Steroid cream (also known as corticosteroid cream) is a topical medication (applied to the skin) used as anti-inflammatory preparation used in the treatment of various skin conditions including irritant and contact dermatitis (sore, red and swollen skin), insect bites and mild to moderate eczema. In today’s post, I will review the strongest over the counter steroid cream: clobetasone cream (brand name: Eumovate Eczema % Dermatitis cream).
The strongest over the counter steroid cream (OTC): legal classification
Eumovate cream, which is available over the counter without a prescription, is classified as pharmacy-only ‘P‘ medication. ‘P’ medicines can only be sold in pharmacies, including online pharmacies with a pharmacist being present at the premises.
Patients who wish to purchase Eumovate Eczema & Dermatitis cream need to request it from a pharmacy. Certain restrictions apply when Eumovate cream is sold as over the counter medication.
Eumovate cream: sale restrictions
When sold in the pharmacy, Eumovate Eczema % Dermatitis cream is restricted in size and comes in the form of a 15g tube. The larger size of Eumovate cream and ointment (30g and 100g) tubes are licensed as prescription-only medicines and need to be prescribed by GP or another prescriber. Both Eumovate OTC and prescription-only Eumovate, contain the same active ingredient clobetasone butyrate 0.05%.
OTC Eumovate is licensed in adults and children over 12 years of age. Children under 12 years of age can use Eumovate cream only under recommendation from a doctor.
One of the main reasons against the use of a steroid cream(s) is the treatment of infections, for example viral, fungal or bacterial infections. Fungal and bacterial infections which are present on the skin may be treated with an antifungal cream (with or without a steroid) and antibiotics creams respectively. Some antibiotic infections can be treated with over the counter antibiotic cream.
The strongest over the counter steroid cream: other restrictions
So far two restrictions were discussed in term of supply of Eumovate over the counter (age, and size of the cream). Other restrictions related to the use of Eumovate cream:
- Eumovate should not be applied to broken, infected or inflamed skin.
- Eumovate should not be applied to treat symptoms of skin conditions including viral infections, for example, herpes, chickenpox, fungal infections or bacterial infections.
- Eumovate should not be used to treat acne, rosacea or pruritus when no rash is present.
- Eumovate should not be applied to face.
- Eumovate should not be applied to genitals, groins or between toes. A patient may be experiencing a fungal infection, as these are common sites form this type of infection. An antifungal cream may be more suitable in this case.
Please read the product information leaflet before using Eumovate cream.
What can Eumovate cream be used for?
Over the counter Eumovate can be used as a short-term treatment (up to seven days) of eczema and dermatitis (irritant and allergic) to help with symptoms of red and itchy skin.
Why Eumovate is the strongest over the counter steroid cream
Steroid creams are classified as mild, moderate, potent and very potent. Although classified as mild cream, Eumovate is the strongest steroid cream, which is available to buy without a prescription. Below is the list of some commonly available steroid creams, prescription-only (POM) and pharmacy-only (P):
|Potency||Active ingredient||Brands||Pack Sizes|
P or POM
|Mild||Hydrocortisone 1%||Various brands||15g|
|Moderate||Clobetasone 0.05%||Eumovate||30g & 100g|
|Potent||Mometasone 0.1%||Elocon||30g & 100g|
|Potent||Betamethasone 0.1%||Betnovate||30g & 100g|
Adopted from NICE (BNF) 2020.
The above list is non-exclusive lists. Additionally, many of the steroids creams come as combination products with an antifungal (some available over the counter) and antibacterial agents (prescription-only).
The only two corticosteroid creams available without a prescription are hydrocortisone and clobetasone creams.
How to use Eumovate Eczema & Dermatitis cream
All steroids creams, including Eumovate, should be applied sparingly and gently rubbed into the affected area only. Eumovate should be applied once or twice daily for up to seven days. If no improvement is seen after seven days or symptoms get worse, patients should speak to their doctor. The same advice applies when some improvement is seen, and treatment is needed beyond seven days.
Use ‘fingertip‘ as a measurement for the amount of cream you needed. Squeeze out the cream from the tube from the top of your index finger to the first crease on your finger.
Half fingertip should be sufficient to cover the area of the skin similar to the size of the palm of your hand. Fingertip is a guided unit for the application of the cream. Less cream may be needed to cover smaller areas of the skin. Apply the cream sparingly.
Do you apply emollient or steroids first?
Emollients (creams or ointments) should be applied first when corticosteroids creams such as Eumovate are used together in the treatment. It is recommended to apply steroid cream 30 minutes after an emollient (NICE, 2018).
