Eczema Treatment

Topical therapies are the first line of defense for eczema because they are applied directly to the skin where symptoms appear.

• Moisturizers and barrier creams are essential for all patients. These products hydrate the skin, reduce dryness, and restore the skin’s natural protective layer. Ointments and thick creams are often recommended over lotions because they trap water more effectively. Some barrier creams contain ceramides and other skin lipids that repair the damaged barrier, reducing irritation and flare-ups.
• Topical corticosteroids are prescription anti-inflammatory creams or ointments. They work by calming the overactive immune response in the skin, which reduces redness, swelling, and itching. They come in different strengths, with milder forms used on sensitive areas like the face and stronger versions used on thicker skin, such as the hands or feet. Because long-term overuse can thin the skin, these medications are generally used during flare-ups rather than daily.
• Topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, are alternatives to steroids. They are instrumental in delicate areas such as the eyelids or skin folds, where long-term steroid use is not advised. They reduce inflammation by directly targeting immune activity. Patients may notice a burning or stinging sensation when first applied, but this usually improves over time.
• Topical PDE-4 inhibitors, such as crisaborole, are newer medications that block enzymes involved in inflammation. These non-steroidal creams are often used for mild to moderate eczema and can be applied to sensitive skin for long-term management.

Oral therapies are usually considered when topical treatments are not enough to control eczema or when symptoms affect sleep and daily life.

• Antihistamines are sometimes recommended to help reduce itching. While they do not directly address inflammation, they can help break the itch-scratch cycle that worsens eczema. Non-drowsy antihistamines are typically used during the day, while sedating antihistamines may be taken at night to improve sleep.
• In severe cases, oral corticosteroids such as prednisone may be prescribed for short periods. These medications work quickly to reduce inflammation throughout the body but are not used long-term due to potential side effects such as weight gain, high blood pressure, and weakened bones.
• Other oral immunosuppressants, including cyclosporine, methotrexate, or azathioprine, may be recommended for severe, persistent eczema. These medications suppress the immune system’s overactivity that drives eczema but require regular monitoring because they can affect the liver, kidneys, or blood pressure.

Phototherapy is a non-drug option that may be recommended for people with moderate to severe eczema who do not improve with creams or pills. This treatment uses carefully controlled ultraviolet B (UVB) light to reduce inflammation, relieve itching, and promote skin healing. Phototherapy is performed in a medical office under supervision and usually requires multiple sessions each week for several months. It is generally safe but can cause temporary tanning or mild burning in sensitive skin.

Systemic treatments work throughout the body and are often reserved for severe eczema.

• Injectable biologics are among the most advanced options. Dupilumab, for example, targets specific immune pathways that cause eczema. By more precisely calming the immune system, biologics can provide long-lasting relief with fewer side effects than traditional oral immunosuppressants. These medications are given as injections every few weeks and are usually well-tolerated.

Other systemic therapies may include newer biologics and small-molecule medications currently being studied or approved for eczema. These treatments are changing the outlook for people with severe disease who have not responded to other approaches.

Because eczema is complex, combination therapy is often the most effective approach. A patient might use daily moisturizers to strengthen the skin barrier, apply topical steroids or calcineurin inhibitors during flare-ups, take oral antihistamines at night for itching, and undergo phototherapy for long-term control. In severe cases, biologics may be added to provide a more complete solution. By combining therapies, dermatologists like Dr. Joshua Freedman can use lower doses of each treatment, reduce side effects, and keep symptoms under control. This layered strategy is tailored to each person’s triggers, lifestyle, and skin needs.