From the Guidelines
The most effective treatment for eczema involves a combination of moisturizers, topical corticosteroids, and trigger avoidance, with the goal of reducing inflammation, repairing the skin barrier, and minimizing the itch-scratch cycle that worsens eczema. According to the most recent and highest quality study 1, moisturizers are considered front-line therapy for both acute and proactive treatment of eczema. Daily moisturizing with fragrance-free emollients like CeraVe, Eucerin, or Vanicream is essential, especially after bathing while skin is still damp.
For mild flares, over-the-counter hydrocortisone 1% cream applied twice daily for up to two weeks can help. More severe cases may require prescription-strength topical corticosteroids like triamcinolone 0.1% or fluocinonide 0.05%, typically used twice daily for 1-2 weeks. Non-steroidal alternatives include topical calcineurin inhibitors such as tacrolimus (Protopic) or pimecrolimus (Elidel), particularly useful for sensitive areas like the face.
Some key points to consider when treating eczema include:
- Avoiding known triggers
- Using lukewarm (not hot) water for bathing
- Patting skin dry rather than rubbing
- Wearing loose cotton clothing
- Maintaining optimal humidity levels at home
- Considering phototherapy or systemic medications for persistent or severe cases, as recommended by a dermatologist 1.
It's also important to note that topical corticosteroids should be used with caution, especially in thinned-skin areas, and that patients should be counseled on the benefits and risks of topical corticosteroids 1. Additionally, antihistamines like diphenhydramine (Benadryl) or cetirizine (Zyrtec) can help manage itching, and topical antimicrobials or antiseptics may be considered in infection-prone patients 1.
From the Research
Eczema Treatment Overview
- Eczema, also known as atopic dermatitis, is a chronic relapsing and remitting inflammatory skin disease that affects one in 10 people in their lifetime 2.
- The treatment of eczema typically involves a combination of topical corticosteroids, emollients, and lifestyle changes.
Topical Corticosteroids
- Topical corticosteroids are the first-line treatment for eczema flare-ups 2.
- They are classified by strength and the risk of adverse effects, with stronger potencies associated with a higher risk of adverse effects such as skin thinning and systemic reactions 3.
- Studies have shown that potent and moderate topical corticosteroids are probably more effective than mild topical corticosteroids in treating eczema, particularly in moderate or severe cases 4.
- The application of topical corticosteroids can be once or twice daily, with no significant difference in effectiveness between the two frequencies 4, 3.
Safety of Topical Corticosteroids
- The safety of topical corticosteroids in atopic eczema has been evaluated in several studies, with most finding no significant increased risk of skin thinning or biochemical adrenal suppression with short-term use 5.
- However, long-term safety data are limited, and the risk of adverse effects may increase with prolonged use or higher potencies 3, 5.
- Systemic corticosteroids are generally discouraged for the treatment of eczema, except in severe cases or special circumstances 6.
Other Treatment Options
- Emollients and moisturizers are essential for maintaining skin hydration and preventing dryness and irritation 2.
- Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, can be used in conjunction with topical corticosteroids as first-line treatment for eczema 2.
- Ultraviolet phototherapy is a safe and effective treatment for moderate to severe eczema when first-line treatments are not adequate 2.
- Newer medications, such as crisaborole and dupilumab, have been approved for the treatment of eczema, but their use is currently limited due to cost 2.