Topical steroids and emollients in atopic eczema – which should be applied first?

Abstract

Atopic eczema is one of the most common skin diseases but it is still often poorly managed by patients and health professionals. David Voegli examines the latest knowledge of the topic and how it can improve treatment Atopic eczema (AE) is one of the most common dermatological diseases, with the number of cases in the UK rising. The use of emollients to maintain skin hydration and restore barrier function remains the principal treatment, in conjunction with topical corticosteroids (TCS) to reduce inflammation. Unfortunately, many health professionals, and patients themselves, fail to consider emollients as an active treatment and may overlook the vital role they play in the maintenance of intact, healthy skin. Despite the overwhelming acceptance of the importance of emollient therapy, there remains a lack of good quality evidence on their effectiveness or whether one is better than another. Patients often receive conflicting or limited advice from health professionals as to how to use them, and if using TCS as well, which to apply first. This may result in incorrect use, reduced therapeutic effect and poor concordance. This article aims to explore normal skin barrier function, the disruption caused by AE, and some of the contemporary issues surrounding emollient therapy and topical corticosteroids.