Skin care and treatment plans for eczema can be time-consuming and complicated. MyEczemaTeam members often discuss the ongoing challenges of managing eczema symptoms with both over-the-counter (OTC) or prescription topical steroids and moisturizers. Some people may ask, “Can I apply moisturizer after hydrocortisone?” Others may ask, “Do steroids go on after moisturizer?” This can understandably get confusing. But does it matter which one you apply first?
The short answer is that it depends, with a slight slant toward applying steroids first. In other words, there is no universally accepted practice regarding which order to apply these products. However, what’s definitely true is that if you’re not getting the results you want from using a topical steroid with a moisturizer or emollient, it may be because you’re not applying your steroid treatment properly. When and how you apply the steroid is essential to reaping its full benefits. Here’s why.
Topical steroids are commonly used for short-term treatment of eczema flare-ups to quickly reduce inflammation and allow skin to start healing. Steroids are naturally occurring hormones in the body that help regulate the immune system. Synthetic (human-made) steroid medications are used for a wide range of health conditions that cause inflammation. Topical corticosteroids — or glucocorticoids — are synthetic topical steroids used to treat numerous inflammatory skin conditions, including eczema.
Eczema results from the immune system being overly reactive to triggers that can irritate and inflame skin. Topical steroids have anti-inflammatory and immunosuppressive properties. They are also antimitotic, which means they stop cells from dividing too much and making too many cells when there’s inflammation.
As topical steroids are absorbed into the skin, they cause vasoconstriction — narrowing of the blood vessels in the skin. This restricts pro-inflammatory agents in the immune system from entering the skin. By reducing inflammation, topical steroids can help control eczema symptoms such as a discolored rash (which can vary in color depending on skin tone) and itchy or dry skin.
Health experts consider consistent moisturizing to be a key part of eczema treatment because it keeps the skin barrier strong and protected. Using moisturizers with other topical therapies, such as topical steroids, is important in that it can help prevent itchy skin and dryness and reduce the amount of required topical medications like steroids.
International guidelines for the treatment of eczema suggest that people with atopic dermatitis (the most common form of eczema) should moisturize their skin twice a day.
Here are some tips on how to properly combine moisturizing with a topical steroid to be sure you’re using a steroid safely and effectively.
Given how important both moisturizers and steroids are in eczema care, there has been a lot of differing research on whether the order of application matters. For example, the National Eczema Association suggests that any prescription topical medication should be applied before moisturizing. The National Eczema Society similarly suggests that topical steroids should be used prior to emollients.
On the other hand, the NHS takes a more neutral approach, saying that application order does not matter as long as you wait at least 30 minutes between product applications.
Current dermatology research suggests that most experts generally recommend applying topical steroids before moisturizers. However, there are likely additional variables that factor into which product should be applied first, depending on the person. If you have specific questions about this, speaking to your dermatologist may help.
Most medical experts agree that regardless of the order in which you apply a topical steroid and a moisturizer, you should wait some time between applications. If possible, it’s good to wait at least 30 minutes between applying a steroid and applying a moisturizer. In fact, some studies have suggested this time should be greater if you apply moisturizer before a steroid.
One reason for waiting between applications is that a topical steroid can become diluted if it mixes with a moisturizer that hasn’t been fully absorbed. As a result, it may lose potency and effectiveness.
Additionally, mixing moisturizer and a steroid while you’re still wet can spread the steroid to skin that does not need treatment. Exposing healthy skin to a steroid increases your risk of side effects. Steroids should be applied only to affected areas of skin that need treatment, while moisturizer should be applied to unaffected areas of the body as well.
Talk to your dermatologist in detail about the proper dosage if you’re using a topical steroid for your eczema. In many cases, a thin layer of a topical steroid is applied only once a day. The amount of cream that squeezes out of the tube onto the end of your finger is measured in fingertip units (FTU). Your healthcare provider will provide you with a specific dosage — like 1 FTU — and show you how to measure it on your finger.
Most topical steroids are prescription medications, other than low-dose hydrocortisone topicals, which are available as over-the-counter ointments and creams. Topical steroids come in different potencies and forms, such as creams, ointments, or foams. Always use a topical steroid exactly as directed by your doctor. Using a steroid longer than your doctor recommends can increase your risk for side effects. Topical steroids usually aren’t used over long periods of time.
Be sure to discuss topical steroid side effects in detail with your dermatologist. Too much of a topical steroid can increase the risk of side effects such as:
Researchers have found that strong steroids in particular aren’t more effective if they are applied more than once a day.
Protecting your skin from sun exposure is an important part of skin care. The order you apply sunscreen in your skin care routine doesn’t really matter. It’s more of a personal decision you can discuss with your dermatologist.
Some sunscreens are mineral-based, like those including zinc oxide or titanium dioxide, and they work in part by reflecting sunlight. Both chemical and mineral sunscreens can lose their effectiveness over time. Waiting to apply sunscreen after applying a topical steroid and moisturizer helps ensure longer effectiveness when you’re outside. Sunscreen should be reapplied every two hours.
Even when using sunscreen, it’s important to avoid direct sunlight as much as possible by wearing protective clothing and staying in the shade. Always use sunscreen with an SPF of at least 30.
If you have questions about applying a topical steroid with a moisturizer, talk to your doctor. Your healthcare team can give you specific directions and tips to help you maintain your skin care and treatment plan. Always ask for medical advice before making any changes to your treatment schedule.
MyEczemaTeam members have shared their own experiences with using steroids and moisturizers together. One member wrote, “For topical care, I use SheaMoisture African Black Soap lotion or hemp seed oil lotion. When my eczema was really bad, the only thing that would help was the steroid cream. If you are itching really badly, just rinse with cool/cold water and pat dry very gently. Let the skin air out for a bit — the fresh air is healing. Then apply the SheaMoisture lotion.”
“I am back to using a topical steroid,” another member said. “I also still use SmartLotion at times and, of course, moisturizers.”
Someone else said, “I normally have to use a cream such as Zero Cream and apply it all over dry skin and then wait for 15 to 20 minutes (normally when the cream has all soaked in). Then I apply a steroid cream over my bad eczema patches.”
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