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 the most recent and highest quality study suggesting that narrowband ultraviolet B (NB-UVB) phototherapy is a highly effective treatment option for moderate-to-severe cases 1.

Key Components of Eczema Treatment

• 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.
• 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) 25mg at bedtime can help manage itching.

Trigger Avoidance and Lifestyle Modifications

• 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.
• Patients should be educated on the proper application of topical preparations and the quantity to use, with a practice or clinic nurse demonstrating how to apply the treatment 1.
• A full skin examination should be carried out to record the extent and severity of eczema, look for evidence of clinical infection, and check for other potential complications 1.

Severe or Resistant Cases

• For severe or resistant cases, phototherapy or systemic medications like dupilumab (Dupixent) may be necessary under medical supervision 1.
• Phototherapy, particularly NB-UVB, has been shown to be highly effective in reducing disease severity and improving quality of life for patients with moderate-to-severe eczema 1.

From the FDA Drug Label

ELIDEL Cream is a prescription medicine used on the skin (topical) to treat eczema (atopic dermatitis). 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.

The treatment for eczema is ELIDEL Cream, a topical calcineurin inhibitor, which should be used exactly as prescribed by a doctor. It is applied only to the affected skin areas, twice a day, and used for short periods with possible repeated treatments and breaks in between, as directed by the doctor 2.

• Key points:
  • Use the smallest amount needed to control eczema symptoms
  • Stop treatment when eczema symptoms go away or as directed by the doctor
  • Follow the doctor's advice if symptoms return after treatment
  • Contact the doctor if symptoms worsen, a skin infection occurs, or symptoms do not improve after 6 weeks of treatment 2.

From the Research

Treatment for Eczema

The treatment for eczema typically involves the use of topical corticosteroids, which have been a first-line treatment for decades 3. However, there are uncertainties over their optimal use, including the potency, frequency of application, and duration of treatment.

Topical Corticosteroids

• Stronger-potency topical corticosteroids are probably more effective than weaker-potency ones in achieving treatment success, defined as cleared or marked improvement on the Investigator Global Assessment (IGA) of clinician-reported signs of eczema 3.
• Applying potent topical corticosteroids once a day probably does not decrease the number achieving treatment success compared to twice daily application 3.
• Local adverse events, such as abnormal skin thinning, are rare and increase with increasing potency of topical corticosteroids 3.

Alternative Treatments

• Topical tacrolimus is an alternative treatment for moderate and severe atopic dermatitis, and is probably more effective than low-potency corticosteroids and pimecrolimus 1% 4.
• Topical pimecrolimus is less effective than moderate and potent corticosteroids and 0.1% tacrolimus, but may be useful for mild eczema 5.

Patient Concerns and Education

• Patients with atopic eczema often have concerns about using topical corticosteroids, including the perceived risk of skin thinning and systemic absorption leading to effects on growth and development 6.
• Education and information provision are important to address these concerns and improve patient compliance with treatment 6.

Long-term Safety

• The long-term safety of topical corticosteroids in atopic dermatitis has been evaluated in a systematic review, which found 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 7.
• However, many knowledge gaps remain, and further studies are needed to fully assess the long-term safety of topical corticosteroids in atopic dermatitis 7.