- Eczema is an umbrella term for a group of inflammatory skin diseases that cause patches of dry, red, itchy skin
- Treatment involves a multimodal approach to include over the counter and prescription medications, and home remedies
- While there is not yet a cure, these treatments can effectively reduce the number and severity of flare-ups
Eczema comprises a group of inflammatory skin diseases that presents as red, raised patches of itchy, burning scaly skin. As there is no cure for eczema, treatments are intended to address symptoms, and reduce and control outbreaks.
Eczema can be a complicated disease to treat as flare-ups can be a result of any number of triggers. While it is understood it is caused by the interplay between the immune system and genetics, environmental factors and stress all play a role.
There is no one established treatment for eczema; every person will respond differently to medications so treatment is tailored to what works best for you.
Over the Counter
There are several over-the-counter (OTC) medications that can soothe irritation and inflammation, as well as the pain and itchiness associated with eczema flare-ups. OTC treatments are effective for mild forms of eczema or to support first-line therapies such as topical corticosteroids.
Hydrocortisone is a low-potency corticosteroid, a mainstay of treatment for inflammatory skin conditions. Corticosteroids work by constricting dilated blood vessels and blocking the chemicals responsible for causing the inflammatory response – and the accompanying itch.
OTC hydrocortisone is available in concentrations of 0.5–2.5% in lotion, gel and cream formulations. This treatment does not have a specified time limit, unlike higher potency corticosteroids.
Emollients and moisturizers play an important role in easing the dryness and tightness of eczema flares, and strengthening the uppermost layer of skin, the skin barrier. They have been proven to make primary treatments more effective, and to reduce the frequency and intensity of flare-ups.
Anti-fungal shampoos can treat seborrheic eczema, a disease that affects the scalp.
Symptoms include red scaly patches of skin and dandruff. Look for medicated shampoos that contain ketoconazole, selenium sulfide, coal tar or zinc pyrithione to alleviate itching and gently remove the scales and flakes from the scalp.
Antihistamines can be used alongside main treatments to relieve the uncomfortable itch that accompanies eczema flare-ups. When the immune system is activated, histamines are released by white blood cells as a defense mechanism and causes inflammation. Antihistamines effectively block the effects of histamine.
There are many products to choose from including diphenhydramine (Benadryl), pseudoephedrine HCI, (Sudafed), loratadine (Claritin) and fexofenadine (Allegra). Read the product label before purchasing as some antihistamines cause drowsiness – a bonus if your itch is keeping you awake at night.
To temporarily relieve the pain, burning and swelling that accompanies eczema flare-ups, there are multiple medications to choose from such as ibuprofen (Motrin, Advil) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen (Aleve, Naprosyn). These all effectively block the chemicals that cause inflammation.
For moderate to severe eczema or for treatment-resistant eczema, your dermatologist may prescribe stronger topical or oral medications.
There are three main types of prescription-strength topical eczema treatments with different mechanisms of action to relieve eczema symptoms.
When topical OTC corticosteroids are ineffective in treating eczema flare-ups, the next step would be prescription strength. These include medium- to high-potency formulations.
As a first-line treatment for inflammatory skin conditions, corticosteroids are available in a number of formulations such as ointments, creams, lotions, gels, foams, oils and solutions.
There is a long list of associated adverse effects with this class of medication, both topical and systemic. To reduce these risks, the least potent medication is prescribed for the shortest period of time, while still maintaining effectiveness.
The quantity needed, strength and duration of treatment will depend on the severity of the eczema and will be determined by your doctor.
Topical calcineurin inhibitors are nonsteroidal medications that block calcineurin, a protein that activates T-cells responsible for inflammation.
This class of medication is used as a second-line treatment, after the first option has failed whether due to inadequate response or side effects. They can be used for delicate areas of skin, such as the eyelids and outer genital skin, when long-term treatment with topical corticosteroids aren’t appropriate.
Two types are available, depending on severity: pimecrolimus cream (Elidel) for mild to moderate eczema and tacrolimus ointment (Protopic) for moderate to severe eczema. Both are available in varying strengths. Your doctor will provide you with specific instructions as to use.
