […]

  9. I found a good article tackling all the myths of steroid, do check out the link below!
    http://www.eczema.org/Steroid_Phobia_Article.pdf

  10. […] At the first consultation, Marcie’s doctor Prof Hugo Van Bever of NUH asked if someone in the family has eczema. I started tracing the family tree, and the eczema gene seemed to be mutating more powerfully (as you can see in the family tree, we could only trace to my mother-in-law who only recalled she had mild itchiness when she’s 20 year old. My husband only had localized eczema, and his brother had quite a severe case. Marcie’s eczema is quite bad before she went on the one-time oral steroid course.) […]

  11. […] stress we all are managing our children’s eczema. For me, I just stick to moisturizing and steroid use under doctor’s instruction. Posted under Other treatments and tagged with Alternative […]

  12. […] my post on “Are you suffering from Steroid-Phobia?”, I have encouraged parents to be open to using steroids under the doctor’s […]

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