Eczema Medication and Treatment
Eczema has no cure, but the right combination of skin care and medication can help keep most flares under control.
At a Glance: Eczema Treatment
- Moisturizer is the first treatment healthcare providers recommend for eczema. Apply it at least twice a day, including once after a bath or shower, to lock in moisture and help prevent flares. The “soak and seal” method, a lukewarm soak and then moisturizer within minutes, can add moisture back to very dry skin.
- Steroid creams (topical corticosteroids) are usually the first medicine healthcare providers add. They calm redness and itching and come in different strengths. Your healthcare provider may adjust which one you use over time.
- Non-steroid creams are another option, including calcineurin inhibitors and newer PDE4 or JAK inhibitor creams. These can be used long-term without the skin-thinning and other risks that come with steroids.
- Biologics are an option for eczema when other treatments haven’t worked. They are given as a shot every 2-4 weeks and work with your immune system to calm inflammation. Approved ages vary by medication. One is approved starting at 6 months, while others start at 12 years and older.
- Other advanced treatment options include JAK inhibitor pills, corticosteroid shots, and light therapy (phototherapy). These treat the whole body, not just the skin, and are usually tried when other treatments haven’t worked well enough.
- An eczema treatment plan made for you can help you manage and control your symptoms. Triggers and symptoms are different for everyone and can even change from flare to flare. Work with your healthcare provider and learn about your medicine’s side effects.
Eczema is a chronic skin disease involving dry, inflamed skin and intense itching. Atopic dermatitis (AD) is a type of eczema that is linked to allergies. Managing eczema requires a multifaceted approach. It involves medications, lifestyle adjustments and skincare routines.
An array of medications and treatments are available to help control eczema and reduce flare-ups. From topical therapies and oral medications to innovative biologic treatments, understanding these options can help you make an informed decision along with your healthcare provider.
Do Moisturizers Help Eczema?
Moisturizers are the first-line therapy in treating eczema symptoms. They help protect the outer layer of the skin by:
- sealing in moisture
- combating dryness and scaly skin
- keeping out allergens, irritants and bacteria
- preventing flare-ups
- soothing the skin for long-lasting hydration
Doctors recommend you apply a moisturizer at least twice per day, including once after a bath or shower. Develop a schedule so that moisturizing becomes part of your skincare routine.
If you experience symptoms on your hands, keep moisturizer by all sinks in the home or carry a small tube with you. This way you can easily moisturize every time you wash your hands throughout the day.
Important: If your doctor prescribed a topical medication to treat your eczema, make sure to use it as directed before you put on a moisturizer.
What Types of Moisturizers Are Used to Treat Eczema?
When considering a moisturizer, it is important to think about the ingredients and feel of the cream. Look for products that do not contain added ingredients — such as fragrances, dyes or alcohols — that can irritate the skin.
Generally, the more oil (or fat) a moisturizer contains, the better it is at protecting the skin barrier and sealing in moisture. However, the best moisturizer is the one that works — and the one you’ll actually use every day.
Ointments
Ointments typically contain the most oil and are effective at sealing in moisture. Mineral oil and petroleum jelly are recommended, as is coconut oil as long as you or your child are not allergic to coconut.
Creams
Creams contain less oil than ointments. If you don’t like the greasy or sticky feeling from using ointments, then consider using a cream.
Lotions
Lotions contain more water than oil. As a result, these do not seal in the moisture as well as ointments and creams. Lotions are also more likely to contain fragrances, preservatives and other ingredients that can harm sensitive skin.
Important: Always check the product label before you buy a moisturizer – not only to confirm its beneficial ingredients but also to find out if it has any allergens or irritants.
What do the ingredients in moisturizers do for eczema?
Different ingredients in moisturizers work in different ways to help hydrate, protect and smooth eczema-prone skin.
- Humectants (ceramides, glycerin, sorbitol) helps draw in moisture.
- Petroleum jelly, mineral oil, coconut oil, silicone and/or lanolin helps seal in moisture.
- Emollients (linoleic and lauric acids) help smooth the skin.
