Eczema (“EGGS-eh-ma” or “ECKS-eh-ma”) is a chronic skin condition that manifests as patches of dry, itchy, inflamed skin. The parts of the body that are commonly affected include the hands, feet, inside the bend of the elbows and knees, ankles, wrists, neck, upper chest, and eyelids. Eczema, or “atopic dermatitis” in medical lingo, is more common in kids than in adults, but it can occur at any age: 7% of US adults (about 16 million) have eczema. People of any race or in any geographic location can get eczema, though it seems to be more common in cities and in developed countries. It’s diagnosed clinically, meaning there usually aren’t any diagnostic tests involved, although in some cases a biopsy (taking a sample of the skin) might be needed if it’s not clear whether the symptoms are due to eczema or another skin condition.

What causes eczema? Like a lot of health conditions, eczema has both genetic and environmental factors (nature vs. nurture). The underlying cause of eczema is overactivity of the immune system. A bit of the science: people with eczema have a predisposition to make antibodies to allergens (things in the environment that trigger an allergic reaction), specifically one type of antibody called immunoglobulin E, or IgE for short. Because of this genetic component, people who have eczema also sometimes have allergies (allergic rhinitis) and/or asthma, and they sometimes have a family history of these three conditions (eczema, allergies, asthma).

Like allergies and asthma, eczema can also have triggers that bring on symptoms or make symptoms worse. Common triggers include heat, certain chemicals (as in soaps, laundry detergents, cleaning supplies, etc.), allergens like dust and pollen, stress, and others. Oftentimes, there’s no particular trigger that can be identified.

The main symptoms and signs of eczema are dryness and itching on the scaly patches of skin, which can also escalate in severe cases to oozing, crusting, and blister formation. Eczema flare-ups may also lead to skin infections because of the disrupted skin barrier. (Eczema itself isn’t an infection and it isn’t contagious.)

Since eczema affects the skin and can therefore be seen by other people, it can hurt self-esteem, and cause anxiety and stress. This can also trigger flare-ups, creating a vicious cycle. Eczema can interfere with sleep when it is severe, which can be very disruptive to daily functioning and mood.

Although there’s no cure for eczema, the symptoms are very treatable and even preventable, and it’s possible to really improve your quality of life with effective eczema treatment.

Triamcinolone (“try-am-SIN-alone”), also referred to as Kenalog (a brand name) or triamcinolone acetonide, is a corticosteroid. Like all corticosteroids, triamcinolone blocks the immune system at the microscopic level, which reduces the intensity of the skin’s reaction to allergens. This translates to decreased itching and redness (or discoloration in people with darker skin tones), and less scaly skin.

It’s important to note that “steroid” here just refers to the chemical compound, and is different from how you might have commonly heard it used. While it is chemically in the same family as anabolic steroids that bodybuilders use, it is a distinct compound, and has different effects.

Topical corticosteroid creams or ointments are considered the best first-line treatment for eczema. Triamcinolone has been used for over 60 years and is effective, well-studied, and well-accepted within the medical community as a treatment for eczema. It is also cost-effective and considered relatively safe. There are many different types of steroid creams, and triamcinolone 0.1% cream is considered medium potency on that spectrum—it’s stronger than the type of cream you might find over the counter, such as hydrocortisone, but not the strongest available type of steroid cream. Stronger formulations are used only for very severe cases, as they are associated with more serious side effects that may require monitoring. The general principle of using steroid creams is to use the smallest and least potent dose needed to relieve symptoms, and to avoid using them for prolonged periods.

It’s important to understand that eczema symptoms may not resolve completely, even with treatment, but by communicating with your doctor about what’s working and what isn’t, the symptoms can significantly improve and allow you to live your life normally.

Also note that if you have a skin infection in addition to an eczema flare, triamcinolone (or any other steroid) cream will not treat the infection. Signs of infection include redness (more than usual for an eczema patch), swelling, pain/tenderness more than usual for an eczema patch, or visible pus. If you think you might have an infection with your flare-up, notify your doctor.

Warnings Potential adverse effects of triamcinolone cream include skin irritation or burning and, somewhat ironically, redness and dryness. More serious effects include skin thinning, discoloration, and raised blood sugar. These effects are generally only seen in people who use the cream for more than several weeks at a time.

See below under “Important Medication Information” for more on warnings.

