Aims This study aimed to determine whether a 3-day burst of a potent steroid is more effective than a weak preparation used for 7 days in treating disease exacerbations and in maintaining remissions in children with atopic eczema.

Methods A randomized, double-blind, parallel group study of 18 weeks' duration. 174 patients with mild or moderate atopic eczema were recruitment from 13 general practices in the Nottingham area. Two primary outcomes were evaluated: (i) the total number of scratch-free days and (ii) the number of disease relapses. Secondary outcomes included the median duration of the 1st disease relapse; the number of nights when sleep was not disturbed; disease severity (SASSAD), two quality-of-life measures (CLQI and DFI) and the number of treatment ‘failures’ in each arm. Skin thickness was measured using B-mode ultrasound.

Results We found no differences between the two groups for any of the outcome measures used. The median number of scratch free days was 118.0 for the hydrocortisone group and 117.5 for the betamethasone valerate group (95% CI median difference −2–4, P = 0.53). The median number of relapses for both groups was 1. Both groups showed clinically significant improvements in disease severity and quality-of-life compared to baseline. No significant changes in skin thickness were observed.

Conclusions For children with mild or moderate atopic eczema in the community, both 1% hydrocortisone used for 7 days, or betamethasone valerate 0.1% used for 3 days, are effective in controlling disease symptoms.