How do I apply moisturizer to treat eczema?
Applying moisturizer the right way can help keep eczema-prone skin soft, hydrated and protected.
- Soften the moisturizer by rubbing it between your hands.
- Apply it to affected areas using your palm, in a downward stroke.
- Use a thick layer; the skin will absorb any excess moisturizer within a minute.
Are Baths a Good Treatment for Eczema?
egular bathing can be an important part of an eczema skin-care routine. A short bath or shower with lukewarm water can help hydrate the skin and wash away irritants. Bathing alone does not cure eczema. Think of it as one part of an overall treatment plan that may also include moisturizers, prescription medicines and avoiding triggers.
Some people believe that bathing dries out the skin and makes eczema worse. It’s true that frequent handwashing can leave hands feeling dry, but water isn’t the main culprit. The real issue is using hot water and the type of soap. It also matters what you do right after bathing. Not moisturizing after washing lets the water evaporate instead of locking it in.
So moisturizing after your bath or shower is essential. Talk with your healthcare provider about ways to ensure moisturizing after bathing is effective.
Eczema has no cure, so preventing and managing flare-ups becomes a priority. The trick is figuring out how to get moisture back into the skin and keep it there.
What is the ‘soak-and-seal’ method for eczema?
Bathing too often can sometimes dry out the skin and worsen eczema, but skipping baths isn’t the solution. Instead, doctors suggest keeping baths short and focused.
To soothe itching and rehydrate the skin, they recommend the “soak-and-seal” method. Soak the skin to let it absorb water, then apply a moisturizer right away to lock in the moisture.
Soak
Soak your skin in lukewarm water (not hot water), either a bath or a shower, for 10-15 minutes. Skip the soap or bubble bath: stick to clear water. If necessary, use a gentle cleanser free of fragrances and chemicals. For areas like your face that can’t be soaked in a tub, apply a wet washcloth for at least 5 minutes.
Pat Dry
Gently pat the skin dry with a soft towel – don’t rub, as that will irritate the sensitive areas.
Moisturize
Apply moisturizer right away – ideally within three minutes – to lock in moisture. If you’re using a prescription skin medication, apply it first to the affected areas. Then use a high-oil-content ointment.
While petroleum jelly may be messy, it’s often an effective option for managing eczema flare-ups. Look for fragrance-free, dye-free, or clear ointments, as they are gentler on sensitive skin. Be cautious with creams that may have preservatives or fragrances that could irritate your skin. Avoid lotions, which contain too much water or alcohol and evaporate quickly.
What is wet wrap therapy for eczema?
People with eczema often face two main challenges: 1) a weakened skin barrier that loses moisture easily and allows allergens and germs to enter more readily; and 2) an overly reactive immune system. Treatment needs to be twofold:
- Repair the damaged skin.
- Avoid exposure to allergens and irritants.
For patients with hard-to-control or moderate to severe eczema, one treatment option is wet wrap therapy.
After doing a soak-and-seal warm bath and applying medication, the patient’s eczema-affected skin is then wrapped in a layer of wet cloths. The skin is then topped by dry clothes – such as pajamas, a sweatshirt or tube socks. (Plenty of videos demonstrating wet wrap therapy for eczema are available online.)
Wet wrap therapy can help reduce the need for medication, but it should only be done after consulting with a physician.
Other types of baths that may help eczema
Some healthcare providers suggest putting a half-cup of household bleach (called a bleach bath) or a cup of vinegar into the bath water. The theory is that bleach and vinegar may help kill bacteria and prevent infection.
Others suggest adding bath oil, salt, baking soda or oatmeal to help ease persistent itching. (Baking soda and oatmeal can also be made into a paste that can be applied to the skin.)
Talk with your healthcare provider about whether you should try these specific types of baths.
Bathing Infants and Young Children
Bathing is important for managing eczema at any age, but it tends to be more critical for infants. Their skin is thinner, less mature, and loses moisture more quickly than adults. They are more likely to be exposed to irritants like saliva (drool), milk or formula, or diaper-related moisture. This makes regular hydration through bathing and moisturizing particularly important.
