Eczema Medication and Treatment
Eczema is a chronic skin disease involving inflammation, dryness, and intense itching. Atopic dermatitis (AD) is a type of eczema that is linked to allergies. Managing eczema requires a multifaceted approach. It involves lifestyle adjustments, skincare routines, and in many cases, medical treatments.
An array of medications and treatments are available to help control eczema symptoms and reduce flare-ups. From topical therapies and oral medications to innovative biologic treatments, understanding these options can empower you to make informed decisions along with your healthcare providers.
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.
Treating and managing eczema for all people
What types of moisturizers are used to treat eczema?
When considering a moisturizer, the first thing to look for is how much oil it contains. The more oil in a moisturizer, the better it is for treating eczema. If your skin feels greasy or sticky after applying a moisturizer, that means the product likely contains plenty of oil.
Look for products that do not contain added ingredients – such as fragrances, dyes or alcohols – that can irritate the skin.
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 also are 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?
- 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?
- 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?
Eczema is more than just dry skin. Flares erupt unpredictably: dry, scaly, irritated spots on the face or hands, or inside the crease of the elbow or knee. The itch is almost unbearable – and scratching makes it worse, resulting in what feels like an endless cycle.
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. Slathering on moisturizer by itself usually won’t do it; neither will simply soaking in a bath.
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 the soap we use and skipping an important step: applying moisturizer after washing to lock in hydration.
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?
While bathing too often can sometimes dry out the skin and worsen eczema, 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.
Extra Help
Some doctors suggest putting a half-cup of household bleach 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 doctor about whether you should try these specific baths.
Bathing Infants and Young Children
Bathing is important for managing eczema at any age, but it tends to be more crucial for infants. Their skin is thinner, less mature, and loses moisture more quickly than adults. They are more likely to have 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 isn’t helping enough, your doctor might suggest medicines to put on your skin (topical) or take by mouth or injection (systemic). Talk with your doctor about the pros and cons of each option to decide what’s best for you.
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 | Short-term treatment of mild to moderate atopic dermatitis; apply 2X per day; approved for non-immunocompromised adults and children 12 years of age and older |
| 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 |
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.
What is wet wrap therapy for eczema?
People with eczema often face two main challenges: a weakened skin barrier that loses moisture easily and allows allergens and germs to enter more readily; and an overly reactive immune system.
That means treatment needs to be twofold:
- Repair the damaged skin.
- Avoid exposure to allergens and irritants.
Sounds simple, but anyone who deals with eczema knows that it is anything but easy. Calming itchy skin is key to stopping the itch-scratch cycle.
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-damaged skin is wrapped in a layer of wet cloths, topped often by dry clothes – such as pajamas, sweatshirt or tube socks. Plenty of videos demonstrating wet wrap therapy for eczema are available online.
Wet wrap therapy can reduce the need for medication, but it should be done only after consulting with a physician.
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 and prescription medications are available to relieve symptoms.
Remember: every individual’s eczema is unique, with different triggers and different symptoms. As a result, treatments 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.
It’s important to work with your physician on a personalized treatment plan. Then get to know your medications so you understand how to manage your symptoms most effectively. Talk with your doctor or pharmacist about any possible side effects. Read labels carefully and follow dosing and safety instructions.
How do topical corticosteroids help eczema?
Topical corticosteroids are ointments that are placed on affected skin. Many prescription and over-the-counter types are available. They can:
- Relieve itchy skin.
- Reduce skin inflammation.
- Reduce dry skin.
- Prevent eczema flares from recurring.
What do I need to know about topical corticosteroids used to treat eczema?
Important points about the use of topical corticosteroids include:
- Corticosteroids are usually prescribed first before other medication options.
- They are available as creams, solutions, foams and ointments.
- Low potency doses are available without a prescription.
- If recommended by a physician, corticosteroids may be used 1-2 times per week to prevent outbreaks in areas that commonly flare.
- They come in different strengths; do not substitute one for another without consulting a doctor.
