What are the treatment options for eczema?
Do moisturizers help eczema?
Moisturizers are the first-line therapy in treating eczema. They help protect the outer layer of the skin by sealing in moisture, combating dryness, keeping out allergens, irritants and bacteria and preventing flare-ups. And they soothe 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.
Eczema Medications for Skin of All Colors:
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 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 contain less oil than ointments. If you don’t like the greasy or sticky feeling from using ointments, then consider using a cream.
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.
In fact, some people think bathing dries out the skin and makes it worse. We all know how frequent hand-washing dries out the hands. The reason for this is not the water itself, however, but the soaps we use and the fact that we often just wash and dry – forgetting to add a moisturizer to seal in the water.
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?
It may be true that bathing too frequently can dry out skin and exacerbate eczema, but rather than skipping baths, doctors recommend shorter ones.
To ease the itch and rehydrate the skin, doctors recommend a “soak and seal” method. Soak the skin to allow water to absorb, then use a moisturizer immediately to seal in the wetness.
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.
Gently pat the skin dry with a soft towel – don’t rub, as that will irritate the sensitive areas.
Apply moisturizer immediately (within 3 minutes is the rule) to seal the water in. If you have a prescription skin medication, use that first on affected areas. Then use a high-oil-content ointment.
Petroleum jelly may be messy, but it’s often the best solution for eczema flares. In general, use fragrance-free, dye-free or clear ointments. Lotions contain too much water or alcohol and easily evaporate, while some creams have preservatives or fragrances to which you may be sensitive.
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.
What’s the Best Treatment for My Atopic Dermatitis?
|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|
|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
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What is wet wrap therapy for eczema?
People with eczema often have two problems: a defective skin barrier that dries out easily and is more open to invasion from allergens and germs than normal; and an overly sensitive 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. Stopping the itch is key, as the itch-scratch cycle feeds upon itself.
For patients with difficult-to- manage 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.
Doctors recommend wet wrap therapy as an intervention for moderate-to-severe cases. Wet wrap therapy can reduce the need for medication, but it should be done only after consulting with a physician.
What medications are used to treat eczema?
While there are no medications that “cure” the condition, the good news is that there are many medications both over the counter and by prescription that can relieve symptoms.
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?
Many prescription and over-the-counter corticosteroids are available. They can:
- Relieve itch
- Reduce inflammation
- Reduce dryness
- Prevent flares from recurring
What do I need to know about topical corticosteroids used to treat eczema?
Topical corticosteroids are steroids that are placed topically, on the skin. Important points about their use include:
- Corticosteroids are often the first line of treatment for eczema.
- Corticosteroids are available as creams, solutions, foams and ointments.
- Low potency doses available without a prescription.
- Corticosteroids cause thinning of skin.
- 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. 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?
Prednisone, prednisolone, methylprednisolone, and dexamethasone are all types of corticosteroid. These steroids are used for eczema and may be given orally or by injection. They relieve itching and inflammation.
What do I need to know about oral or injectable steroids used to treat eczema?
Oral or injectable corticosteroids:
- Should be used short-term only; follow recommended dosing schedule closely.
- Are approved for severe or difficult-to-treat eczema.
- Side effects may include bone loss, diabetes, weight gain and eye problems.
- 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?
Protopic® (tacrolimus) ointment and Elidel®(pimecrolimus) cream are topical calcineurin inhibitors. They will:
- Reduce inflammation
- Reduce itch
- Combat dryness
- Prevent flares from recurring
What do I need to know about topical calcineurin inhibitors used to treat eczema?
- Topical calcineurin inhibitors are an alternative to topical corticosteroids, when skin is being damaged or there is concern about overuse of steroids.
- 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, you need to avoid sunlight and sunlamps – calcineurin inhibitors may cause skin to be more sensitive to light.
- They may cause skin pain (such as a burning sensation), especially when applied to acutely inflamed skin.
- Topical calcineurin inhibitors have an FDA warning. They may increase risk of skin cancer and non-Hodgkin’s lymphoma. The American Academy of Dermatology says this risk 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?