What’s the Best Treatment for My Atopic Dermatitis?
If keeping your skin moisturized and avoiding eczema triggers is not helping, your healthcare provider might suggest medicines to put on your skin (topical) or take by mouth or injection (systemic). Talk with your healthcare provider about the pros and cons of each option.
Topical Treatments
Medicated ointments, creams, lotions, gels, oils or sprays that you apply to the skin.
| Corticosteroids | Calcineurin inhibitors | Crisaborole 2% | JAK inhibitors | |
|---|---|---|---|---|
| Use: | Controls inflammation and itching; apply 1-2X per day; approved for adults and children, including infants as young as 3 months | Controls inflammation and itching when topical corticosteroids aren’t working; apply 1-2X per day; approved for adults and children ages 2 and older | Controls inflammation, itch and rash for mild to moderate eczema; apply 2X per day; approved for adults and children 3 months of age and older | A cream placed on the skin 2X per day; approved for moderate-to-severe eczema in adults and children 12 years of age and older; also approved for children ages 2-11 with mild-to-moderate eczema |
| Side effects: | Redness, stretch marks, skin thinning, spider veins; may develop dependence, leading to Topical Steroid Withdrawal Syndrome | Stinging or burning may occur upon first use; very slight risk of infection | Stinging or burning sensation may occur | Nose and throat pain or swelling; bronchitis; diarrhea; ear infection; runny nose; hives, tonsillitis |
| Cost*: | Low to moderate cost | Moderate to high cost | High cost | Moderate to high |
Systemic Treatments
Injectable biologics, oral corticosteroids or phototherapy designed to treat the entire body – typically prescribed for patients with persistent, moderate-to-severe atopic dermatitis who need more than topical treatments.
| Biologics | Oral or injectable corticosteroids | Phototherapy (light therapy) | JAK inhibitors | |
|---|---|---|---|---|
| Use: | Injected under the skin every 2 weeks; tralokinumab approved for adults, dupilumab approved for adults and children 6 months of age and older | Daily pill or long-acting injection given at doctor’s office – should not be used long-term due to side effects; approved for children | Exposure to ultraviolet (UV) light to reduce inflammation and itch and boost the body’s ability to fight bacteria; can be applied to specific areas or entire body; approved for children ages 6 and older | A pill taken 1X daily for moderate to severe atopic dermatitis for adults and children 12 years of age or older whose disease is not well controlled by other systemic treatments |
| Side effects: | Redness or itching at injection site; eye or eyelid inflammation; allergic reaction; cold sores; joint pain; mouth and throat pain; difficulty sleeping | Weakened muscles, bone thinning, eye problems, diabetes, weight gain, sleep problems, mood swings or behavior changes, Cushing syndrome, slowed growth in children; symptoms may worsen after treatment | Sunburn; skin aging; risk of skin cancer | Shortness of breath; chest pain or pressure; nausea; vomiting; cold sweat; lightheadedness; slurred speech; weakness on one side of your body |
| Cost*: | High cost | Low cost | Moderate to high cost | Moderate to high |
* Costs may be covered by commercial or federal insurance plans. Patient assistance programs from drug manufacturers are also available. Learn more on our “What if I Can’t Afford My Eczema Medications” page.
You Make the Call
To begin a discussion on eczema treatment with your doctor, complete the Shared Decision-Making Tool, created in partnership with ACAAI. Share the results with your doctor and work together on choosing the best treatment plan for you.
Learn about Biological Medications: What they are, how they work, and who might benefit ➤
What Medications are Used to Treat Eczema?
Many over-the-counter (OTC) and prescription medications are available to relieve symptoms.
Remember: every person’s eczema is unique, with different symptoms and triggers Treatment will vary from one person to another – and even from one flare to another. What works for you one time may need to be changed in the future.
Work with a specialist — preferably an allergist or dermatologist — on a personalized treatment plan. Then get to know your medications so you understand how to manage your symptoms most effectively.
Review with your specialist (allergist or dermatologist) or pharmacist any possible side effects. Read medication labels carefully and follow dosing and safety instructions.