This class of medication can be used safely, not only short term to treat active flares, but also longer term to prevent them, by extending flare-free intervals.
Topical PDE4 inhibitors
Topical phosphodiesterase 4 (PDE4) inhibitors are fairly new to eczema treatment. They work by regulating cytokine production, proteins which trigger an inflammatory response. Research demonstrates these inhibitors are safe and effective in treating mild-to-moderate atopic dermatitis.
Crisaborole (Eucrisa) 2% topical ointment is steroid-free and can be used safely for all skin tones and types. Very few adverse effects are associated with this type of medication; the most common are burning and stinging.
Immunosuppressant drugs are not approved by the FDA for treating eczema and are therefore used off-label. They are only prescribed for those with moderate to severe eczema who have failed traditional therapy; the goal is to gain control of the disease, then switch to topical medications for long-term symptom management.
Cyclosporine and methotrexate both work effectively to tamp down the body’s immune response to calm flares and provide rapid relief.
Use of this class of drugs is associated with a list of very serious adverse events including increased risk of elevated blood pressure, infections and cancer; liver and kidney damage.
This is why oral immunosuppressants are prescribed only for short-term use.
Phototherapy, also known as light therapy, is another second-line treatment for moderate to severe acne that is very effective in reducing inflammation for some people. Ultraviolet B (UVB), ultraviolet A (UVA), or a combination of both can be used.
While this treatment can be effective, it can be challenging for some people to adhere to the recommended two-times-a-week treatment schedule. Adverse effects include worsening of symptoms and rarely, increased risk of skin cancer.
Natural remedies can provide additional benefits and support doctor-prescribed therapies. Before incorporating a natural remedy within your skin care routine, speak with your doctor first to ensure they won’t interact with your other medications.
There are a variety of oils and creams to choose from to reduce inflammation, speed up healing and soothe the pain and itchiness that present with eczema flare-ups.
Coconut oil can bring fast relief to uncomfortable flare-ups. As an emollient, it can hydrate and soften irritated patches of dry skin. It has anti-inflammatory and antimicrobial properties that target inflammation and infection.
Jojoba oil contains wax esters which act as a humectant by providing moisture and sealing in moisture. It can also unclog hair follicles, which in turn helps other topical medications to better absorb into the skin. It also has proven anti-inflammatory effects.
Making a few lifestyle changes can go a long way in supporting doctor-prescribed therapies and reducing the frequency of flare-ups.
- Take care of your skin: Use your prescribed medications as instructed. Wash your skin gently and moisturize well to relieve dryness and irritation
- Stress has a negative effect on health and is a known eczema trigger. Find an activity you enjoy and take control of your stress levels through exercise, meditation or yoga. Ensure you get enough sleep; studies show that this enables you to better cope with stressful situations
- Identify your triggers: Examine your household cleaning products, cosmetics and fabrics to identify and eliminate eczema-causing irritants
- Maintain a healthy vitamin-rich diet: Identify and avoid the foods that trigger your flare-ups (such as citrus fruits, high-fat dairy products, gluten or wheat). Include foods that are part of an anti-inflammatory diet (to include high-fiber whole grains, lean protein and green, leafy vegetables)
Eczema is an inflammatory skin disease that is challenging to treat. It is understood that genetics and an overactive immune system play a part as do multiple environmental triggers.
While eczema cannot be cured, it can be controlled through a combination of topical, oral, OTC and prescription-strength medications. These all work in different ways to suppress inflammation and reduce the discomfort and pain of eczema flare-ups.
Home remedies can relieve symptoms and lifestyle changes can greatly reduce flare-up activity.
Your doctor will work with you to find the right dose and medication that is most effective for you. Often it is a matter of trial and error, and begins with low-dose medications before moving on to more stronger formulas.
It is important to follow your doctor’s instructions for both safety and efficacy. With time, eczema can be controlled and you should see an improvement in both severity and frequency of flare-ups.
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