- Children’s skin absorbs medicine more quickly and thoroughly than adult skin, so 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.
- 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.
- Always tell your physician and pharmacist about current or recent use of all forms of corticosteroids, including oral, inhaled, nasal, topical and eye drops.
How do oral or injectable corticosteroids help eczema?
Oral or injectable corticosteroids are sometimes given to treat severe eczema flares. Prednisone, prednisolone, methylprednisolone, and dexamethasone are all types of corticosteroids. They help relieve itching and inflammation.
What do I need to know about oral or injectable steroids used to treat eczema?
Important points about oral or injectable corticosteroids include:
- They should be used short-term only. Follow recommended dosing schedule closely.
- They are approved for severe or difficult-to-treat eczema.
- Side effects of short-term oral corticosteroid (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.
- Skin may flare when 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 oral, inhaled, nasal, topical and eye drops.
How do topical calcineurin inhibitors help eczema?
Topical calcineurin inhibitors are medications that inhibit the enzyme calcineurin. This helps block the release of inflammation. Protopic® (tacrolimus) ointment and Elidel® (pimecrolimus) cream are common topical calcineurin inhibitors. They can:
- Reduce inflammation.
- Reduce itchy skin.
- Combat dryness.
- Prevent eczema flares from recurring.
What do I need to know about topical calcineurin inhibitors used to treat eczema?
Important points about topical calcineurin inhibitors include:
- Topical calcineurin inhibitors are an alternative to topical corticosteroids. They are considered when skin is being damaged or there is concern about overuse of corticosteroids.
- They are approved for adults and children age 2 and up.
- They may be used 2-4 times weekly as maintenance/preventive treatment.
- When used, avoid sunlight and sunlamps – topical calcineurin inhibitors may cause skin to be more sensitive to light.
- When applied to skin, they may initially cause skin pain (such as a burning sensation), especially if the skin is already inflamed.
- Topical calcineurin inhibitors have an FDA warning. They may increase 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.
How do topical PDE4 inhibitors help eczema?
Topical PDE4 inhibitors target the PDE4 enzyme, which can trigger inflammation. Eucrisa® (crisaborole) ointment and Zoryve® (roflumilast) cream are topical PDE4 inhibitors. They can:
- Reduce inflammation.
- Reduce swelling.
- Reduce itchiness and discomfort.
What do I need to know about topical PDE4 inhibitors used to treat eczema?
Important points about PDE4 inhibitors include:
- PDE4 inhibitors are approved to treat mild-to-moderate eczema in adults and children ages 2 and up.
- The PDE4 enzyme is produced by cells in our immune system and helps the body regulate inflammation.
- They may be more suitable for long-term use, as they generally have fewer side effects like skin thinning.
How do oral or topical antibiotics help eczema?
Oral or topical antibiotics help eczema by treating underlying bacterial or staph infections.
What do I need to know about oral or topical antibiotics used to treat eczema?
Important points about oral or topical antibiotics include:
- Topical antibiotics are used for small, localized bacterial infections. Oral antibiotics are used for more extensive or severe skin infections.
- Topical antibiotics are sometimes not recommended. They can cause contact dermatitis in some people and may contribute to antibiotic drug resistance.
- Mupirocin is a prescription topical antibiotic usually applied to the affected area three times per day for 1-2 weeks.
How do oral antihistamines help eczema?
Over-the-counter and prescription oral antihistamines can relieve allergy symptoms that may trigger or worsen eczema. They can also help relieve itchy skin.
“First-generation” sedating antihistamines such as diphenhydramine (Benadryl®) may help you sleep, especially at night when itching is often at its worst. Non-sedating antihistamines may help during the day without the drowsiness.
How do injectable biologics help eczema?
Biologics are advanced medications made from living cells. They are mostly prescribed for people with moderate-to-severe eczema. Biologics target specific parts of the immune system and aim to stop eczema symptoms before they can start. They help block specific proteins that activate skin inflammation and trigger symptoms.