Topical corticosteroids
Topical corticosteroids (sometimes just called topical steroids) are ointments and creams that are placed on eczema-affected skin. Many over-the-counter and prescription types are available.
How can topical corticosteroids help eczema?
Topical corticosteroids can:
- Relieve itchy skin.
- Reduce skin inflammation.
- Reduce dry skin.
- Prevent eczema flares from coming back.
What to know about topical corticosteroids used to treat eczema
Important points about the use of topical corticosteroids include:
- Topical corticosteroids are usually prescribed first before other medication options.
- They are available as ointments, creams, solutions and foams.
- Low-potency doses are available without a prescription.
- They come in different strengths; but do not substitute one for another without consulting a doctor.
- Children’s skin absorbs medicine more quickly and thoroughly than adult skin. Recommended medications and dosages differ according to age.
- For best and long-lasting results, use the medication for the full amount of time recommended by your physician.
- A healthcare provider may recommend proactive maintenance. This is when corticosteroids may be used up to 3 times per week to prevent outbreaks in areas that commonly flare.
- Side effects may include thinning of the skin, a lightening or darkening of the skin, stretch marks or inflammation with hair follicles. Discuss any concerns about side effects before discontinuing use.
- There is a risk that the skin may flare back up when topical corticosteroids are stopped. This is called topical steroid withdrawal (TSW) syndrome. TSW is a severe, debilitating skin reaction that can occur after prolonged or high-potency topical steroid use. Talk with your doctor about how to prevent TSW after taking topical corticosteroids. The condition is still being studied.
- Before using topical corticosteroids, tell your physician or pharmacist about current or recent use of any form of corticosteroids, including other topicals and oral, inhaled, nasal and eye drops. Using steroids from more than one source can add up, increasing your risk of side effects, even if each individual product seems low-risk on its own.
Oral or injectable corticosteroids
Oral or injectable corticosteroids are sometimes used to treat severe eczema flare-ups. They should not be used as a long-term treatment option, however.
How do oral or injectable corticosteroids help eczema?
Prednisone, prednisolone, methylprednisolone and dexamethasone are corticosteroids that can be taken by mouth or given by injection, depending on the medication and formulation.
They help relieve itching and inflammation. This type of steroid is called a systemic steroid because the medication works in the whole body, unlike a cream, which only works where it is applied.
What to know about oral or injectable corticosteroids used to treat eczema
Important points about the use of oral or injectable corticosteroids for eczema include:
- The medications should be used short-term only. (It’s usually called a “short course”.) Follow the recommended dosing schedule closely.
- Oral or injectable corticosteroids are approved for severe or difficult-to-treat eczema flare-ups.
- Side effects of short-term oral corticosteroids (OCS) use may include weight gain (especially in abdomen, face or neck), eye problems, muscle weakness, sleep problems, high blood pressure, high blood-sugar levels, and mood changes.
- Side effects of long-term OCS use may include bone loss, osteoporosis, skin thinning, diabetes onset, glaucoma, cataracts, immune system suppression and increased infection risk.
- There is a risk that the skin may flare back up when the medication is stopped.
- To prevent health risks from overuse of corticosteroids, tell your doctor or pharmacist about all current or recent use of corticosteroids, including other oral or injectable corticosteroids and inhaled, nasal, topical and eye drops.
Topical calcineurin inhibitors
Topical calcineurin inhibitors are medications that inhibit the enzyme calcineurin inside your body. Protopic® (tacrolimus) ointment and Elidel® (pimecrolimus) cream are two common topical calcineurin inhibitors.
How do topical calcineurin inhibitors help eczema?
Topical calcineurin inhibitors help block the release of chemicals that cause skin inflammation. This can:
- Reduce inflammation.
- Reduce itchy skin.
- Combat dryness.
- Prevent eczema flares from coming back.
What to know about topical calcineurin inhibitors used to treat eczema?
Important points about using topical calcineurin inhibitors include:
- Topical calcineurin inhibitors are considered an alternative to topical corticosteroids. They are prescribed when skin is damaged or there is concern about overuse of corticosteroids.
