What is the treatment for eczema?

From the Guidelines

The treatment for eczema involves a multi-faceted approach focusing on skin hydration, inflammation reduction, and trigger avoidance, with topical corticosteroids being the mainstay of treatment, as recommended by the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London 1. The goal of treatment is to reduce inflammation, repair the skin barrier, and minimize the itch-scratch cycle that worsens 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 1% hydrocortisone 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, as supported by the management of atopic eczema workshop report 1. Non-steroidal alternatives include topical calcineurin inhibitors such as tacrolimus (Protopic) or pimecrolimus (Elidel), particularly useful for sensitive areas like the face.
• Antihistamines like diphenhydramine (Benadryl) 25-50mg at bedtime can help manage itching. Lifestyle modifications are crucial:
• Use lukewarm water for short (5-10 minute) showers.
• Wear loose cotton clothing.
• Avoid known triggers like harsh soaps or specific allergens, as advised by the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London 1.
• Maintain optimal humidity levels at home. For severe or widespread eczema unresponsive to these measures, oral immunosuppressants or biologics like dupilumab (Dupixent) may be prescribed by a dermatologist, with narrowband ultraviolet B phototherapy being a viable option, as reported in the British Journal of Dermatology 1.

From the FDA Drug Label

Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily

The treatment for eczema is applying hydrocortisone (TOP) to the affected area, not more than 3 to 4 times daily for adults and children 2 years of age and older, to temporarily relieve itching associated with minor skin irritations, inflammation, and rashes due to eczema 2. For children under 2 years of age, it is recommended to ask a doctor 2.

From the Research

Treatment Options for Eczema

• Topical corticosteroids are a first-line treatment for eczema, with stronger-potency topical corticosteroids probably being more effective than mild topical corticosteroids for moderate or severe eczema 3
• The effectiveness of topical corticosteroids is similar between once daily and twice daily (or more) frequent use to treat eczema flare-ups 3
• Topical corticosteroids weekend (proactive) therapy is probably better than no topical corticosteroids/reactive use to prevent eczema relapse (flare-ups) 3
• A short burst of a potent topical corticosteroid is just as effective as prolonged use of a milder preparation for controlling mild or moderate atopic eczema in children 4

Long-Term Treatment Concepts

• Proactive therapy, which involves long-term, low-dose intermittent application of anti-inflammatory therapy to the previously affected skin, together with an ongoing emollient treatment of unaffected skin, is a novel concept for preventing eczema relapse 5
• Emollient therapy is an important part of long-term treatment for atopic dermatitis, and can help to stabilize the skin barrier and prevent flare-ups 5

Safety of Topical Corticosteroids

• The long-term safety of topical corticosteroids in atopic dermatitis has been evaluated in several studies, with evidence suggesting that intermittent use of topical corticosteroids probably results in little to no difference in risk of growth abnormalities, non-skin infections, impaired vaccine response, and lymphoma/non-lymphoma malignancies 6
• Topical corticosteroid phobia is common among patients with atopic eczema, with concerns about skin thinning and systemic effects being the most frequent causes for concern 7