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. 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, as supported by the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London 1. 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 considerations in managing eczema include:

• Avoiding triggers is crucial—use gentle, fragrance-free soaps, wear loose cotton clothing, maintain moderate humidity levels at home, and identify and eliminate food or environmental allergens, as recommended by the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London 1.
• Antihistamines like diphenhydramine (Benadryl) 25mg at bedtime can help manage itching, with their therapeutic value residing principally in their sedative properties 1.
• Wet wrap therapy can provide relief during severe flares by applying medication, moisturizer, then damp bandages.
• Systemic corticosteroids have a limited but definite role in tiding occasional patients with severe atopic eczema, but their use should never be taken lightly and they should not be considered for maintenance treatment until all other avenues have been explored 1.
• Phototherapy, including narrowband ultraviolet B (NB-UVB), may be helpful in selected patients, with studies showing its efficacy in treating atopic eczema, as reported in the British Journal of Dermatology 1.

Overall, the goal of eczema treatment is to repair the skin barrier, reduce inflammation, and break the itch-scratch cycle that worsens eczema, with a focus on individualized care and patient education, as emphasized by the management guidelines for atopic eczema 1.

From the FDA Drug Label

A patient should use ELIDEL Cream exactly as prescribed A patient should use ELIDEL Cream only on areas of skin that have eczema. A patient should use ELIDEL Cream for short periods, and if needed, treatment may be repeated with breaks in between. A patient should stop ELIDEL Cream when the signs and symptoms of eczema, such as itching, rash, and redness go away, or as directed by the physician

The treatment for eczema with ELIDEL Cream is to apply a thin layer to the affected skin areas, twice a day, as directed by the physician.

• Key points:
  • Use exactly as prescribed
  • Only on areas of skin with eczema
  • For short periods with breaks in between if needed
  • Stop when symptoms go away or as directed by the physician 2

From the Research

Treatment Options for Eczema

• Topical corticosteroids are a common treatment for eczema, with stronger potencies (e.g., potent, very potent) being more effective than mild potencies for moderate or severe eczema 3
• Pimecrolimus cream 1% has been shown to effectively control atopic eczema when applied twice daily from the first signs or symptoms of eczema until clearance, with a favorable safety profile 4
• Tacrolimus ointment (0.03%) applied once or twice daily is more efficacious than 1% hydrocortisone acetate in children with moderate to severe atopic dermatitis 5
• A short burst of a potent topical corticosteroid can be just as effective as prolonged use of a milder preparation for controlling mild or moderate atopic eczema in children 6

Application Frequency and Duration

• Applying potent topical corticosteroids once daily probably does not decrease the number achieving treatment success compared to twice daily application 3
• Twice weekly application (weekend, or 'proactive therapy') to prevent relapse (flare-ups) versus no topical corticosteroids/reactive application probably results in a large decrease in likelihood of a relapse 3

Patient Concerns and Education

• Patients with atopic eczema often have concerns about using topical corticosteroids, with the most frequent cause for concern being the perceived risk of skin thinning 7
• Education and information about the safety, potency, and appropriate use of topical corticosteroids are necessary to address patient concerns and improve compliance with treatment 7