How Eczema (Atopic Dermatitis) Is Treated

Eczema is a broad term to describe patches of skin that are typically dry, scaly, and red; itch is often the most bothersome symptom. Various prescription treatments are available, including topical corticosteroids and injectable medications. Immunotherapy (aka allergy shots) is considered in rare cases (e.g., dust mite allergy), although severe eczema will not likely improve substantially. Good home care and regular use of moisturizers are also important as this helps heal existing rashes and prevent eczema flareups.

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Home Remedies and Lifestyle

Paying careful attention to your skincare routine, and being mindful of what comes in contact with your skin, goes a long way in treating eczema. In some cases, good home care can almost eliminate eczema flareups.

Eliminate Triggers

Avoiding the triggers of itching should be the first priority if you have atopic dermatitis. Environmental triggers are anything that causes itching or irritation of the skin.

  • Clothing: Avoiding wool, nylon, and stiff or irritating clothing that may irritate your skin and promote sweating. Instead, wear cotton clothing or soft, breathable fabrics.
  • Laundry detergents: Washed your clothing in a mild detergent such as Dreft or All Free & Clear, or use a double rinse cycle. Use caution with fabric softeners, which may irritate your skin. Dryer sheets may be irritating and reusable dryer balls can be used instead.
  • Keep nails trimmed short. Avoid traumatizing your skin by keeping your fingernails short and your hands clean to avoid scratching and infecting your skin.
  • Keep your house at the right temperature and humidity. In the summer months, using an air conditioner prevents sweating, which can irritate the skin. In the winter months, use a humidifier to add moisture to the air to prevent your skin from getting dried out.

Get Tested for Allergies

If you have significant atopic dermatitis that is not improving with moisturizing regimens outlined above, you should seek evaluation by an allergist who, depending on your history, may recommend allergy testing to aeroallergens or in rare cases even to food allergens.

Maintain Good Skincare

Good skincare starts with adequate moisturizing and hydration, which decreases itching and formation of eczema. Pay careful attention to everything that you put on your skin. Fragrance-free, hypoallergenic products are generally better for people prone to eczema because they're less likely to cause irritation.

  • Keep the skin well moisturized. The key is to apply moisturizers within three minutes of getting out of the bath or shower, while your skin is still damp.
  • Choose gentle skin cleansers. Fragrance-free, lipid-free cleansers are less drying than traditional soaps.
  • Avoid hot baths and showers. These can strip the natural oils from your skin.
  • Protect your skin from the sun. Be aware that many of the prescription medications, such as topical steroids, may make your skin more sensitive to the sunlight. Fragrance-free sunscreen designed for sensitive skin types is a good choice.

Over-the-Counter Therapies

Many cases of eczema can be successfully controlled with over-the-counter (OTC) treatments.

Emollients

As mentioned before, keeping the skin hydrated is key in treating and controlling eczema. Emollients are products that contain ingredients that soothe and soften the skin.

These include creams and ointments like:

  • Keri
  • Lubriderm
  • Nivea
  • Nutraderm
  • Eucerin

Less expensive moisturizers include generic forms of Johnson and Johnson’s Baby Lotion, which is actually more of a cream, available at discount retailers.

The difference between a lotion and a cream is that a lotion contains more water and is less effective at retaining moisture in the skin.

When choosing a moisturizing product, look for ingredients such as ceramides and urea. These have been shown to improve hydration and help heal active eczema rash.

Vegetable shortening such as Crisco, or plain coconut oil, can also be used as inexpensive emollients because they form a thick barrier on the skin. They're a good choice for babies or toddlers hands and face; little ones are always putting their hands in their mouths and these oils won't harm them.

Always get your healthcare provider's OK before putting any home remedy on your child's eczema.

Pure petroleum jellies such as Vaseline can also be used, although they don't always work as well to moisturize unless they're placed on top of a moisturizer or moist skin. It will work best as an occlusive agent, to help seal in existing moisture.