- Topical calcineurin inhibitors are approved for adults and children age 2 and up.
- They may be used 2-4 times weekly as a maintenance or preventive treatment.
- When used, avoid sunlight and sunlamps – topical calcineurin inhibitors may cause your skin to be more sensitive to light.
- When first applied to skin, these medicines may initially cause some skin pain (such as a burning sensation), especially if the skin is already inflamed.
- Topical calcineurin inhibitors have an FDA warning. They may increase the risk of skin cancer and non-Hodgkin’s lymphoma. The American Academy of Dermatology (AAD) says this risk mostly applies to oral forms of the medication taken at high doses for long periods of time. The risk is lower with limited topical use.
Topical PDE4 inhibitors
Topical PDE4 inhibitors target and block the PDE4 enzyme. The enzyme is produced by cells in our immune system and can trigger skin inflammation. Eucrisa® (crisaborole) ointment, Zoryve® (roflumilast) cream and Adquey™ (difamilast 1%) ointment are topical PDE4 inhibitors.
How do topical PDE4 inhibitors help eczema?
By blocking the PDE4 enzyme, these ointments and creams can help calm the skin. They can:
- Reduce inflammation.
- Reduce swelling.
- Reduce itchiness and discomfort.
What to know about topical PDE4 inhibitors used to treat eczema?
Important points about topical PDE4 inhibitors include:
- Topical PDE4 inhibitors are approved to treat mild to moderate eczema in adults and children.
- Roflumilast is approved for adults and children ages 2 and up. Crisaborole is approved for adults and children ages 3 months and up.
- Topical PDE4 inhibitors may be more suitable for long-term use. They generally have fewer side effects.
- Stinging or a burning sensation can occur after the medication is applied to the skin.
Biologics
Biologics are advanced, injectable medications for moderate to severe eczema. They are prescribed by specialist – allergist or dermatologist. Biologics are given as an injection by syringe either in a healthcare provider’s office or at home with a pre-filled auto-injectable pen. Dupilumab (Dupixent®), tralokinumab (Adbry®), lebrikizumab-lbkz (Ebglyss®) and nemolizumab-ilto (Nemluvio®) are injectable biologics available to treat moderate-to-severe eczema.
How do biologics help eczema?
Biologics target specific parts of the immune system to stop eczema symptoms before they can start. Biologics block certain proteins that cause skin inflammation and trigger symptoms. They can:
- Reduce skin inflammation.
- Calm the immune system.
- Provide better long-term control.
What to know about biologics used to treat eczema?
Important points about biologics include:
- Biologics are approved for children and adults. Dupixent is approved starting at 6 months of age. Adbry, Ebglyss and Nemluvio are for children ages 12 and older.
- Biologics are typically injected every 2-4 weeks.
- The first biologic injection is typically given in a healthcare provider’s office. After that, depending on health insurance, patients may be able to take the injection in the healthcare provider’s office or self-administering it at home using an auto-injectable pen.
- Biologics are add-on medications, meaning they can be used alongside topical corticosteroid creams or ointments.
- Side effects depend on the biologic used, but in general they may include eye problems, headache, joint pain, muscle pain, and an increased risk of infections.
- Biologics are not a cure. You still need to continue moisturizing your skin and avoiding eczema triggers.
- Biologics are expensive but many are covered by insurance. Patient assistance programs are also available from biologic manufacturers. These can help make biologics more accessible to all patients.
JAK inhibitors
Janus kinase (JAK) inhibitors are medications designed to block an overactive enzyme pathway in the immune system. By doing so, they limit the production of cytokines – immune messengers that play a key role in triggering eczema symptoms.
JAK inhibitors come as topical creams or pills. They are prescribed to treat moderate-to-severe eczema. Currently, four JAK inhibitors are approved for eczema treatment.
- Abrocitinib (Cibinqo®) – taken orally as a tablet for adults and children ages 12 and older
- Upadacitinib (Rinvoq®) – taken orally as a tablet for adults and children ages 12 and older
- Ruxolitinib (Opzelura®) – taken as a topical medication (a cream) for adults and children ages 2 and older with mild-to-moderate eczema.
