People with atopic dermatitis (the most common type of eczema) and other forms of the condition often go through symptom-free periods (remissions) followed by flare-ups, when symptoms become severe. Eczema mainly causes dry, itchy skin, which inevitably causes people to scratch or rub the affected area. This can result in inflammation, rashes, blisters, and skin that “weeps” (oozes clear liquid), among other symptoms. Bacterial, viral, and fungal infections can also develop because eczema breaks down the skin barrier. There is no cure for eczema — natural or otherwise. The goal of treatment is to reduce symptoms, heal the skin and prevent further damage, and prevent flare-ups. Applied directly to the affected areas of skin, these ointments, creams, or lotions may:
Reduce inflammationTame allergic reactionsEase irritation or sorenessReduce itching and the desire to scratch
Topical corticosteroids should not be used as moisturizers and should only be applied to areas of the skin that are affected by eczema. Over time, these drugs can thin the skin, cause changes in color, or result in stretch marks.
Eye problems (glaucoma and cataracts)Avascular necrosis (death of bone tissue due to loss of blood supply)Worsening diabetesCushing syndrome (a condition with wide-ranging symptoms that are caused by too much of the hormone cortisol in the body)High blood pressureBlemishes (acne, bumps, and pus-filled follicles)Adrenal suppressionTopical steroid addiction
If topical corticosteroids aren’t working, doctors may prescribe a systemic corticosteroid, taken by mouth or injected.
Though TCIs don’t cause the same side effects as topical corticosteroids, patients should only use them for short periods of time. A boxed warning alerts patients to the possible cancer risk associated with these drugs. PDE4 inhibitors, another class of topical drugs for eczema, work by blocking an enzyme called phosphodiesterase 4 (PDE4) from producing too much inflammation in the body. There is currently only one PDE4 inhibitor on the market that is approved by the U.S. Food and Drug Administration (FDA) for atopic dermatitis: crisaborole (Eucrisa). The skin cream ruxolitinib (Opzelura), the first topical Janus kinase (JAK) inhibitor for atopic dermatitis, is another approved treatment. The FDA has placed a boxed warning on this medication for potentially increasing the risk of all-cause mortality, as well as increasing the risk of developing dangerous infections, heart attack, stroke, and thrombosis (blood clots) and certain cancers, including lymphoma. Wet-wrap therapy is another option for severe eczema. Sometimes given in a hospital, this treatment involves applying topical medicines (corticosteroids) and moisturizers to affected areas, then sealing them with a wrap of wet gauze. Dupilumab (Dupixent) is the first FDA-approved biologic drug for the treatment of moderate to severe eczema in people who have not responded well to topical approaches. A self-administered injectable drug, dupilumab works by blocking the activity of certain inflammatory chemicals in the body, and it is sometimes used in conjunction with light therapy. The side effects of dupilumab are generally mild, and they include pink eye, injection site reactions, and cold sores. Tralokinumab-ldrm (Adbry) is the second injectable biologic approved by the FDA. It works by blocking a protein that plays a role in the body’s immune response that leads to inflammation of the skin. In especially severe eczema cases, doctors may prescribe an oral immunosuppressant, such as cyclosporine (Neoral, Sandimmune, or Restasis), methotrexate (Trexall or Rasuvo), or mycophenolate (CellCept). These drugs carry potentially serious side effects, such as an increased risk of developing dangerous infections and cancers. In addition to ruxolitinib cream, the FDA has approved two oral JAK inhibitors, upadacitinib (Rinvoq) and abrocitinib (Cibinqo), to treat moderate to severe atopic dermatitis. Rinvoq and Cibinqo are not recommended for use in combination with other JAK inhibitors, biologics, or other immunosuppressants. The FDA has placed a boxed warning on these medications for potentially increasing the risk of all-cause mortality, serious infections, certain cancers (including lymphoma), heart attack, stroke, and thrombosis (blood clots). Antihistamines may help prevent nighttime scratching, which can further damage the skin and cause infections. Various protectant repair creams may also help ease eczema symptoms by restoring essential skin components, like ceramides, fatty acids, and cholesterol. If patients develop a skin infection that is affected by eczema, doctors will prescribe antibiotic, antiviral, or antifungal drugs to treat it, depending on the particular cause. Light therapy (phototherapy) using ultraviolet waves is a common treatment for people with moderate to severe atopic dermatitis. Skin improvements don’t occur immediately but instead become evident after one to two months of treatments several times a week, according to the National Eczema Association. Light therapy is effective for up to 70 percent of people with eczema. Burns, increased skin aging, and a higher risk of skin cancer are potential side effects, particularly if the patient receives light therapy for a long period of time. A potential new approach to treating eczema involves using “good” bacteria to kill pathogenic (disease-causing) bacteria like Staphylococcus aureus, which is commonly found in large quantities on the skin of people with eczema and is known to cause symptom flare-ups. Though such treatments are not yet available to the public, preliminary research is encouraging. An early study published in JCI Insight found that more than half of a small group of adults treated with Roseomonas mucosa (a type of bacteria found on healthy skin) in a spray form experienced improvement in their eczema, with some reporting that they needed less steroid cream to manage their symptoms. And a study published in Nature Medicine looked at using a particular “good” bacteria strain, known as Staphylococcus hominis A9, to kill a “bad” bacteria, Staphylococcus aureus. According to the researchers of the study, roughly half of people with eczema have a significant problem with bacterial infections, particularly from S. aureus. The scientists reasoned that if there was a type of bacteria found on healthy skin that could inhibit the growth of S. aureus, it could prevent infection and bring the microbiome into better balance. In the clinical trial, symptoms improved in two-thirds of the subjects after applying the “good” bacteria. These measures include:
Keeping fingernails short, and avoiding scratching the skinMoisturizing skin frequently with ointments (petroleum jelly), creams, and lotions that are free of alcohol, fragrances, and dyesUsing a humidifier, particularly if the air is dryAvoiding skin irritants, such as wool or man-made fibers (wear soft cotton clothing instead), strong soaps and detergents, and situations or environments that cause sweatingAvoiding airborne allergens, such as pollen, pet dander, and dust mites
When bathing, it’s important to minimize time in the tub or shower and to use cool or lukewarm water. Use gentle body washes and cleansers, and avoid scrubbing or toweling off for too long.
Adding oatmeal, baking soda, or fragrant-free bath oils to bathwaterGetting a massage with essential oils, such as chamomile, chickweed, licorice, or thymeManaging stress through yoga, meditation, biofeedback, or mindfulness training
Supplements for Atopic Dermatitis
Some patients report that certain dietary supplements offer some eczema relief, including:
ProbioticsFish oilVitamin DVitamin CBromelain (an enzyme derived from pineapple)Flavonoids
Talk with a doctor or dermatologist for more information about how diet might affect eczema.
