Topical steroid or emollient - which to apply first? A critical review of the science and debate

Smoker, Annabel and Voegeli, David (2014) Topical steroid or emollient - which to apply first? A critical review of the science and debate. Dermatological Nursing, 13 (2), 15-26.

Record type: Article

Abstract

Emollients and topical corticosteroids (TCS) are common therapies used in the management of inflammatory skin problems, such as atopic eczema. The emollient counteracts dryness and hydrates the skin, while the TCS is anti-inflammatory and immunosuppressive. Prescriptions may specify frequent application of emollients (two, four or even six times daily), interspersed with a once- or twice-daily TCS. Unfortunately patients and carers often receive conflicting advice from professionals as to order of application, time intervals between the two treatments and the supporting rationale.

Importantly, there is no substantive evidence to demonstrate the complex interplay between emollients and TCS and thereby underpin practice. This lack of clarity may affect treatment concordance and consequently individual therapeutic gain. These uncertainties have been identified by practitioners as research priorities (NICE, 2007; UK DCTN, 2012; UKMi, 2012).

This article examines the mechanisms of emollient and TCS actions, the intricacies of dermal absorption, takes a historical overview and questions current guidance and practice regarding their consecutive application.

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