Over-the-Counter Hydrocortisone

If eczema isn't improving with moisturizing creams, over-the-counter hydrocortisone cream can help. Hydrocortisone helps relieve itching and inflammation.

OTC hydrocortisone is sold at the drug store in strengths of 0.5% to 1%. Brands include Cortisone-10, Cortaid, and various store brands.

After cleansing, apply a thin layer of the medication to the rash and gently rub it in. Low-strength hydrocortisone can be used on the face, but keep it well away from the eyes.

Before using OTC hydrocortisone on babies or toddlers, get advice from your child's pediatrician.

OTC hydrocortisone shouldn't be used long-term. Instead, use it just when you're having a flareup. They shouldn't be used continuously for more than four weeks.

If you find you have to apply hydrocortisone constantly to get relief, or if you're using them regularly with no improvement, it's time to talk to your healthcare provider. You may need a stronger steroid or a different treatment altogether.

Antihistamines

Since histamines aren't the cause of the itching, most antihistamines may not help in your specific case. However, sedating antihistamines such as Benadryl (diphenhydramine) or Atarax (hydroxyzine) can be used at night if severe itching is making it hard to sleep.

Diluted Bleach Baths

If your atopic dermatitis is severe, your healthcare provider might recommend that you take a bath in diluted bleach twice a week to help control your symptoms, particularly if you keep getting skin infections.

Don't use diluted bleach baths to treat your, or your child's, eczema unless recommended to do so by a medical professional. Always follow your healthcare provider's recommendations for dilution and bathing time.

Although a bleach bath sounds like a harsh treatment, the bleach is very dilute in a tubful of bathwater, similar to that of a chlorinated pool.

Prescriptions

Once your eczema has worsened as a result of uncontrolled itching and scratching, medications are needed to control the problem.

Topical Steroids

Topical steroids are the first-line therapy for atopic dermatitis and are available in lotions, creams, ointments, and solutions (for the scalp). In general, medications in ointment forms are stronger than cream forms, which are stronger than lotion forms.

Topical steroids should be used in the lowest strength possible, for the shortest time possible, as side effects such as thinning of your skin, pigment changes in your skin, and absorption into your body are possible.

Topical Calcineurin Inhibitors

Elidel (pimecrolimus) and Protopic (tacrolimus) are approved for short-term use in children older than 2 years of age for atopic dermatitis. They do not cause thinning of or pigment changes in the skin and can be used safely on your face. These medicines are often preferable if there are concerns about corticosteroid use.

Newer Topical Medications

Eucrisa (crisaborole) is labeled for use in mild to moderate eczema in infants as young as 3 months old. The safety of this medication is thought to be superior to topical corticosteroids and topical calcineurin inhibitors. The biggest downside is efficacy is not as strong as the more potent topical corticosteroids (thus it is not labeled for use in severe atopic dermatitis) and it is very costly, with few insurances sharing significant costs.

Oral Steroids

Rarely, short courses of oral steroids are required to achieve control of a severe flare of atopic dermatitis. Extreme caution should be used, as while eczema typically gets better on the oral steroids, a “rebound effect” can occur with worsening of your symptoms soon after the steroids are stopped.

If oral steroids are required, the dose should be tapered slowly to minimize this risk.

Oral and Topical Antibiotics

In some cases, worsening atopic dermatitis can be a result of a skin infection or colonization with a common bacterium, Staphylococcus aureus, and a course of antibiotics against this type of bacteria is required. It's usually safe to continue the use of topical steroids even if the eczema is infected.

Topical antibiotics are typically enough for localized infections of eczema while oral antibiotics may be needed for infections involving larger areas of skin.

Immunotherapy

Atopic dermatitis is the most common form of eczema and is often the first symptom of allergic disease. In many children with atopic dermatitis, allergic rhinitis will begin to develop at school age, and some of these children will develop asthma by adolescence. This progression of this allergic disease is called the "atopic march."

