From the Guidelines
Eczema treatment should prioritize the use of topical corticosteroids, with the least potent preparation required to keep the eczema under control, as well as emollients and trigger avoidance, and for severe cases, consider phototherapy or systemic therapies such as biologics like dupilumab, as recommended by the most recent guidelines 1.
Treatment Approach
The treatment of eczema involves a multi-faceted approach, including:
- Regular application of fragrance-free moisturizers like CeraVe, Eucerin, or Vanicream immediately after bathing to lock in moisture
- Use of topical corticosteroids, with the least potent preparation required to keep the eczema under control, as recommended by the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London 1
- Identification and avoidance of triggers such as harsh soaps, certain fabrics, stress, and allergens
- Consideration of phototherapy or systemic therapies for severe cases, as recommended by the American Academy of Dermatology 1
Topical Corticosteroids
Topical corticosteroids are the mainstay of treatment for atopic eczema and can be used safely if certain precautions are taken, as noted in the study by the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London 1. The basic principle is to use the least potent preparation required to keep the eczema under control, and when possible, the corticosteroids should be stopped for short periods.
Systemic Therapies
For severe cases of eczema, systemic therapies such as biologics like dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib may be considered, as recommended by the American Academy of Dermatology 1. The decision to initiate these more advanced therapies should be made using shared decision-making between patients and clinicians, taking into account the severity of eczema, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions.
Quality of Life
The treatment of eczema should prioritize the improvement of quality of life, as noted in the study by the American Academy of Dermatology 1. The use of topical corticosteroids, emollients, and trigger avoidance can help to reduce the symptoms of eczema and improve quality of life. For severe cases, consideration of phototherapy or systemic therapies may be necessary to achieve adequate control of the disease and improve quality of life.
From the FDA Drug Label
ELIDEL Cream is a prescription medicine used on the skin (topical) to treat eczema (atopic dermatitis). ELIDEL Cream is for adults and children age 2 years and older who do not have a weakened immune system. Use ELIDEL Cream exactly as prescribed. Use ELIDEL Cream only on areas of your skin that have eczema. Use ELIDEL Cream for short periods, and if needed, treatment may be repeated with breaks in between.
Eczema Treatment with Pimecrolimus (TOP): Pimecrolimus cream 1% is used to treat mild to moderate atopic dermatitis (eczema) in adults and children aged 2 years and older.
- Apply a thin layer of ELIDEL Cream only to the affected skin areas, twice a day, as directed by your doctor.
- Use the smallest amount of ELIDEL Cream needed to control the signs and symptoms of eczema.
- Stop ELIDEL Cream when the signs and symptoms of eczema go away, or as directed by your doctor 2, 2.
From the Research
Eczema Treatment Options
- Topical corticosteroids are a common treatment for eczema, with stronger potencies (e.g. potent and very potent) being more effective than weaker potencies (e.g. mild) 3
- The frequency of application of topical corticosteroids can vary, with once daily application being as effective as twice daily application 3, 4
- Proactive therapy, which involves long-term, low-dose intermittent application of anti-inflammatory therapy to previously affected skin, can help prevent flares and stabilize the skin barrier 5
Comparison of Topical Anti-Inflammatory Treatments
- A network meta-analysis found that potent topical corticosteroids, tacrolimus 0.1%, and ruxolitinib 1.5% were among the most effective treatments for eczema, while mild topical corticosteroids, roflumilast 0.15%, and crisaborole 2% were among the least effective 6
- Topical calcineurin inhibitors, such as tacrolimus 0.1%, were found to be effective for sensitive sites, but may be more likely to cause local adverse effects such as application-site reactions 6, 7
Emollient Therapy and Other Treatments
- Emollient therapy is an important part of eczema management, but there is limited evidence to support the use of specific emollients or bath additives 7
- Systemic immunosuppressive drugs and biologics may be necessary for severe eczema, but should be used under the guidance of a healthcare professional 5, 7
- Some treatments, such as oral antihistamines, oral or topical antistaphylococcal treatments, and probiotics, have limited evidence to support their use in eczema treatment and may be considered for discontinuation 7