- Delgocitinib (Anzupgo®) – taken as a topical medication (a cream) to treat chronic hand eczema in adults
How do JAK inhibitors help eczema?
JAK inhibitors help reduce skin inflammation and itching. They improve skin texture by minimizing thickness and scaling and promoting clearer skin.
Many patients on JAK inhibitors see improvement in eczema symptoms, including itch relief, within days to a few weeks.
What to know about JAK Inhibitors for eczema?
Important points about JAK inhibitors include:
- JAK inhibitors can weaken the immune system, making patients more susceptible to infections and other illnesses. Other potential side effects include nausea, nasal swelling, cough, and elevated blood pressure.
- FDA requires product warnings on some JAK inhibitors about increased risk of serious heart-related events and blood clots.
- Patients may need to avoid sunlamps and limit the amount of time in sunlight while taking JAK inhibitors for eczema.
- Your healthcare provider will regularly check your skin for signs of certain cancers while you’re taking JAK inhibitors.
- JAK inhibitors are typically covered by insurance, but insurers may require step therapy — meaning you may have to try other treatments first (such as topical medications or biologics) before they approve coverage. Patient assistance programs and co-pay cards are also available from manufacturers.
Immunosuppressants
Systemic immunosuppressants slow down the immune system from overreacting to triggers. They can be taken as a pill or as an injection. Azathioprine, cyclosporine, methotrexate, and mycophenolate mofetil are types of systemic immunosuppressants.
Immunosuppressants are not specifically approved to treat eczema. They are sometimes used in special circumstances prescribed by a specialist -allergist or dermatologist, for moderate-to-severe eczema.
How do immunosuppressants help eczema?
Systemic immunosuppressants can:
- Calm the immune system.
- Reduce skin inflammation.
What to know about immunosuppressants used to treat eczema?
Important points about immunosuppressants include:
- Immunosuppressants are very strong medications. They are developed for chemotherapy and to prevent organ rejection after transplants.
- They are prescribed for short-term use only. Your healthcare provider will require regular checkups to monitor your blood pressure.
- Side effects may include high blood pressure and kidney or liver problems.
- They are sometimes used as an alternative to phototherapy.
Phototherapy
Phototherapy, also called light therapy, is an in-office procedure that involves a special light machine. It delivers targeted bands of ultraviolet (UV) light to affected areas of the skin.
Phototherapy is considered a second-line treatment. It is only used in people with moderate to severe eczema. Phototherapy is usually tried after other treatments, like ointments, creams and moisturizers, haven’t worked well enough on their own. An allergist or dermatologist can usually administer the procedure.
How does phototherapy help treat eczema?
Phototherapy can help reduce inflammation that is a part of eczema. It can provide relief from the itching and swelling, and also help boost the body’s bacteria-fighting abilities. The procedure also allows the skin time to heal, although it does not make eczema go away permanently. Moisturizers should be applied following therapy since the procedure can dry out the skin.
Patients can use it on specific areas of the body that aren’t responding to other treatments, or over the entire body if needed.
Phototherapy involves very short and frequent sessions. This might make it difficult for some people to fit it into busy schedules. Your doctor will determine what type of UV light is right for you. The goal is to time the treatments to avoid potential health risks from UV light exposure.
Nearly 70% of patients who are treated with phototherapy have positive results.
Some areas of the country may not have phototherapy readily available and accessible. Talk with your doctor. A trip to the tanning bed is not a replacement for phototherapy. Tanning beds do not deliver the controlled, medical-grade UV doses that phototherapy uses, and they carry their own health risks.
What to know about phototherapy used to treat eczema?
Important points about immunosuppressants include:
- One important precaution to take while undergoing phototherapy is to wear goggles to prevent injury to the eyes.
- When done under the direction of a doctor, phototherapy is safe, but there are several side effects that can occur. As with any exposure to UV light, the skin can get sunburned or appear to age more rapidly. There are some reports this treatment can lead to skin cancer.
