Various creams which are used to treat different types of itchy skin conditions
What causes the skin to itch? Do you have itchy rash all over the body? There are so many types of skin diseases where itching is the main symptom. As we all know itching is a distressing feature to have. Common skin diseases causing itching are Eczema (Atopic dermatitis), Psoriasis, Miliaria (Heat rash), Tinea (Ringworm infection), Intertrigo, Urticaria (Hives), Contact dermatitis and Scabies.
Sometimes itching or pruritus can be so severe, that it may affect day to day activities and even disturb sleep. So it is important to treat these conditions properly for relief from itching and cure of the skin disease.
How do we select the most suitable cream?
Although there are several anti-itch creams available as over the counter products, one should be careful and know which cream should be used for what type of skin disease. Using the wrong cream will worsen the skin condition and cause unnecessary side effects. Sometimes blind use of any anti-itch cream might work, but not always.
That’s where the doctor comes in. He will thoroughly examine your skin condition by asking few questions like What causes the skin to itch? What is your diet? Does itching occur at specific parts of the body, etc? The analyze should be made correctly to prescribe the most suitable cream where necessary. Along with the topical applications, oral medications will have to be combined depending on the skin disease and its severity. It is the responsibility of the patient to comply with the instructions given and continue the application as long as the prescribed duration for proper recovery. Stopping the treatment before the prescribed duration will not properly heal the skin disease and it may reappear after some time.
Is there a “Best cream” for all itchy skin diseases or an itchy rash all over the body?
There is no “Best cream” for all types of itchy skin conditions. A cream used for one condition may not work for another. The doctor will decide which cream to prescribe and for how long. Sometimes combinations may have to be used (like steroid and antibiotic combination or steroid and anti-fungal combination etc.)
For mild skin diseases, a mild cream is sufficient, whereas more severe it is, the doctor will determine the strength of the ingredients in each cream and will prescribe a stronger cream, taking side effects into consideration. For a mild skin disease using a strong cream will cause quick cure at the expense of unnecessary side effects. So there should be a balance of the effects and the adverse effects. It is the responsibility of the doctor to weigh these two and prescribe the best product, which he/she thinks is suitable for the particular skin disease.
Sometimes the cost of the treatment may be a decisive factor too.
What are the common itchy skin diseases where steroid creams are used?
Eczema (Atopic dermatitis)
It is a chronic skin condition with occasional flares and the inflammation of the skin leads to red patches, scaly, cracked lesions associated with dry skin. Itching is intense in eczema. The most important treatment here is steroid topical applications, which reduces the inflammation.
For eczema in children, mild forms of steroids like hydrocortisone or Tacrolimus is used. For adults, a stronger steroid like betamethasone, triamcinolone, mometasone can be used as topical applications.
If the rash is on the face or neck, where the skin is a more sensitive milder form of steroid should be used topically. Whereas if the eczema is rough and thickened due to frequent scratching, a short course of strong steroid like clobetasol can be prescribed and then gradually go to a milder form if itchy rash all over the body.
Psoriasis is a long-term disease where skin cells form at a faster rate and the accumulated skin cells lead to thick scales or plaques on the skin surface. These lesions are dry and itchy with red/ purplish patches with silvery scales.
While steroid creams are prescribed to use over the lesions, there are also other topical preparations which can be combined like retinoids, vitamin D analogues and salicylic acid.
This is a red itchy rash caused by contact with a substance like poison ivy, detergents, cosmetics, metals etc. leading to an allergic reaction. As there is a lot of inflammation a steroid cream is necessary as an anti-inflammatory agent. The strength of the cream and the duration of application should be decided by the doctor.
What are the side effects of steroid creams?
The side effects of steroid creams are;
- Thinning of the skin (skin atrophy)
- Whitening of skin
- Stretch marks (striae)
- The appearance of prominent blood vessels on the skin (telangiectasia)
- Easy bruising
So the patient should take caution to use it only until the prescribed duration, and not use it as he or she wishes.
Sometimes the long-term application of steroid creams into large areas of skin can lead to absorption of steroids into the blood. This may lead to several unwanted adverse effects like acne, reduction of bone density, gastritis etc.
How to decide whether cream or ointment is better?
Creams are better for wet or “weeping” skin conditions where there is oozing from the lesions or when the area of the rash is large. The cream can cover a large area as the thickness (viscosity) of the cream is less due to the higher water content in creams. Creams are not greasy like ointments, so they are not that messy.
Ointments are thicker and best used over dry skin conditions like eczema and psoriasis. As the viscosity is more, ointment traps the moisture in and keeps skin moist for a long time. Although it is greasy and messy ointment is better and helps absorption of the active ingredients better than a cream. Ointments are better to use over sensitive skin as many creams may contain sensitizing preservatives. As the ointment allows greater penetration of the active ingredient, it is a better moisturizer.
Usually, a doctor prescribes a cream with an added antibiotic if there are features of infection. (Neosporin, polysporin)
What are the steroid creams available as OTC products?
Due to the risk of side effects only milder steroids are available as OTC products. (1% Hydrocortisone, Cortaid, Cortizone 10)
Other steroid creams like Triamcinolone, Betamethasone, Kenalog, Clobetasol which are stronger always need a prescription.
What are the itchy skin conditions which need anti-fungal creams or ointments?
Tinea or Ringworm infection which is a fungal infection needs to be treated with a long-term antifungal topically. There are various anti-fungal creams and ointments available for prescription. They are Miconazole, Ketoconazole, Clotrimazole, Terbinafine etc. The doctor will prescribe the most suitable product and treatment should be at least for 6 weeks, as it is difficult to kill the fungus. If you stop earlier than the recommended duration, the fungus will multiply and the rash will reappear and may even be resistant to treatment. So it is a must to comply with instructions.
Intertrigo is an inflammatory skin condition which occurs in skin folds like axilla and groin. It is a red, macerated and intensely itchy rash, often caused by Candida (yeast). Intertrigo worsens in warm, humid climates. Long-term treatment with a topical anti-fungal is needed for cure. If severe, oral anti-fungal like Fluconazole or Itraconazole may be combined.
Itchy skin diseases where emollients are used?
Emollients are a must for dry skin conditions with itching, such as Eczema and Psoriasis.
Itchy skin conditions which respond to Calamine lotion
Miliaria (Heat rash) will respond well to calamine lotion.
Urticaria (Hives) which is a common allergic reaction causing itchy red bumps will also respond to calamine lotion. But if severe, a mild steroid like hydrocortisone cream can be used additionally to reduce inflammation and itching.
This is a red rash caused due to an allergic reaction from the skin to a mite which burrows into the skin. This condition is extremely itchy. Until a scabicide (Permethrin, Sulphur or Benzyl benzoate) is applied the itching will persist.
Take home message
There is no single cream which works for all types of itchy skin diseases. As there are so many itchy skin conditions due to many causes, treatment should be based on proper analyze. Blind treatment is discouraged as there can be unnecessary side effects and sometimes worsening of the skin condition if the wrong product is used for treatment.
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