Treatments for Eczema
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Medically reviewed by Brendan Camp, MD
Eczema (also known as dermatitis) is a condition that primarily affects the skin, causing dryness, itchiness, scaliness, rashes, and blisters. In some cases, eczema can lead to skin infections. While there isn’t a cure for eczema, there are several treatments to manage and reduce symptoms. Your healthcare provider will recommend a treatment plan depending on the type of dermatitis you have, your age, and your specific symptoms.
Most often, these medications may impact your skin barrier or your immune system. However, some types of eczema—such as neurodermatitis or statis dermatitis, among others—may require additional treatment. The following are some common treatments for the many types of eczema.
Moisturizing
One form of treatment and management for people with eczema is reducing skin dryness. This involves applying moisturizer (also called an emollient) at least twice daily, or more frequently if needed. Moisturizers often come as ointments (which have the highest oil content), creams, or lotions (which have the lowest oil content). Ointments are your best bet when it comes to getting the most moisture, but if they are too greasy, creams can help lock in moisture as well.
Look for moisturizers that contain petroleum jelly, especially if you have eczema that is prone to dryness, such as asteatotic or nummular dermatitis.
Be careful of some lotions, which may more likely contain preservatives that can be potential allergens or irritants. In general, aim for fragrance-free products. For extra moisture, try skin barrier repair creams containing oils that naturally occur in your skin, like ceramides, which help protect your skin barrier.
Wet Wrap Therapy
Wet wrap therapy involves moisturizing your skin and wrapping it with damp fabric or bandages, then following it by wrapping it with dry fabric or bandages to lock in moisture. Wet wraps are worn for a few hours or overnight, depending on your healthcare provider's guidance. It's particularly beneficial for moderate to severe cases of eczema.
Wet wrap therapy can hydrate your skin, offer cooling relief, reduce inflammation, and enhance the effects of topical medications. However, it may not be suitable for all eczema types and therefore should be done under the supervision of a dermatologist (a medical doctor who specializes in hair, skin, and nails).
Over-The-Counter Medication
Over-the-counter (OTC) medications can help provide temporary relief from eczema symptoms. OTC medications for eczema include:
Hydrocortisone cream: This is a mild corticosteroid that is available without a prescription. It can help reduce itching and inflammation in mild cases of eczema.
Calamine lotion: This contains zinc oxide, which can be soothing for itchy skin.
Antihistamines: These medications, such as Benadryl (diphenhydramine), Zyrtec (cetirizine), or Claritin (loratadine), can help reduce itching. This is especially helpful when itching is keeping you up at night—which can often happen with atopic or nummular eczema. In cases like this, your provider may recommend taking oral antihistamines before bed.
Pain relievers: If your eczema is causing pain, burning, and irritation, you may find relief from a medication such as Tylenol (acetaminophen) or Advil (ibuprofen).
Related: Bug Bites and Other Irritants are No Match for the Best Anti-Itch Creams
Prescription Topical Medication
When regular creams and other moisturizers cannot provide enough relief from eczema symptoms, many people turn to prescription topical medication. These medications vary significantly in strength, so it's important to work with your dermatologist to find the right fit for you.
Corticosteroids
Corticosteroids are anti-inflammatory creams, ointments, lotions, or foams. They work by reducing inflammation and suppressing your immune response, which helps reduce the itching, redness, and swelling associated with eczema. Corticosteroids are generally recommended for short-term use to control flare-ups and manage symptoms without causing significant side effects. They include:
Kenalog (triamcinolone acetonide)
Cutivate (Fluticasone propionate)
Elocon (Mometasone furoate)
Diprolene (Betamethasone)
Temovate (Clobetasol propionate)
Calcineurin Inhibitors
Topical calcineurin inhibitors are a class of medications used to treat eczema, particularly atopic dermatitis. They do not contain steroids, making them a preferred choice for certain situations, such as when sensitive areas of the skin are affected. Two common topical calcineurin inhibitors used for eczema are:
Protopic (tacrolimus): This is available in ointment form and is used to reduce inflammation and control the symptoms of atopic dermatitis.
