From the Guidelines
Topical corticosteroids are the first-line treatment for most cases of eczema, with the goal of using the least potent preparation required to keep the eczema under control 1. For mild to moderate eczema, low to medium potency options like hydrocortisone 1% or triamcinolone 0.1% should be applied thinly to affected areas twice daily for 1-2 weeks. Some key points to consider when treating eczema include:
- For more severe cases, stronger steroids like fluocinonide 0.05% may be needed.
- Topical calcineurin inhibitors such as tacrolimus (Protopic) and pimecrolimus (Elidel) are non-steroidal alternatives that work well for sensitive areas like the face.
- For intense itching, oral antihistamines like cetirizine (10mg daily) or diphenhydramine (25mg every 6 hours) can provide relief.
- Moisturizing is crucial and should be done at least twice daily with fragrance-free products like CeraVe, Eucerin, or Vanicream to maintain the skin barrier.
- For severe, widespread eczema that doesn't respond to topical treatments, systemic medications like oral corticosteroids, dupilumab (Dupixent), or immunosuppressants may be prescribed by a dermatologist, as outlined in recent guidelines 1. The most recent guidelines from 2024 and 2023 emphasize the importance of personalized treatment plans, considering the severity of eczema, its impact on the patient, and the efficacy, safety, and accessibility of available interventions 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 in a class of medicines called topical calcineurin inhibitors ELIDEL Cream is for adults and children age 2 years and older who do not have a weakened immune system.
Medication for Eczema:
- Pimecrolimus (TOP) cream 1% is a prescription medicine used to treat eczema (atopic dermatitis) in adults and children 2 years of age and older.
- It is used on the skin for short periods, and if needed, treatment may be repeated with breaks in between.
- It is for use after other prescription medicines have not worked or if the doctor recommends that other prescription medicines should not be used 2, 2, 2.
From the Research
Medications for Eczema
- Topical corticosteroids are a first-line treatment for eczema, with potent and moderate topical corticosteroids being more effective than mild topical corticosteroids, primarily in 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, 4
- Topical corticosteroids can be used safely and effectively in patients who are pregnant or lactating, and are available in various formulations such as ointments, creams, lotions, gels, foams, oils, solutions, and shampoos 4
- Other topical anti-inflammatory treatments, such as tacrolimus 0.1% and ruxolitinib 1.5%, are also effective in improving patient-reported symptoms and clinician-reported signs of eczema 5
Treatment Strategies
- The "get control then keep control" regimen, which involves using topical therapies to control eczema flare-ups and then maintaining control with ongoing treatment, is a recommended approach 6
- Systemic treatments may be necessary for severe disease, and good patient education is essential for effective management of eczema 6
- Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, can be used in conjunction with topical corticosteroids as first-line treatment for eczema 7
Safety and Adverse Events
- Local adverse events, such as abnormal skin thinning, are more common with higher-potency topical corticosteroids, but the overall frequency is low 3, 5
- Skin thinning is not increased with short-term use of any topical steroid potency, but may be a concern with longer-term use 5
- Topical corticosteroids can be used safely in children, but lower potencies and shorter durations should be used to minimize the risk of adverse effects 4