There has been some success in stopping the atopic march through the use of medications and immunotherapy (allergy shots).

Immunotherapy, including allergy shots and allergy drops, are the only allergy treatments that actually change the underlying problem of allergies, and are the only possible cure. For many years, immunotherapy has been used for the treatment of allergic rhinitis, allergic conjunctivitis, and allergic asthma.

More recently, various studies suggest that immunotherapy may also be useful for the treatment of atopic dermatitis.

Allergy Shots

Various studies have been conducted in recent years to examine the possibility that allergy shots may actually be helpful for the treatment of atopic dermatitis. A number of these studies revealed that allergy shots are helpful in reducing atopic dermatitis symptoms (as measured by SCORAD, a tool useful in assigning a numerical value based on the amount of skin involved, from 1 to 100) as well as reducing topical steroids required to control symptoms.

Allergy shots were most effective at treating people with dust mite allergies as a trigger for their atopic dermatitis.

Allergy Drops

Allergy drops, or sublingual immunotherapy, involve taking what a person is allergic to and placing it under the tongue. The result is very much the same as traditional allergy shots—the reduction of allergy symptoms, reduction in the amount of allergy medication required, and the potential for allergy symptoms to be cured.

There are four FDA-approved sublingual allergy tablets—Odactra, Grastek, Oralair, and Ragwitek.

Similar to allergy shots, allergy drops have been used for the treatment of allergic rhinitis, allergic conjunctivitis, and allergic asthma—but traditionally not used for atopic dermatitis.

A few studies have examined the benefit of allergy drops for the treatment of atopic dermatitis, all in people with dust mite allergy. One such study, published in 2017, found that allergy drops containing dust mite were effective for the treatment of mild to moderate atopic dermatitis. In this group, there was a decrease in atopic dermatitis symptoms and a decrease in the amount of medication required to treat atopic dermatitis symptoms. The drawback of this study was the small sample group.

Safety of Immunotherapy

Allergy shots are generally a safe and effective treatment for various allergic conditions; because of the possibility of anaphylaxis; however, people receiving immunotherapy should be monitored in a healthcare provider’s office for 30 minutes. Allergy drops and sublingual immunotherapy tablets are traditionally given at home, given the extremely low risk for this method of immunotherapy to cause severe anaphylaxis.

Complementary and Alternative Medicine (CAM)

Although natural remedies don't have as much scientific backing as conventional treatments do, there are certain therapies that may hold promise. Consider these as add-ons to your current eczema treatment.

As always, seek advice from your healthcare professional before trying any alternative treatment for eczema.

Coconut Oil

As mentioned before, coconut oil is sometimes suggested as a moisturizer for eczema for a variety of different reasons.

It acts as an occlusive agent to seal in moisture. Studies have also shown coconut oil to have anti-inflammatory and antimicrobial properties.

A study published in 2014 in the International Journal of Dermatology found that children with eczema had improved skin hydration after applying virgin coconut oil to the skin for eight weeks.

Other oils, like sunflower and shea butter, also may have moisturizing qualities. Olive oil, on the other hand, may actually cause the skin to dry out.

Probiotics

Probiotics are found naturally in certain fermented foods, like yogurt and kefir. They're also found in the digestive system.

Studies on probiotics and the effect they have on eczema have yielded mixed results. Some have found that taking probiotics can help reduce eczema symptoms. Others, though, show that probiotics caused no improvement.

Whether or not probiotics will help improve your eczema symptoms is unclear, but they may have additional health benefits beyond clearing eczema. If you're interested in supplementing with probiotics, ask your healthcare provider for guidance.

A Word From Verywell

Although eczema can't be cured, it can be successfully controlled with the right treatment. Careful skincare with a consistent moisturizing routine is a big part of treatment. Medications, both OTC and prescription, can be used to help treat eczema flares. Your healthcare provider can help guide you in developing an appropriate skincare regimen and treatment routine.

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