Elidel (pimecrolimus): This is used to manage mild to moderate atopic dermatitis, particularly in sensitive areas such as the face.
Topical calcineurin inhibitors work by suppressing the immune response and reducing inflammation of the skin. They are usually used for short-term and intermittent treatment of eczema flare-ups. They are considered safe for use on delicate areas of the skin where corticosteroids may carry a higher risk of side effects, such as the face and neck.
Phosphodiesterase 4 Inhibitors
Topical phosphodiesterase 4 (PDE-4) inhibitors are eczema medications that target specific enzymes involved in the inflammatory response of the skin. Eucrisa (crisaborole) is an example; it's an ointment for mild to moderate eczema in children and adults. It can be applied to the affected skin to relieve itching and inflammation.
PDE-4 inhibitors may be a preferable option for those who want to avoid steroids or who have sensitive skin areas affected by eczema.
Topical JAK Inhibitor
Topical Janus kinase (JAK) inhibitors are medications used to specifically treat atopic dermatitis, a type of eczema. JAK inhibitors work by targeting specific proteins involved in your body's inflammatory response. When applied topically, they can help reduce itching and inflammation.
A common topical JAK inhibitor for eczema is Opzelura (ruxolitinib). Opzelura was approved by the U.S. Food and Drug Administration (FDA) in 2021 for the treatment of mild to moderate atopic dermatitis in people ages 12 years and older. It helps to suppress your immune response and reduce skin inflammation.
Topical JAK inhibitors are generally considered when other treatments, such as emollients, topical corticosteroids, and calcineurin inhibitors, have not provided sufficient relief or when there is a desire to reduce the use of stronger systemic medications.
Prescription Oral Medications
There are a variety of prescription medications available for eczema. Your dermatologist can prescribe various treatments to treat your eczema, reduce flare-ups (periods of worsening symptoms), and help manage symptoms such as skin inflammation.
Immunosuppressants and Immunomodulators
If your symptoms are moderate to severe, your provider might prescribe oral systemic immunosuppressants, such as systemic corticosteroids. This type of medication can help reduce overactive immune responses related to skin inflammation. Another treatment option is an immunomodulator, which is a type of drug that targets a specific part of your immune system.
As you can become immunocompromised while taking either of these drugs that alter your immune system, your doctor would only prescribe them when all other treatments fail to relieve your symptoms and the side effects of taking them outweigh their health benefits.
JAK Inhibitors
Oral JAK inhibitors work the same way as topical JAK inhibitors. They are recommended only in more severe cases of eczema when other medication options have been exhausted. The two oral JAK inhibitors for eczema include:
Rinvoq (upadacitinib): This is FDA-approved for people over age 12 with moderate to serious atopic dermatitis.
Cibinqo (abrocitinib): This is FDA-approved for adults with refractory (eczema that worsens due to allergens), moderate-to-serious atopic dermatitis.
These medications have been met with criticism; people who took them in the clinical trials reported a greatly reduced quality of life. They include a black box warning, which is the strictest warning that the U.S. Food and Drug Administration (FDA) gives a medication.
Biologics
In severe cases of eczema that don't respond to other treatments, your dermatologist may prescribe biologics. Biologics are prescription injectable medications and are known as "targeted therapy." They use antibodies to target your immune system and change the way your immune system responds to eczema triggers.
Biologics are typically used in limited, controlled situations due to potential side effects. They were considered a last line of treatment for eczema, but now they are generally recommended before trying oral JAK inhibitors.
Common biologics used for eczema treatment include Dupixent (dupilumab) and Adbry (tralokinumab-ldrm).
