From the Guidelines
The most effective treatment for eczema is a combination approach that includes topical corticosteroids, moisturizers, and, for severe cases, biologics like dupilumab, as recommended by the most recent guidelines 1.
Treatment Options
- For mild to moderate eczema, regular use of moisturizers (emollients) and topical corticosteroids such as hydrocortisone 1% or stronger preparations like triamcinolone 0.1% or fluocinonide 0.05% are effective for controlling flares.
- For maintenance, non-steroidal alternatives like tacrolimus (Protopic) 0.03-0.1% or pimecrolimus (Elidel) 1% can be used to avoid steroid side effects.
- For severe or widespread eczema, oral medications may be necessary, including short courses of oral corticosteroids, immunosuppressants like cyclosporine, or newer biologics like dupilumab (Dupixent), which is given as a subcutaneous injection every two weeks.
Phototherapy
- Phototherapy, including narrowband UVB, is also a recommended treatment option for adults with moderate to severe eczema, as it has been shown to be effective in reducing symptoms and improving quality of life 1.
Biologics
- Biologics like dupilumab, tralokinumab, and upadacitinib have been shown to be effective in treating moderate to severe eczema, with a strong recommendation for their use in adults with moderate to severe disease 1.
Lifestyle Changes
- Identifying and avoiding triggers, taking short lukewarm showers, and using gentle, fragrance-free skin products can also significantly improve outcomes.
Key Recommendations
- Dupilumab is recommended for adults with moderate to severe eczema, with a strong recommendation and moderate certainty of evidence 1.
- Tralokinumab and upadacitinib are also recommended for adults with moderate to severe eczema, with a strong recommendation and moderate certainty of evidence 1.
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. The most effective treatment for eczema, according to the provided drug label, is ELIDEL Cream (pimecrolimus), a topical calcineurin inhibitor, for short periods with possible repeated treatment and breaks in between.
- It is used for eczema (atopic dermatitis) in adults and children aged 2 and above without a weakened immune system.
- The cream should be applied twice a day as directed by the doctor, to the affected skin areas only. 2
From the Research
Treatment Options for Eczema
- Topical corticosteroids are a common treatment for eczema, with potent and moderate topical corticosteroids being more effective than mild topical corticosteroids 3
- Tacrolimus 0.1% is an effective treatment for moderate and severe atopic dermatitis, and is better than low-potency corticosteroids, pimecrolimus 1%, and tacrolimus 0.03% 4
- Janus kinase inhibitors, such as ruxolitinib 1.5%, are also effective treatments for eczema, and are ranked among the most effective topical anti-inflammatory treatments 5
Comparison of Treatment Options
- Tacrolimus 0.1% is more effective than low-potency corticosteroids, but has equivocal results when compared to moderate-to-potent corticosteroids 4
- Tacrolimus 0.03% is superior to mild corticosteroids and pimecrolimus 1%, but has equivocal results when compared to moderate-to-potent corticosteroids 4
- Potent topical corticosteroids are probably more effective than mild topical corticosteroids, but there is uncertain evidence to support any advantage of very potent over potent topical corticosteroids 3
Safety and Adverse Effects
- Local application site reactions are most common with tacrolimus 0.1% and crisaborole 2%, and least common with topical steroids 5
- Skin thinning is not increased with short-term use of any topical steroid potency, but is reported in 0.3% of participants treated with longer-term topical steroids 3
- Burning is more frequent in those using calcineurin inhibitors than those using corticosteroids, but symptoms are mild and transient 4