- Patients should always talk with their healthcare provider to see if phototherapy is right for them.
Additional and secondary treatments for eczema
Eczema can involve infections that require separate treatments. There are also treatments that do not treat eczema but can help reduce itchiness and allergy symptoms related to eczema.
Oral or topical antibiotics
Oral or topical antibiotics do not treat eczema itself. They are used to treat bacterial infections that can develop on eczema-affected skin, such as infections caused by staphylococcus aureus bacteria. Signs of infection may include yellow crusting, swollen bumps or pus-filled blisters.
Topical antibiotics are used for a skin infection in one area. Oral antibiotics are used for more extensive or severe skin infections.
Mupirocin is a prescription topical antibiotic usually applied to the affected area three times per day for 1-2 weeks.
Topical antibiotics are sometimes not recommended. They can cause contact dermatitis in some people and may contribute to antibiotic drug resistance.
Antihistamines
Antihistamines are not typically prescribed for eczema symptoms. However, OTC and prescription oral antihistamines can help relieve allergy symptoms that trigger or worsen eczema. They may reduce itch and help people sleep better at night.
There are two types of antihistamines: newer (second-generation) and older (first-generation).
- Newer antihistamines, such as cetirizine (Zyrtec®) or loratadine (Claritin®), cause little to no drowsiness and are generally the recommended choice today.
- Older antihistamines, such as diphenhydramine (Benadryl®), cause drowsiness. Because of this and other side effects, they are generally not the first choice.
Some people may choose to use the older, sedating antihistamine at night, when itching is often at its worst. The drowsy effect can help with sleep.
Talk to your healthcare provider about which type, if either, may be right for you.
Conditions that can look like eczema
Several skin and immune conditions cause rashes, itching, or swelling that get mistaken for eczema. They differ in what triggers them, how they are diagnosed, and how they are treated. If a rash is not responding to eczema treatment, ask a board-certified allergist or dermatologist whether one of these could be the cause:
- Aquagenic urticaria causes hives after contact with water.
- Celiac disease can cause dermatitis herpetiformis, an intensely itchy blistering rash.
- Chronic spontaneous urticaria (CSU) is hives lasting six weeks or longer with no identifiable trigger.
- Chronic urticaria (hives) causes welts that move around, with individual welts usually fading within 24 hours.
- Cold urticaria brings on hives, swelling, and welts after exposure to cold.
- Contact dermatitis is actually a form of eczema, but it is triggered by an allergen or irritant touching the skin rather than by atopic disease.
- Hereditary angioedema (HAE) causes deep swelling without hives or itching, and does not respond to antihistamines or corticosteroids.
- Mast cell diseases, including mastocytosis and mast cell activation syndrome, can cause unexplained skin rashes along with other body-wide symptoms.
- Primary immunodeficiency diseases include several disorders that produce severe, treatment-resistant eczema-like rashes starting in infancy.
- Psoriasis produces thick, sharply defined, scaly plaques, often on elbows, knees, and scalp.
- Rosacea causes flushing, lasting changes in skin color, and sometimes acne-like bumps on the face, often with burning or stinging.
- Scabies is caused by tiny mites that burrow into the skin, producing a rash with intense itching that often worsens at night.
- Seborrheic dermatitis is a form of eczema that causes flaky, sometimes greasy patches on the scalp, face, and other oily areas of the skin.
October 2026
Reviewed by:
Luz Fonacier, MD is Professor of Medicine at NYU Long Island School of Medicine and is the Head of Allergy and Training Program Director in Allergy and Immunology at NYU Winthrop Hospital. In 2020-21, she served as President of the American College of Allergy, Asthma & Immunology (ACAAI), becoming the fourth woman and first Asian American to serve in that role.
William E. Berger, MD, FACAAI, is a board-certified allergist and immunologist who serves as a media spokesperson and Chair of the Medical Advisory Council for Allergy & Asthma Network. He is a Distinguished Fellow and Past President (2002-03) of the American College of Allergy, Asthma & Immunology (ACAAI).