Phototherapy
Your dermatologist may recommend phototherapy if you have a severe case of nummular dermatitis, atopic eczema, or neurodermatitis that hasn’t improved after trying other treatments, like prescription topicals. Phototherapy exposes your skin to a specific range of ultraviolet (UV) light to reduce the inflammation in your skin that contributes to eczema. However, it’s not recommended for eczema that affects the genitals.
There are various types of phototherapy used for eczema, including:
Narrowband UVB (NB-UVB): This is the most common type of phototherapy for eczema. It involves exposure to a specific wavelength of UVB light that has been found to be effective in treating the condition. UVB light is the type of light that causes sunburn, so it's important to monitor your skin for any concerning changes.
Ultraviolet A1 (UVA1): UVA1 phototherapy utilizes a longer wavelength of UVA light. It is less commonly used for eczema but may be considered in specific cases.
PUVA (Psoralen plus UVA): This involves the use of psoralen, a medication that sensitizes your skin to UVA light. It is also less commonly used for eczema but may be considered in certain situations.
Your provider might use an FDA-approved medical lamp, laser, or other device to administer this treatment. It can be used as the main treatment or with other treatments, like moisturizers and topical corticosteroids.
Treatments for Infections
If you have eczema, your skin barrier may be more susceptible to skin infections. This is especially true if you have a tendency to scratch, as this can break your skin barrier as well as cause bacteria from your fingernails to enter your skin.
If your skin lesions do become infected, your healthcare provider can prescribe appropriate antibiotic treatments, which may include creams or lotions applied to the skin.
If you have seborrheic dermatitis (dandruff), your dermatologist can prescribe topical antifungals and antimicrobial shampoos. These can help treat infections on your scalp and reduce flaking.
Lifestyle Adjustments
Lifestyle adjustments can play a significant role in managing eczema (atopic dermatitis) and reducing the frequency and severity of flare-ups. Here are some practical lifestyle changes that may help you if you have eczema:
Gentle cleansing: Use mild, unscented cleansers when bathing. It's best to avoid hot water, as it can strip the skin of its natural oils. Limit your showers or baths to 10-15 minutes.
Avoid harsh soaps and detergents: Use hypoallergenic or fragrance-free soaps, detergents, and shampoos. Avoid products with sulfates, parabens, and other potentially irritating ingredients.
Pat dry, don't rub: After bathing, pat your skin dry with a soft towel rather than rubbing, which can irritate your skin.
Cotton clothing: Wear loose-fitting, breathable clothing made from natural fabrics like cotton. Avoid rough, scratchy materials like wool, which can cause more itching and irritation.
Maintain a comfortable room temperature and humidity level: Extreme heat and low humidity can worsen eczema. Use a humidifier in dry environments during the winter months.
Avoid scratching: Scratching can damage your skin and worsen your eczema. Use cold compresses, moisturizers, or prescription topical medications to help with itching.
Sun protection: Use sunscreen to protect your skin from UV rays, as sunburn can worsen eczema. Choosing a sunscreen that is suitable for sensitive skin may improve your comfort.
A Quick Review
Eczema, also known as dermatitis, is a chronic skin condition that can be challenging to manage, but several treatment options are available to help alleviate your symptoms. The primary goal of eczema treatment is to reduce inflammation, relieve itching, and restore your skin's barrier. The choice of treatment depends on the severity of your condition, your age, and your individual preferences.
In mild cases, over-the-counter moisturizers can help prevent dryness and itchiness. For more moderate to severe cases, your dermatologist may recommend topical corticosteroids, calcineurin inhibitors, or topical phosphodiesterase 4 (PDE-4) inhibitors, among other topical and oral medications. Systemic medications or biologic therapies may be considered in severe or refractory cases.
Lifestyle changes, including avoiding triggers, using gentle soaps and detergents, and maintaining good skincare practices, can help you manage your symptoms and improve your quality of life. Overall, it is important that your dermatologist take a personalized approach to your eczema care, taking in to account your specific needs.
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