Dupilumab (Dupixent®), tralokinumab (Adbry®), lebrikizumab-lbkz (Ebglyss®) and nemolizumab-ilto (Nemluvio®) are injectable biologics available to treat moderate-to-severe eczema. They can:
- Reduce inflammation.
- Calm the immune system.
- Improve skin barrier function.
- Provide long-term control.
What do I need to know about biologics used to treat eczema?
Important points about biologics include:
- Biologics are injectable medications. They are injected every two to four weeks.
- They 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.
- The first biologic injection is typically given in a doctor’s office. After that, patients have the choice of taking the injection in the doctor’s office or self-administering it at home using an auto-injectable pen.
- They can be used with or without topical corticosteroid creams or lotions.
- Biologics are expensive and are not always covered by insurance. Patient assistance programs are available from biologic manufacturers.
- Side effects depend on the biologic used, but in general they may include eye problems, headache, joint pain, muscle pain and increased risk of infections.
- Biologics are not a cure. You still need to continue moisturizing your skin and avoiding any eczema triggers.
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 are JAK Inhibitors and how do they treat eczema?
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, such as itching, inflammation, and skin damage.
JAK inhibitors help reduce itching and inflammation, improve skin texture by minimizing thickness and scaling, and promote clearer skin.
JAK inhibitors come as topicals or pills. They are prescribed to treat moderate-to-severe eczema. Currently, three JAK inhibitors are approved for eczema treatment. Abrocitinib (Cibinqo®) and upadacitinib (Rinvoq®) are taken orally as a tablet. Ruxolitinib (Opzelura™) is taken as a topical medication.
What do I need to know about JAK Inhibitors for eczema?
Important points about JAK inhibitors include:
- They are approved for use in adults and children aged 12 and older.
- 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.
- JAK inhibitors can be costly, but they are often covered by insurance, which helps make them more accessible to patients.
How do oral or injectable systemic immunosuppressants help eczema?
Systemic immunosuppressants are designed to slow down the immune system from overreacting to triggers. Azathioprine, cyclosporine, methotrexate, and mycophenolate mofetil are systemic immunosuppressants. They can:
- Suppress the immune system.
- Reduce eczema inflammation.
What do I need to know about immunosuppressants used to treat eczema?
Important points about immunosuppressants include:
- Immunosuppressants are not specifically approved to treat eczema. They are sometimes used off-label for moderate-to-severe eczema.
- They are sometimes used as an alternative to phototherapy.
- 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 doctor will require regular checkups to monitor blood pressure.
- Side effects may include high blood pressure and kidney or liver problems.
How is phototherapy used to treat eczema?
Phototherapy, also called light therapy, can help reduce inflammation that is a part of eczema. It can both lessen the itch and help boost the body’s bacteria-fighting abilities.
Phototherapy is an in-office procedure conducted by either an allergist or dermatologist. It involves a special light machine that delivers targeted bands of ultraviolet (UV) light to affected areas of 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 is considered a second-line treatment and is used only for patients who haven’t had success with other measures.
Nearly 70 percent of patients who are treated with phototherapy have positive results, but it’s important to note that this treatment is not for everybody.
Phototherapy may start with very short sessions, delivered often. This might make it difficult for some people to fit into busy schedules. The doctor will determine what type of UV light is right for you in order to time the treatments and avoid potential health risks with UV light exposure.
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.
What do I need to know about phototherapy used to treat eczema?
Phototherapy can provide relief from the itching, swelling and tenderness of eczema, with fewer potential side effects than some other treatments.
The procedure allows the skin time to heal, although it does not make eczema go away permanently. Moisturizers must be applied following therapy since the procedure can dry out the skin.
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 doctor to see if phototherapy is right for them.
Treating the Whole Person with Atopic Dermatitis:
Are there other conditions that may look like eczema but are not eczema?
Several skin conditions can mimic eczema, but they differ in symptoms, diagnosis, and treatment. Here are a few examples:
