How Eczema Is Treated

Daily moisturizing and topical drugs remain central to treatment

There is no cure for atopic dermatitis (eczema), but there are treatments that can help manage this common inflammatory skin condition. Mild eczema can often be controlled with emollient-rich moisturizers and over-the-counter hydrocortisone creams. Moderate to severe cases may require prescription drugs and specialist therapies. Irrespective of the stage of the disease, self-care is important to alleviating current symptoms and preventing future episodes.

Home Remedies and Lifestyle

Eczema can be triggered or worsened by things you are sensitive to (like pollen or certain food) and things you do (like scratching or getting stressed). Lifestyle and self-care play a central role in your ability to prevent or manage acute episodes, called flares. This includes proper daily skincare and the avoidance of eczema triggers.

Topical Moisturizers

Itching and dry skin (xerosis) characterize eczema at every stage of the disease. At the same time, dry skin can trigger a flare if left untreated.

Not only is dry skin itchier, but it also compromises the barrier function of the skin, allowing bacteria, fungi, and viruses easy access to vulnerable tissues. Even if these microbes do not establish an active infection, they can incite the inflammation needed to trigger a flare.

Moisturizing daily an emollient-rich ointment, cream, or lotion can help rehydrate the skin and restore its barrier function. (Emollients are ingredients used in skincare products that form a water-tight seal on the outermost layer of cells.) People with eczema need to moisturize more than most other people to effectively control their condition.

Moisturize at least three times daily, applying the ointment, lotion, or cream in a thick layer and rubbing in a downward motion. Avoiding rubbing in circles or up-and-down as this can generate heat and irritate already inflamed skin.

It is also important to choose the right moisturizer. Ointments tend to be the best choice since they are more "greasy" and provide a longer-lasting moisture barrier. Many contain ingredients like petrolatum or mineral oil.

Creams are good options for people with mild to moderate eczema who don't like greasy skin, while lotions (composed primarily of water) may be okay for those with mild eczema. Whatever option you use, avoid fragrances and dyes that can be irritating.

Studies have also shown that moisturizers with ceramides and urea may also be beneficial to people with eczema as they appear to enhance hydration and the healing of an active eczema rash.

"Soak and Seal" Baths

Water constantly evaporates from the deeper layers of the skin, an effect known as transepidermal water loss (TEWL). When you oversaturate the skin, this effect is amplified, drawing out even more water and leaving it tight and dry.

For people with eczema, these concerns are more than cosmetic. Though bathing is clearly beneficial—loosening skin scales and reducing itch—it needs to done safely in what is known as the "soak and seal" technique. To do this:

  • Draw a lukewarm (not hot) bath, soaking for no more than 15 minutes.
  • Use a mild cleanser rather than harsh soap.
  • Avoid scrubbing.
  • Towel off gently by blotting (not rubbing) the skin.
  • Apply any topical medications you may be using.
  • While the skin is still damp and porous, apply moisturizer.
  • Allow the moisturizer to absorb for several minutes before dressing.

If you are experiencing a severe flare, you may want to avoid cleansers altogether and just use water. The same applies to babies, toddlers, and younger children with an eczema rash.

Sun Exposure

Many people with eczema claim that sunlight helps improve mild to moderate symptoms of the disease. It is believed that doing so increases the production of vitamin D in the skin which, in turn, releases anti-inflammatory compounds (called cathelicidin) that reduce local redness and swelling.

Natural sunlight is generally considered safe limited to no more than 10 to 30 minutes several times per week. When first starting out, five minutes may be enough to gauge how well you tolerate sunlight. If there is no redness, tingling, or pain, you can gradually increase over the course of days and weeks.

When it comes to sun exposure, more is not always better. Too much sun can have a contradictory effect, triggering an eczema flare while increasing the risk of sun damage and skin cancer.

When outdoors, always wear sunscreen with an SPF rating of 15 or higher. This allows enough ultraviolet (UV) radiation to penetrate the skin but not enough to cause burning.

Bleach Baths

If your eczema is severe, a twice-weekly bleach bath may help control symptoms, particularly if you have recurrent skin infections. Although research remains split on its efficacy, a bleach bath is generally considered safe and may help neutralize bacteria and other infectious agents on the skin.

A bleach bath can be made with 1/4-cup to 1/2-cup of 5% household bleach to 40 gallons of lukewarm water. You should soak for no longer than 10 minutes and moisturize immediately after rinsing and toweling off. Never submerge your head in a bleach bath, and rinse your eyes immediately if you get water in them.

A bleach bath should never be used in children without your pediatrician's approval. People with severe cracking may want to avoid a bleach bath since it can be painful on broken skin.

Avoidance of Triggers

There is a wide variety of triggers that can instigate an eczema flare. These can vary from one person to the next and may include:

  • Stress
  • Very dry skin
  • Soaps and household cleaners
  • Fragrances
  • Food allergens
  • Metals, especially nickel
  • Cigarette smoke
  • Cold, dry weather
  • Hot, humid weather
  • Colds and flu
  • Abrasive fabrics, especially wool and polyester
  • Antibacterial ointments like neomycin and bacitracin

Sadly, it is often difficult to know which triggers are causing your flares. If this is the case, you may want to keep a trigger diary to record exposures to suspected triggers, especially when your eczema is starting to flare.

Avoiding triggers is often easier said than done. It involves buy-in from your family and a clear set of rules to avoid accidental exposures. This includes reading ingredient labels if you have sensitivities, dressing appropriately for the weather, getting an annual flu vaccine, and using stress management techniques to reduce your risk of flares.

Over-the-Counter (OTC) Therapies

Mild to moderate eczema can often be managed with over-the-counter (OTC) medications. In addition to daily moisturizing, a low-potency hydrocortisone cream can help treat rashes and reduce skin inflammation. Oral antihistamines are also sometimes used if itching is interfering with sleep.

Hydrocortisone Cream

If your eczema isn't improving with moisturizing creams, an OTC hydrocortisone cream can help. Hydrocortisone is a type of topical steroid that helps reduce itching and swelling by suppressing inflammatory chemicals produced by the immune system.

OTC hydrocortisone is sold at drugstores in strengths of 0.5% and 1%. After cleansing, a thin layer is applied to the affected skin and gently rubbed in. A moisturizer can then be applied to lock in moisture.

In the United States, topical steroids are classified by potency levels from 1 (highest) to 7 (lowest). Both 0.5% and 1% hydrocortisone belong to Class 7.

While technically safe to use on the face, OTC hydrocortisone cream is only intended for occasional, short-term use and should be used with extreme caution around the eyes.

Common side effects including stinging, burning, redness, and dryness. Acne, folliculitis ("hair bumps"), stretch marks, discoloration, and skin atrophy (thinning) may also occur, especially when overused. Most people won't experience any side effects if a low-potency hydrocortisone cream used for less than four weeks.

Antihistamines

Despite what some might tell you, antihistamines do not inherently relieve itching in people with eczema. Antihistamines work by blocking a chemical known histamine that the immune system produces when confronted with an allergen (like pollen or pet dander). Since histamine is not a major player in an eczema itch, the benefits of antihistamines can vary from one person to the next.

For example, if eczema is triggered or exacerbated by an allergy (such as a food allergy or hay fever), an antihistamine may avert a flare or reduce its severity. On the other hand, if an allergy is not involved, an antihistamine may have no effect.

Antihistamines are most often recommended if itching is keeping you up at night. Older generation antihistamines like Benadryl (diphenhydramine) have a sedating effect that can you rest and may temper systemic inflammation.

If an antihistamine is needed during the day, a non-drowsy formulation should be used, such as:

Topical antihistamines should be avoided as they can irritate the skin and provoke an eczema flare.

Prescriptions

If your eczema symptoms worsen or fail to respond to conservative treatment, prescription medications may be prescribed. These are sometimes used on their own or in combination with other treatments.

Topical Steroids

Stronger topical steroids are prescribed in the first-line treatment of moderate to severe eczema. These work similarly to OTC hydrocortisone creams but have more significant side effects. Topical steroids are available in ointments, lotions, and creams as well as specialized solutions for the scalp and beard area.

The choice of a topical steroid is directed by the location of eczema, the age of the user, and the severity of the rash. Lower-potency steroids are typically used where the skin is thinnest (like the face and back of the hands), while a high-potency steroid may be needed for thick skin (such as the feet).

Examples of topical steroids commonly used are:

  • Potency Class 6: Desonex gel (0.05% desonide)
  • Potency Class 5: Dermatop cream (0.1% prednicarbate)
  • Potency Class 4: Synalar (0.025% fluocinolone acetonide)
  • Potency Class 3: Lidex-E cream (0.05% fluocinonide)
  • Potency Class 2: Elocon ointment (0.05% halobetasol propionate)
  • Potency Class 1: Vanos cream (0.1% fluocinonide)

Topical steroids should always be used in the lowest effective potency for the shortest amount of time to avoid side effects. Side effects include skin atrophy, easy bruising, stretch marks, and spider veins (telangiectasia).

Topical steroids are intended for the short-term treatment of acute eczema symptoms. They are not used to prevent flares or as a substitute for a moisturizer.

The overuse or prolonged use of topical steroids can have potentially serious consequences, including irreversible skin atrophy, pustular psoriasis, and corticosteroid withdrawal.

Topical Calcineurin Inhibitors

If topical steroids fail to provide relief, a class of drugs called topical calcineurin inhibitors (TCIs) may be prescribed. TCIs work by blocking a protein called calcineurin that stimulates the production of inflammatory cytokines.

Elidel (pimecrolimus) and Protopic (tacrolimus) are the two TCIs currently approved for use in the treatment of eczema. They are used as second-line therapy for moderate to severe eczema in adults or children two years of age and older.

Unlike topical steroids, Elidel and Protopic are not absorbed into deeper tissues and do not cause skin thinning or discoloration. As such, they can be used safely on the face and other delicate skin. Common side effects include skin redness, headache, acne, nausea, folliculitis, and flu-like symptoms.

In 2006, the FDA issued a black box warning advising health professionals and consumers that Elidel and Protopic may increase the risk of skin cancer and lymphoma.

Oral Steroids

On rare occasions, a short course of oral steroids may be prescribed to gain control of a severe eczema flare. These are generally only recommended if eczema symptoms are resistant to other therapies or treatment options are limited. Few doctors will ever consider using an oral steroid in children with eczema, however severe.

Extreme caution should be exercised as the prolonged use of steroids (30 days or more) can increase the risk of sepsis, thromboembolism, and bone fractures. It can also cause a "rebound effect" in which the treated symptoms will re-emerge violently once the treatment is stopped. To avoid this, the steroid dose would be gradually tapered down over the course of weeks or months.

Prednisone, hydrocortisone, and Celestone (betamethasone) are among the oral steroids doctors may consider.

Antibiotics

In some cases, eczema can compromise the skin and allow bacteria to establish an infection. Secondary bacterial skin infections are common among people with eczema (most especially Staphylococcus aureus infections), the conditions of which can be treated with topical or oral antibiotics.

Topical antibiotics are usually enough to treat minor local infections, while oral antibiotics may be needed for infections involving larger areas of skin. Cephalosporins, nafcillin, and vancomycin are among the antibiotics most commonly used.

The duration of therapy can vary depending on the severity of symptoms but generally does not exceed 14 days due to the risk of antibiotic resistance.

Antibiotics can only treat bacterial infections. Fungal infections like ringworm can be treated with antifungal drugs (like miconazole cream), while viral infections like herpes simplex can be treated with antivirals (like acyclovir).

The risk of secondary skin infections can be greatly reduced by washing your hands thoroughly before applying emollients and topical treatments to the skin.

