As parents, we aren’t exactly lacking for choice when browsing the skin care aisle for our child. There’s an assortment of creams, ointments, and moisturisers that claim to soothe irritated skin, particularly for those prone to eczema flareups. To add to that, many parents know in the back of their mind that prescription eczema creams exist. It’s not uncommon to start believing you’re wasting your time with over-the-counter (OTC) options when stronger ones are available.
In reality, prescription eczema treatment has its place, but it’s not a simple upgrade over OTC choices. Different options have different use cases, depending on severity of the condition and how each person’s skin reacts. At times, prescription options aren’t actually a suitable option, and often, they are ideally used in combination with OTC products. There are several complex factors that go into a decision like this.
Today, we’ll dive into some of the questions you might be asking about eczema treatment. It’s ultimately crucial to understand how these products work, and how they differ. By explaining all the strengths, weaknesses and use cases of OTC and prescription eczema treatment, we hope to arm you with the knowledge to make informed decisions about your child’s skincare.
What’s the Difference Between OTC and Prescription Eczema Creams?
A question like this has a lot of layers, but we’ll start by pointing out the obvious. Broadly speaking, the biggest differences are the formulations themselves, and accessibility.
OTC eczema creams can be bought from a pharmacy without a prescription. In general, they’re designed mainly to soothe, hydrate, and protect the skin barrier. Nourishing the skin barrier is a key goal in any decent skin routine, but it’s especially important for eczema sufferers as the barrier often gets damaged. Proper maintenance will go a long way towards reducing dryness and preventing flare-ups.
OTC products can also contain some of potent actives that you’ll find in prescription options, but at a significantly lower dosage. We’ll go into this more later on.
Prescription eczema creams contain active ingredients that directly target inflammation, itching, and immune responses. When eczema becomes more severe, widespread, or unresponsive to basic care, these options are suited to provide relief. However, these medicines can affect how the skin and immune system behave, so they must be monitored by a healthcare professional.
Both play a role in eczema management. OTC is great for daily maintenance, and prescription creams step up when stronger anti-inflammatory control is needed. It’d be no surprise if your child needs a combination of the two at different times, depending on how their skin behaves.
What Do Over-the-Counter Eczema Creams Typically Contain?
Most OTC eczema treatments fall into two categories: moisturisers (emollients) and low-strength anti-inflammatory creams.
1. Emollients and barrier repair creams
Moisturisers are the mainstay of eczema care and can be used multiple times a day.
They help to:
- Rebuild the skin barrier, reducing water loss.
- Relieve dryness, flaking, and tightness.
- Minimise triggers by forming a protective film.
Common ingredients include:
- Ceramides – lipids that restore the skin barrier.
- Colloidal oatmeal – soothes itching and irritation.
- Shea butter or petrolatum – create a sealing layer to retain hydration.
This is hardly an exhaustive list of the ingredients you might find in a daily moisturiser. Even for infants, these creams are safe for daily use, and are the foundation of eczema maintenance.
The main thing you need to look out for are fragrances or preservatives that can irritate sensitive skin. Always look for fragrance-free, dye-free, and soap-free products labelled for eczema or sensitive skin.
2. Mild corticosteroids
Low-dose steroid creams such as hydrocortisone 0.5% or 1% are available OTC in Australia. These can help calm mild flare-ups by reducing inflammation and redness. They’re typically applied once or twice daily to affected areas for a short duration (usually under seven days).
Even though these products are available without a prescription, you still need to exercise some caution. While safe for occasional use, even mild steroids should be used carefully on children’s thinner skin (e.g. face or skin folds). If symptoms don’t improve within a week, it’s best to check with a GP and avoid using them long-term.
Limitations of OTC treatments:
OTC creams are excellent for prevention and mild eczema, but they may not be adequate for moderate to severe inflammation. Persistent itching and broken skin are signs that your child likely needs prescription-strength intervention.
What Makes Prescription Creams Different?
Prescription eczema treatments interrupt the inflammatory process more effectively than OTC products. This is because they contain more potent or targeted active ingredients for this cause. Note that this doesn’t mean they are superior, but rather they work better for the specific use cases where inflammation is more than a mild issue.
1. Stronger corticosteroids
Prescription steroids come in a range of strengths and formulations (cream, ointment, lotion, gel). They work by reducing redness, swelling, and itching. Examples include mometasone, betamethasone, and methylprednisolone.
For prescription-strength activities, the appropriate dosage is important. This will be professionally decided based on:
- The child’s age and skin thickness.
- The location of the eczema (thinner areas like the face require milder options).
- The severity of the flare-up.
Used correctly and for limited periods, topical steroids are safe and highly effective. The main worries come from overuse or unsupervised application, which can thin the skin or cause temporary lightening in sensitive areas. We must insist on proper prescription monitoring for this reason.
2. Topical Calcineurin inhibitors (TCIs)
Sometimes steroids aren’t suitable (e.g. for long-term use on the face or eyelids). Dermatologists may instead prescribe TCIs (tacrolimus or pimecrolimus) which block the calcineurin protein from contributing to inflammation. These creams help regulate immune activity in the skin without the side effects of steroids. However, because of their effect on the immune system, they can worsen skin infections. In many cases, dermatologists prefer if topical steroids have been tried first.
3. Compounded treatments
When a child struggles with standard formulations due to sensitivity or ingredient intolerance, a compounding pharmacy can prepare customised creams. This can include adjusting the concentration of actives, removing potential irritants like propylene glycol, or combining multiple beneficial ingredients into one product. Such an approach can dramatically improve long-term tolerability and adherence when applicable.
Can OTC and Prescription Treatments Be Used Together?
Yes. In fact, they almost always work best when combined correctly.
During active flareups, prescription creams target inflammation. Whereas between flares, regular OTC moisturising maintains the skin’s strength and resilience. In combination, these products handle both the short-term and long-term concerns of eczema.
While people have preferences, there are no standard rules regarding which to apply first. However, it is important to leave a gap of at least 10 minutes between the two. Ideally, a 20–30 minute gap is recommended to avoid diluting the strength of the topical steroid. It also reduces the risk of it spreading to areas not affected by eczema.
Are There Risks With Using the Wrong Type of Cream?
While OTC and prescription options are safe, there are always risks if used incorrectly.
Using prescription-strength steroids too often or for too long can lead to side effects such as thinning skin and increased fragility. Conversely, if an emollient is your only solution for severe eczema, it’s unlikely to be enough to combat worsening symptoms.
Speaking of emollients, there are many different types that cater towards different skin types. We recommend trying various types to find the best one for your child. To avoid a negative reaction, test new products on a small area of unaffected skin for 48 hours. It may seem overly cautious, but even emollients marketed for eczema have been known to cause irritation for some children.
If your child is prescribed TCIs, they have their own risks. TCIs and topical steroids shouldn’t be used at the same time on the same area of the body. And while TCIs should always be used in conjunction with emollients for proper management, some TCIs require at least a 2-hour gap between the two. They’re also not suitable for skin infected by bacteria, or viruses, nor should they be used under wet wraps.
When used correctly, eczema treatment is considered safe and highly effective. Nonetheless, make sure you always understand the risks and follow professional guidance.
The Verdict
Over-the-counter eczema creams and prescription medications each serve an important role. Rather than one being superior over the other, they’re intended for different stages of the condition. OTC products are excellent for maintaining hydration and protecting the skin barrier, while prescription treatments step in when inflammation needs stronger control. Ultimately, they work in combination, and long-term eczema sufferers are likely to gain experience using both.
Written By
Zen Xiao