Eucrisa® (crisaborole) ointment is a topical PDE4 inhibitor. A PDE4 medication:
- Reduces inflammation
- Reduces swelling
- Targets PDE4 enzymes deep within the skin to reduce inflammation
What do I need to know about PDE4 Inhibitors used to treat eczema?
- PDE4 inhibitors are approved to treat mild-to-moderate eczema in adults and children ages 2 and up.
- PDE4 inhibitors work differently than other topical treatments such as corticosteroid ointments and calcineurin inhibitors.
- PDE4 is produced by cells in our immune system and helps the body regulate inflammation.
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?
- 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, as they can be associated with contact dermatitis 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.
- Bleach baths may also be effective in treating and preventing infection.
How do oral antihistamines help eczema?
- Relieve allergy symptoms related to eczema
- May help with sleep
How do injectable biologics help eczema?
Dupilumab (Dupixent®) and tralokinumab (Adbry®) are injectable biologics available to treat moderate-to-severe eczema. Biologic medications:
- Reduce inflammation
- Calm the immune system
What do I need to know about biologics used to treat eczema?
- Dupixent is administered by injection every 14 days.
- Dupixent is approved for adults and children ages 6 months and older to uncontrolled moderate-to-severe eczema.
- Dupixent can be used with or without topical corticosteroid creams or ointments.
- Biologic medications are expensive and are not always covered by insurance.
- There is a risk of eye-related side effects.
What are JAK Inhibitors and how do they treat eczema?
- Janus kinase inhibitors, or JAK inhibitors for short, is a medication that blocks off an overactive pathway of enzymes. This limits the production of immune messengers called cytokines that can cause eczema symptoms.
- Three are available: abrocitinib (Cibinqo®), ruxolitinib (Opzelura™) and upadactinib (Rinvoq®).
- JAK inhibitors can relieve itching and inflammation, reduce skin thickness and scaling, and promote clear skin. They are approved for adults and children ages 12 and older.
- JAK inhibitors alter the immune system’s ability to react to germs, which can put patients at risk for infections and other diseases. Side effects may include nausea, nasal swelling, cough and high blood pressure.>
- The medications are expensive but usually covered by insurance.
How do oral or injectable systemic immunosuppressants help eczema?
Azathioprine, cyclosporine, methotrexate, and mycophenolate mofetil are systemic immunosuppressants that:
- Suppress the immune system
- Reduce the inflammation
What do I need to know about immunosuppressants used to treat eczema?
- Not specifically approved to treat eczema; sometimes used off-label for moderate-to-severe eczema.
- Sometimes used as an alternative to phototherapy.
- Very strong medications, developed for chemotherapy and to prevent organ rejection after transplants.
- Require short-term use and regular blood test monitoring by a doctor.
Side effects may include blood pressure and kidney or liver problems.
How is phototherapy used to treat eczema?
Phototherapy, also called light therapy, can reduce the inflammation that is a part of eczema. It can both lessen the itch and help boost the body’s bacteria-fighting abilities. It can be used in specific areas that aren’t responding to other treatments, or over the entire body if needed.
Phototherapy is an in-office procedure conducted by either an allergist or dermatologist. It involves exposing the skin that is affected by eczema to ultraviolet (UV) light.
Phototherapy is considered a second-line treatment and is used only for patients who haven’t had success with other measures. A special light machine is used to deliver targeted bands of UV light just where it’s needed.
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.
It is important for the doctor to determine what type of UV light is right for you in order to time the treatments and avoid risks to your health. The amount of light exposure is timed and increased as treatment progresses.
Phototherapy may start with very short sessions, delivered often, making it difficult for some people to fit this into their busy schedules.
Some areas 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 often provides relief from the itching, swelling and tenderness of eczema, with fewer potential side effects than some other treatments.
Phototherapy often allows the skin time to heal, although it does not make eczema go away permanently. Patients should always talk with their doctor to see if phototherapy is right for them.
Phototherapy, when done under the direction of a doctor, is considered 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.
One important precaution to take is to wear appropriate goggles to prevent injury to the eyes. Moisturizers must be applied following therapy since the procedure can dry out the skin.
Treating the Whole Person with Atopic Dermatitis:
Are there other conditions that may look like eczema but are not eczema?
Chronic Idiopathic Urticaria (CIU)
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