Wash your hands before and after applying the cream. It’s okay if the skin is slightly moist before applying. Apply a thin film of cream to the area(s) of your flare-up and rub it in gently until it’s absorbed.

Again, the general principle for steroid creams is to use only as much as is needed to improve your symptoms. Don’t cover or bandage the area unless directed by your physician.

For active flare-ups, apply as above twice a day for two weeks (or as directed by your physician).

If you have severely broken skin or an infection on top of the area affected by the flare-up, you should tell your doctor, and avoid using triamcinolone cream unless they specifically direct you to. Small cracks in the skin may be okay.

Triamcinolone cream should be stored at room temperature away from light. You should complete the entire course of treatment (usually around two weeks) as directed by your physician.

In some cases, your physician may prescribe a small dose between flares to help prevent them from happening or help reduce the severity. This may involve using the steroid cream 2–3 times per week or only on weekends, for example. If you think you may need this type of preventative treatment, ask your doctor.

As mentioned above, the term “steroid” refers to the chemical compound and is different from how it’s used in common language (i.e., different from anabolic steroids that bodybuilders use).

There is a risk of skin thinning and/or discoloration from steroid cream, and it’s important to understand this. These negative effects are generally seen in people who use large amounts of the cream over a prolonged period of time without any gaps in treatment. This is why it’s recommended to use the smallest effective dose for the shortest amount of time needed (two weeks for an active flare-up or as directed by your physician).

Also note that when steroids are taken as a pill or injection (systemic steroids), prolonged steroid use is associated with more serious potential effects including higher risk of serious infections from immunosuppression, glaucoma, diabetes, high blood pressure, osteoporosis, and others. This is not the case with topical steroids. Although there is a small risk of a small amount of the steroid being absorbed into the bloodstream, typical use is not associated with these serious side effects.

See more under “Warnings” and “Important Medication Information” below.

There is no set maximum dosage of triamcinolone cream, and an “overdose” of triamcinolone cream applied to the skin is not expected to produce life-threatening symptoms. The negative effects of steroid creams are mostly seen after using the cream for longer than is necessary and without any gaps in treatment, as there is a theoretical increase in risk that it is absorbed into the bloodstream. See below under “Warnings” for more detail on potential negative side effects and precautions.

Triamcinolone cream, when applied correctly, relieves symptoms of inflammation including itching and redness.

It’s important to keep in mind that you might feel much better right away and be tempted to stop the treatment, but it’s important to complete the full course as directed by your doctor, usually two weeks. If not, the flare-up may come back sooner.

If your treatment isn’t working (or isn’t working as well as you expected), tell your doctor. They may recommend applying the cream more frequently, or that you see a doctor in person to be evaluated for more aggressive treatment, if your flare-up is very severe.

Based on your online visit, your physician has determined that treatment with triamcinolone 0.1% cream is appropriate for you. This means no additional testing is necessary at this time.

It is important to remember that your online visit with Ro does not replace routine in-person care with your healthcare provider, such as your annual physical. While telemedicine has its benefits, there are some components of a health check-up that can’t be fully completed via telemedicine, including the physical exam and laboratory testing. There may also be recommended screening tests for you depending on your age, sex, and family history that require in-person evaluation.

You should still plan on seeing your in-person provider as you normally would, especially if treatment is not working for you. In this case, your healthcare provider may be able to perform additional tests to evaluate any potential underlying causes of your condition.

Other prescription topicals include topical calcineurin inhibitors (TCIs), such as tacrolimus, or pimecrolimus. These are generally only recommended if topical steroids like triamcinolone cream don’t work, as they are associated with slightly more serious side effects. Another newer topical is crisaborole, a non-steroid anti-inflammatory ointment. It has not yet been incorporated into treatment guidelines. Topical antihistamines and topical antibiotics have also been studied, but are not as effective as topical steroids or TCIs and are not currently recommended for use.

Systemic treatment (oral or injectable medication) may be needed in very severe cases. This includes immunosuppressants (such as cyclosporine, interferon gamma 1b, dupilumab), which are very, very potent systemic drugs (they’re more commonly known as drugs used alongside chemotherapy and in patients undergoing organ transplants). They are associated with increased infection risk and increased risk of liver and kidney damage, so they’re only used in extreme cases that don’t respond to any other treatment, and should never be used long term for eczema. UV light therapy (phototherapy) is another option for severe cases.

Here are some simple things you can try to help prevent flare-ups (or help make them less severe).

