Is hormone ointment bad for your skin?

If you’ve ever had to deal with eczema, chances are that hormone creams immediately come to mind. After all, they’re often the first thing a doctor prescribes. But there are all sorts of horror stories surrounding hormone creams: they’re said to thin your skin, stunt your growth, and even harm your health. When my son Armaan developed severe eczema at just two weeks old, I got completely lost in the maze of facts and myths about hormone creams. But is that fear justified?

In this blog I would like to discuss whether hormone ointment is your friend or foe in the fight against eczema.

Why use hormone ointment?
Eczema can be extremely intense, with severe itching, pain and a red, fiery skin. At such a time, basic ointments are often not enough, and then hormone ointment, also called corticosteroid ointment, comes into play. This ointment has an anti-inflammatory effect and reduces symptoms such as itching and redness. Hormone ointment is a medical product and is only provided on prescription from a doctor or dermatologist. Its use is always combined with fatty creams to support the skin.

With Armaan, we saw improvement very quickly when the hormone cream was applied during his flare-ups. The itching and redness subsided, and he was finally able to sleep better. However, as a parent, I felt an internal struggle. The cream initially worked quickly, but then the effect seemed to slow down, and sometimes it didn’t work at all. This led to the temptation to apply more than prescribed, in the hope of getting the flare-ups under control faster. Eventually, stronger and stronger creams were prescribed to control his eczema, and my fear of the possible side effects grew. Had I applied too much? Was the fear of hormone cream justified?

How does hormone ointment work?
Eczema is a genetically determined skin condition that can flare up due to various triggers, such as stress, colds or changes in the weather. Hormone ointment does not cure eczema, but it does effectively suppress the inflammation and symptoms.

With Armaan we saw that his eczema often got worse during stressful moments or when he was ill. Hormone ointment provided temporary relief and gave us some breathing space.

Four classes of hormone ointment
Did you know that hormone ointments are divided into four strength classes, from mild to very strong? The right class is chosen based on the severity of the eczema and the location on the body. On thin skin, such as on the face, a lighter variant is usually prescribed.

We were given different types of ointments for different parts of the body, and it was sometimes difficult to follow the schedule precisely. Once we had found a rhythm, we were often prescribed a new dosage or a different variant at the next consultation.

How do you use hormone ointment correctly?
Lubrication schedules and fingertip amounts; mindfuck.

Usually, the doctor will give you a lubrication schedule, for example to lubricate every day for a week and then gradually reduce this. The goal? Prevent your skin from getting thinner or getting other side effects. But I honestly admit, the lubrication schedule was not always easy for me to follow. Especially when I saw my child itching and crying and wanted to do something right away.

I can tell you, applying more or more skin care ointments did not make his skin heal faster. But when you are desperately looking for skin relief, it is not strange that you unconsciously apply more and more. It is a mindset that slowly turns from focus and 'following instructions' to desperation and fear. Fear of having another flare-up. And when that fear takes over your focus, you can quickly start to deviate from prescribed advice.

For example, you will receive instructions from the fingertip unit when you have to start with hormone ointment. 1 fingertip cream is equal to the amount you may apply to a hand including fingers. But what if the eczema is only on a small spot between your finger? Do you then apply the amount of the fingertip to that small spot or should you use less? And if the eczema is on multiple spots and spread out, what do you do then? Unnecessary difficult questions made applying an ointment a difficult task for me.

I often puzzled over calculations about how much hormone ointment I should use. And well, then that little voice comes into your head: "Oh, maybe just apply a bit more by feeling." You can't keep asking a doctor endless, perhaps unnecessarily difficult questions, I thought. But I should have. Because when a variant of hormone ointment doesn't work, a doctor can recommend another, heavier variant instead of incorrectly using a lighter class. This can prevent side effects. Because incorrectly using hormone ointments can actually cause side effects.

Side effects of hormone ointment
The most common side effect of hormone ointment is that your skin can become thinner. However, this only happens with incorrect use, such as applying too often or applying to healthy skin. When the eczema keeps coming back in the same place, it can sometimes be difficult not to apply too often to the same places.

Armaan eventually developed very sensitive skin and boils due to the frequent use of hormone ointment. His open skin could no longer tolerate even the mildest greasy creams. This took a long time to heal. In older children and adults, the recovery can take even longer.

What is a hormone ointment addiction?
If you see that applying hormone ointment does not have the desired effect and even causes more irritation, it is advisable to go back to a dermatologist.

At some point, applying hormone ointments no longer helped Armaan. His skin became covered in boils and his skin became very sensitive. Even the greasy ointments burned his skin. On social media, I read a lot about people who use hormone ointments getting the so-called topical steroid withdrawal syndrome, a hormone ointment addiction. And because of that, I also started to doubt and feel guilty about whether I had perhaps applied too much hormone ointment to Armaan, which had made his skin so vulnerable. His flare-ups came back faster and more severely.

TSW is a phenomenon that has not yet been well defined, dermatologist Dirk Jan Hijnen of the Erasmus MC Rotterdam once explained in a blog. Dirk Jan explains: “This mainly concerns people with constitutional eczema who have been using topical corticosteroids, also known as hormone ointments, for a long time. They think they have become addicted to these agents because they have to apply increasingly heavier classes of ointments to keep their skin complaints under control. If they use these agents incorrectly or stop applying them abruptly, serious cutaneous rebound symptoms can occur. And these symptoms can actually only be treated by applying topical corticosteroids again. This creates a vicious circle and patients experience a confirmation of the 'addiction': the skin can no longer do without hormone ointments.”

At a certain point I stopped applying Armaan's ointments 'according to the book' and I also stopped when his skin was calm. I just wanted to get rid of those hormone ointments because I had become confused by facts and fables, fears and observations. But soon eczema flare-ups returned and in more severe forms. With the help of dermatologists, a good plan of action (lubrication schedules) and a clear explanation of quantities, Armaan's skin returned to a reasonably calm state after a period of years. Armaan was already 4 years old and his skin was full of scars and spots from scratching. He also had thickened elephant skin in many places. Children started to question him about this and that broke me as a mother. I didn't want Armaan to have to go through this whole struggle with flare-ups so often throughout his life. And that is why I have chosen to develop products with Rivaana Skincare that can naturally control eczema skin and thus limit eczema flare-ups as much as possible.

The golden rule: ensure good basic care and a healthy lifestyle
In addition to using hormone creams, good basic skin care is essential, day in and day out. Keeping your skin healthy and avoiding triggers can help reduce eczema flare-ups. At Rivaana Skincare, we believe in the power of preventative skin care and strive to support eczema skin as best as we can.

And Armaan? The weekly visits to the dermatologist are now fortunately rare. Thanks to good daily skin care and an adapted, healthy lifestyle, we are teaching Armaan to keep his eczema under control. And if his immune system does temporarily gain the upper hand, his eczema still flares up sometimes. But we now know how to keep it well under control. And when in doubt, we do not hesitate to consult a doctor for medical support when it is really necessary. What reassures me is that I am no longer constantly looking for a second opinion, but try to keep control myself at the 'front end' preventively before a flare-up has room to do so. The energy I get from basic care helps me to effectively tackle eczema triggers in my son.

Your experience?
Do you have eczema or do you know someone with eczema? Share your experiences below. Together we can find the balance between relieving eczema and minimizing side effects. I believe that by sharing experiences, we can strengthen each other.

Want to learn more about how to manage eczema? Keep following our blogs for deeper insights and practical tips.

- Anisha Biharie, Founder Rivaana Skincare