Eumovate cream: possible side effects
Eumovate Eczema & Dermatitis Cream is generally well tolerated. Very rarely Eumovate can cause hypersensitivity reactions manifested by reddening of the skin, rash, itchiness and local skin burning. Other infrequent side effects may include allergic reactions and worsening of the symptoms (eMC, 2017).
With prolonged topical corticosteroid can cause:
- thinning of the skin
- skin discolouration
- stretch marks
- telangiectasias, ‘spider veins formed due to dilated or broken blood vessels under the skin.
In addition to their anti-inflammatory actions, topical corticosteroids reduce the amount of collagen in the skin. Collagen has various functions in the body. Collagen is responsible for the elasticity of the skin and supports its structure.
Steroid creams should not be applied on the face (unless recommended by a doctor). Long-term use of steroids on the face can result in damaging side-effects mention above. Additionally, topical steroids can contribute to the development of acne. When used, topical corticosteroids can degenerate an outer layer of the skin where follicles are located. Follicles have various roles in the skin including the attachment of the hair into the skin. Damage to the follicular epithelium (skin) increases the number of fats (free fatty acids) which promotes bacteria growth and consequently may result in comedogenesis – the formation of blackheads (Coondoo et al, 2014).
It is essential to follow the recommended duration of seven-day treatment unless a doctor gives different advice. Patients should also remember to apply steroid cream thinly.
The strongest over the counter steroid cream: alternative options
I briefly mentioned that Emovate (clobetasone) and hydrocortisone 1% cream are the only two steroid creams available without a prescription from the pharmacy. Hydrocortisone 1% is a weaker corticosteroid; however, it is licensed for the treatment of the same skin conditions with an addition of skin bites management.
Many restrictions that apply to Emovate also apply to hydrocortisone 1% cream. The age restrictions for the use of hydrocortisone 1% are lower with licensed use for children over ten years of age.
Parents of children or patients who are not sure about the treatment needed for the skin conditions should seek advice from a pharmacist who may be able to identify a condition, recommend most appropriate treatment (for example antifungal treatment) or refer to a GP when necessary.
Patients who use steroid cream in the management of eczema should use emollients alongside to treat their skin dryness. Learn more about over the counter anti-itch creams for the management of dry, irritated and itchy skin.
Steroid creams are useful and effective in the management of different skin conditions, including eczema and dermatitis. Eumovate is the strongest over the counter steroid cream available without a prescription. Patients need to follow instructions on the use and stick to the recommended duration of the treatment to reduce the chance of getting side effects.
In the UK the only hydrocortisone cream available over the counter is 1% hydrocortisone cream. When purchased over the counter steroid cream are used for one week only. When prescribed, GP may recommend a longer treatment duration, very often by recommending intermediate use. The steroid cream should not be applied on the face unless prescribed by a doctor. Ointments are 'thicker' (more oily) in their formulation than cream, therefore they give longer and more occlusive effect, which makes them better than creams. However, ointments are more oily, therefore their use may have it's practical limitations. Steroid cream which is purchased over the counter should not be applied on the face. When prescribed a doctor may advise to use steroid cream on the face.
Can you buy Hydrocortisone 2.5% over the counter?
How long can I use topical steroids?
What steroid cream is safe for face?
Which is better ointment or cream?
Is it OK to put steroid cream on your face?
In the UK the only hydrocortisone cream available over the counter is 1% hydrocortisone cream.
When purchased over the counter steroid cream are used for one week only. When prescribed, GP may recommend a longer treatment duration, very often by recommending intermediate use.
The steroid cream should not be applied on the face unless prescribed by a doctor.
Ointments are 'thicker' (more oily) in their formulation than cream, therefore they give longer and more occlusive effect, which makes them better than creams. However, ointments are more oily, therefore their use may have it's practical limitations.
Steroid cream which is purchased over the counter should not be applied on the face. When prescribed a doctor may advise to use steroid cream on the face.
Coondoo A, Phiske M, Verma S, Lahiri K. Side-effects of topical steroids: A long overdue revisit. Indian Dermatol Online J. 2014;5(4):416-425. doi:10.4103/2229-5178.142483 Available at: https://dx.doi.org/10.4103%2F2229-5178.142483 Accessed on 30/08/2020
eMC (2017). SmPC: Eumovate Eczema & Dermatitis 0.05% Cream. Available at: https://www.medicines.org.uk/emc/product/3929/smpc Accessed on 28/07/2020
NICE (2018). Corticosteroids – topical (skin), nose, and eyes. Scenario: Topical treatment. Available at: https://cks.nice.org.uk/corticosteroids-topical-skin-nose-and-eyes#!scenario Accessed on 28/07/2020
NICE (2020). Topical corticosteroids. Available at: https://bnf.nice.org.uk/treatment-summary/topical-corticosteroids.html Accessed on 28/07/2020