Specialist-Driven Procedures

There are a handful of procedures that may benefit people with severe, recurrent, or treatment-resistant eczema symptoms. These are not used on their own but are typically combined with other therapies.

Phototherapy

Phototherapy, also known as light therapy, functions similarly to sun exposure and involves controlled bursts of UV-A or UV-B radiation delivered either in a dermatologist office or specialized clinic. Phototherapy is typically added to the treatment plan when topical therapies prove less than effective.

Phototherapy can reduce itch and inflammation associated with eczema and usually requires multiple treatments. Common side effects include skin dryness, redness, and mild sunburn. In rare cases, phototherapy can cause skin eruptions, liver spots (lentigines), and the reactivation of a herpes infection.

Phototherapy can be extremely effective in some people, but its use is often limited by cost, availability, and inconvenience.

Wet Wrap Therapy

Wet wrap therapy is sometimes recommended for people with severe, difficult-to-treat eczema. The aim of wet wrap therapy is to help rehydrate the skin while enhancing the absorption of topical drugs. A bottom wet layer provides steady hydration, while a top dry layer helps lock in moisture.

Wet wrap therapy is individualized but typically involves the following steps:

  • The skin is soaked in warm water for 15 to 20 minutes and patted dry.
  • Topical medications are applied.
  • The skin is wrapped with a layer of wet gauze and covered with an elastic bandage or other dry fabric.
  • The wrap is left in place for two to six hours.

While wet wrap therapy can be performed at home, it should always be directed by a doctor or dermatologist. It is not appropriate for everyone, particularly those with broken skin in whom the risk of bacterial infection is high.

Allergy Shots

If you are prone to seasonal allergies and suffer recurrent eczema symptoms, speak to your doctor about allergy shots as they may help reduce the frequency or severity of flares.

To determine what shots you need, the allergist will conduct a skin prick test to identify your specific allergens. Sadly, allergy shots cannot treat food allergies.

Complementary and Alternative Medicine (CAM)

Although there is not a lot in the way of scientific evidence to support the use of complementary and alternative therapies for eczema, there are few that have shown promise.

Vitamin D

Vitamin D plays a central role in the effects of sun exposure on eczema. It makes sense, therefore, that vitamin D supplements taken orally may also help relieve eczema symptoms.

A 2016 review of studies published in the Nutrients supported the hypothesis, demonstrating that vitamin D deficiency was more common in people with eczema and that supplementation in those with a deficiency resulted in a roughly 40% improvement in symptoms.

While other studies have shown little benefit to supplementation, high rates of vitamin D deficiency in the United States (hovering around 40%) means that it may be beneficial even if it does not improve eczema symptoms.

Probiotics

Probiotics are live bacteria sold in supplement form and found naturally in fermented foods like yogurt, miso, and kefir. They help support healthy gut flora and aid with digestion.

According to a review of studies published in JAMA Pediatrics, the use of probiotic supplements for at least eight weeks improved eczemas in children one year of age and older. Supplements containing mixed bacterial strains proved more effective than those with a single strain.

While other studies have shown little or no be effect, the use of probiotics does not appear to cause any harm and may even help improve milk allergy symptoms (a common eczema trigger) in some children.

Speak with your doctor before trying any complementary therapy to ensure that it is safe and does not interfere with your treatment or any of your medications.

A Word From Verywell

Although eczema cannot be cured, it can be successfully controlled with the right combination of treatments. Careful skin care with a consistent moisturizing routine is a big part of the treatment plan. Medications, both OTC and prescription, can be used to help treat eczema flares.

Your doctor can help guide you in developing an appropriate treatment plan. In some cases, other specialists⁠—such as dermatologist, allergist, or nutritionist⁠—may be needed to unlock the right combination of treatments for you as an individual. Persistence and patience are key.