• Keep your skin moisturized. Note that moisturizers do not actually add any moisture to the skin, but help lock in existing moisture. They can also act as a barrier from things that might trigger flare-ups. Some tips for best practices include:

  • Use a gentle, fragrance-free moisturizer without any added dyes, as these can irritate the skin. If you use a facial cleanser, this should ideally also be fragrance-free and dye-free.

  • Apply moisturizer as soon as possible after washing hands or showering (within 1 minute).

  • Pat skin dry instead of rubbing. Leaving a little bit of moisture on the skin can also help.

• This sounds obvious, but whenever possible, try to avoid triggers and other factors that make your eczema worse. If you think your eczema might be brought on by things coming in contact with your skin, such as certain laundry detergents or soaps, try to avoid using them. Wearing loose clothing may also help.

• Try to take short showers or baths (<10 minutes) with lukewarm water. Again, patting skin dry instead of rubbing, and applying moisturizer within 1 minute of getting out of the shower, can also help reduce dryness.

• Avoid scratching (of course, this is hard since eczema causes itching!). If you tend to get flare-ups on your hands, you can try wearing gloves at nighttime.

The information below is taken from the Prescribers’ Digital Reference (PDR), which can be found here.

Side Effects

The following is a summary of important potential side effects and does not include every side effect possible. Be sure to read the package insert and report any side effects you experience whether on the list below or not.

Severe

• Exfoliative dermatitis (massive inflammation and scaling of the skin)

• Hyperglycemia (elevated blood sugar)

Moderate

• Erythema (redness)

• Impaired wound healing

• Skin ulcer

• Edema (swelling)

• Phlebitis (inflammation of a vein)

• Contact dermatitis (skin inflammation from contact with a substance)

Mild

• Xerosis (dry skin)

• Skin irritation

• Pruritus (itching)

• Rash

• Telangiectasia (visible, small dilated blood vessels)

• Urticaria (hives)

• Striae (stretch marks)

• Petechiae (small red or purple spots)

• Skin hyperpigmentation

• Acne

• Folliculitis

Contraindications

• True corticosteroid hypersensitivity is rare and generally associated with intravenous steroids, but patients who have any prior allergic reaction to triamcinolone should not receive any form of triamcinolone. It is also possible (but rare) that such patients will have cross-reactivity to other corticosteroids. Patients who have a hypersensitivity reaction to any corticosteroid are recommended to undergo skin testing, which may help to determine if there is potential hypersensitivity to other corticosteroids, and should be carefully monitored during and following the administration of any corticosteroid.

Precautions

• The extent of absorption of triamcinolone depends on the condition of the skin and is determined by multiple factors, including the integrity of the skin, duration of therapy, and presence of inflammation or other disease processes. Absorption is increased in areas of skin damage, inflammation, or thin skin, such as the eyelids, genitals, and face. Topical preparations are metabolized in the skin, but a small amount may be absorbed systemically.

• In some patients who receive prolonged administration of pharmacological doses of topical steroids (resulting in systemic absorption), hypothalamic-pituitary-adrenal (HPA) suppression and/or manifestations of Cushing’s syndrome may occur.

• While treatment with topical or inhaled corticosteroids lessens the risk of immunosuppression as compared with high-dose or prolonged systemic corticosteroids, localized effects may be seen.

• Topical corticosteroids should be used for brief periods only. Patients with evidence of preexisting skin atrophy (thinning) should receive topical corticosteroids under close medical supervision. Older adult patients are more likely to have preexisting skin atrophy from normal aging. Purpura (purple or red spots) and skin lacerations may also be more likely to occur in this population.

• In pregnant patients, topical triamcinolone should be used with caution. It should not be used in large amounts, on large areas, or for prolonged periods of time in pregnant women. Guidelines recommend topical agents with mild to moderate potency over highly potent corticosteroids, and they should be used in short durations.

• Whether topical triamcinolone causes sufficient systemic absorption to produce detectable quantities in breast milk is not known. Most dermatologists stress that topical corticosteroids can be safely used during lactation. If applied topically, the infant should avoid direct contact with the area of application, such as the breast. Increased blood pressure has been reported in an infant whose mother applied a high potency topical corticosteroid ointment to the nipples. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition.

Drug interactions

The risk of topical steroids (including triamcinolone cream) interacting with other drugs is low, and they do not have significant interactions with other drugs. If other topical medications are being used, they should be used separately to avoid potential interactions and/or diminished effects.