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Article Sources

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  1. Kim BE, Leung DYM. Significance of skin barrier dysfunction in atopic dermatitisAllergy Asthma Immunol Res. 2018;10(3):207-15. doi:10.4168/aair.2018.10.3.207

  2. National Eczema Association. Controlling eczema by moisturizing.

  3. Celleno L. Topical urea in skincare: A review. Dermatol Ther. 2018;31(6):e12690. doi:10.1111/dth.12690

  4. Palmer DJ. Vitamin D and the development of atopic eczemaJ Clin Med. 2015;4(5):1036-50. doi:10.3390/jcm4051036

  5. American Academy of Allergies, Asthma, and Immunology. Eczema (atopic dermatitis) overview.

  6. Chopra R, Vakharia PP, Sacotte R, Silverberg JI. Efficacy of bleach baths in reducing severity of atopic dermatitis: A systematic review and meta-analysisAnn Allergy Asthma Immunol. 2017;119(5):435-40. doi:10.1016/j.anai.2017.08.289

  7. Gabros S, Zita P. Topical corticosteroids. In: StatPearls; updated November 25, 2019.

  8. Hajar T, Leshem YA, Hanifin JM, et al. A systematic review of topical corticosteroid withdrawal ("steroid addiction") in patients with atopic dermatitis and other dermatoses. J Am Acad Dermatol. 2015;72(3):541-49. doi:10.1016/j.jaad.2014.11.024

  9. Coondoo A, Phiske M, Verma S, Lahiri K. Side-effects of topical steroids: A long overdue revisitIndian Dermatol Online J. 2014;5(4):416-25. doi:10.4103/2229-5178.142483

  10. He A, Feldman SR, Fleischer AB. An assessment of the use of antihistamines in the management of atopic dermatitis. J Am Acad Dermatol. 2018;79(1):92-6. doi:10.1016/j.jaad.2017.12.077

  11. National Eczema Association. Prescription topical treatments.

  12. Dhar S, Seth J, Parikh D. Systemic side-effects of topical corticosteroidsIndian J Dermatol. 2014;59(5):460-4. doi:10.4103/0019-5154.139874

  13. Carr WW. Topical calcineurin inhibitors for atopic dermatitis: review and treatment recommendationsPaediatr Drugs. 2013;15(4):303-10. doi:10.1007/s40272-013-0013-9

  14. U.S. Food and Drug Administration. FDA approves updated labeling with boxed warning and medication guide for two eczema drugs, Elidel and Protopic. January 19, 2006.

  15. Drucker AM, Eyerich K, de Bruin-Weller MS, et al. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statementBr J Dermatol. 2018;178(3):768-75. doi:10.1111/bjd.15928

  16. Schweizer ML, Furuno JP, Harris AD, et al. Comparative effectiveness of nafcillin or cefazolin versus vancomycin in methicillin-susceptible Staphylococcus aureus bacteremiaBMC Infect Dis. 2011;11:279. doi:10.1186/1471-2334-11-279

  17. Devillers AC, Oranje AP. Wet-wrap treatment in children with atopic dermatitis: a practical guideline. Pediatr Dermatol. 2012;29(1):24-7. doi:10.1111/j.1525-1470.2011.01691.x

  18. Kim MJ, Kim SN, Lee YW, Choe YB, Ahn KJ. Vitamin D status and efficacy of vitamin D supplementation in atopic dermatitis: A systematic review and meta-analysisNutrients. 2016;8(12):789.. doi:10.3390/nu8120789

  19. Forrest KY, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutr Res. 2011;31(1):48-54. doi:10.1016/j.nutres.2010.12.001

  20. Chang YS, Trivedi MK, Jha A, Lin YF, Dimaano L, García-Romero MT. Synbiotics for prevention and treatment of atopic dermatitis: A meta-analysis of randomized clinical trialsJAMA Pediatr. 2016;170(3):236-42. doi:10.1001/jamapediatrics.2015.3943

  21. Tan-Lim CSC, Esteban-Ipac NAR. Probiotics as treatment for food allergies among pediatric patients: a meta-analysis. World Allergy Organ J. 2018;11(1):25. doi:10.1186/s40413-018-0204-5