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Guide to Topical Eczema Treatments

Posted on November 08, 2021
Medically reviewed by
Kevin Berman, M.D., Ph.D.
Article written by
Joan Grossman

  • Topical therapy is the first-line treatment option for eczema.
  • Topical steroids have been a mainstay for treating eczema flare-ups, but their use must be limited to avoid side effects.
  • Newer classes of topical treatments work by targeting aspects of the immune system and repairing the barrier function of the skin.
  • The newest class of topical treatments is Janus kinase (JAK) inhibitors, which block inflammatory signals.

Topical treatments for eczema are an essential part of your skin care regimen. Prescription topical treatments can treat eczema flare-ups, or they can be used as maintenance medication to control inflammation and prevent flares. Topical eczema treatments have minimal risk for side effects and — if used correctly — are effective at reducing itch, relieving inflammation, and restoring the skin barrier for people with mild to moderate eczema.

It’s important to understand which topical treatment options are available and how they work. Advances in medical research are leading to the development of new topical therapies that you may want to discuss with your dermatologist.

Topical Steroids

Topical steroids — also called corticosteroids — come in a variety of potencies and formulations. Topical steroids, such as hydrocortisone, are a mainstay in the treatment of eczema flares because they have fast-working anti-inflammatory and immunosuppressive properties. They are also antimitotic, which means they inhibit the growth of cells.

Steroids are rated by potency, from class 1 (superpotent corticosteroids) to class 7 (the least potent corticosteroids). Doctors will prescribe different potencies of corticosteroids depending on the severity of the condition and the part of the skin where they are used.

Topical steroids come in many forms, including:

  • Ointments — Typically the most potent and emollient form of topical steroid, ointments are oil- or fat-based and do not quickly absorb into the skin. They should not be used where hair grows.
  • Creams — Water- and oil-based creams dry without leaving residue. They are less potent than ointments.
  • Lotions — These are more liquid than creams and have higher water content. They can be used where hair grows.
  • Gels — Gels are water-based and do not contain oil. They may create a film on the skin, but they do not cause hair-matting.
  • Foams — These are typically used on the scalp or other hair-covered areas.

Side Effects

Steroids should be used for short periods following your doctor’s recommendation. Long-term steroid use is associated with adverse reactions. Side effects from long-term topical steroids usually occur locally, where the treatment is applied, and may include thinning of the skin, scarring, premature appearance of aging, skin atrophy, easy bruising or rupture, rebound dermatitis, and rosacea. The risk for side effects increases with higher potency steroids. High potency steroids are not appropriate for areas where the skin is thinner, such as the face.

Systemic side effects from topical steroids are less common. They may occur when potent topical steroids are used on large areas of the body (a risk for babies and young children) or for such a prolonged period of time that they are absorbed into the bloodstream. Systemic side effects include hyperglycemia (high blood sugar), diabetes, and hypothalamic-pituitary adrenal axis suppression, which can increase the risk for dangerous infections.

Learn more about the Do's and Don'ts of Topical Eczema Treatments.

Topical Calcineurin Inhibitors

Topical calcineurin inhibitors are a newer class of treatment which includes two drugs — tacrolimus ointment (sold under the brand name Protopic) and pimecrolimus cream (sold under the brand name Elidel). Topical calcineurin inhibitors can be highly effective in relieving pruritus — or itch — and other eczema symptoms. Calcineurin inhibitors work by targeting proinflammatory T-cells in the immune system.

Topical calcineurin inhibitors are only approved for the treatment of atopic eczema, also called atopic dermatitis or AD. They are considered a second-line treatment when topical steroids do not work effectively on adults and children over 2 years old. Tacrolimus is used for moderate or severe eczema, and stronger potencies are only used with people 16 years of age or older. Pimecrolimus is used for mild or moderate eczema. Topical calcineurin inhibitors are a good choice for sensitive areas such as the face, where more potent topical steroids cannot be used.

Side effects for topical calcineurin inhibitors include skin discoloration, skin feeling warm or tingly, blocked skin pores, and viral infections on the skin. Although there has been concern about a link between the use of topical calcineurin inhibitors and skin cancer, recent large-scale findings suggest no increased risk of skin cancer.

Topical Phosphodiesterase 4 Inhibitors

Topical phosphodiesterase 4 (PDE4) inhibitors are another newer class of drug for the treatment of atopic dermatitis. PDE4 is an enzyme in the immune system that regulates the production of proinflammatory cytokines, such as the interleukins IL-4, IL-13, and IL-31, which are overactive in people with atopic dermatitis. PDE4 inhibitors target this particular type of immune disorder and have been found to significantly improve symptoms in people with mild to moderate atopic dermatitis.

Eucrisa (crisaborole) ointment is the first topical PDE4 inhibitor approved for the treatment of atopic dermatitis. Other PDE4 topical treatments are currently under review. Side effects include pain and burning at the site where the ointment is applied. This can be mitigated by mixing the medication with moisturizer before putting it on the skin.

Topical Antibiotics

In cases where eczema becomes infected, topical antibiotics may be used to treat the infection. Topical antibiotics are not used for the treatment of eczema itself.

People with atopic dermatitis can have a high prevalence of Staphylococcus aureus bacteria on their skin, which is a factor in bacterial infections. Topical antibiotics may be recommended for some skin infections due to eczema. Mupirocin is commonly prescribed if a Staph infection or impetigo is suspected.

The use of topical antibiotics with eczema is controversial because some studies suggest they are not more effective than other treatments. Overuse of antibiotics can produce antibiotic-resistant bacteria.

JAK Inhibitors

Janus kinase inhibitors are a new class of topical treatments for eczema. In September, Opzelura (ruxolitinib) became the first to be approved by the U.S. Food and Drug Administration (FDA) for the treatment of atopic dermatitis. One study of 307 people with atopic dermatitis showed that ruxolitinib cream improved itching within 36 hours with prolonged relief. More topical JAK inhibitors are currently in the pipeline for the treatment of atopic dermatitis and chronic hand eczema.

Janus kinase molecules are proinflammatory cytokines, or signaling molecules, in the immune system. By blocking these signals, JAK inhibitors can prevent inflammation caused by dysfunctional immune responses. JAK inhibitors are on the forefront of new drugs designed to treat chronic inflammation in skin diseases like eczema and psoriasis.

Adverse effects from topical JAK inhibitors have been limited, but more long-term data is still needed. Talk to your dermatologist about new topical JAK inhibitors currently under review for approval by the FDA, which may be out by the end of 2021.

Maintain Your Treatment Plan

Maintaining home skin care is an essential part of eczema treatment and will improve your quality of life. Your dermatologist may recommend over-the-counter moisturizers and emollients which are effective in treating dry skin, improving symptoms, reducing flares, extending the time between flares, and reducing the need for steroids and other medications. Moisturizing and hydration can control symptoms for many people, but in cases of moderate or severe eczema, such as severe atopic dermatitis, additional treatments may be needed.

Be sure to maintain your skin care regimen along with other aspects of your treatment plan, which may include ultraviolet phototherapy, wet wraps, oral antihistamines, immunosuppressant drugs like methotrexate or cyclosporine, or the biologic drug Dupixent (dupilumab), among other treatment options.

Learn more about Getting the Best Results With Topical Eczema Treatments.

Talk to your dermatologist if you would like to adjust your topical treatment plan. Never make any changes to your treatment plan without medical advice.

Talk With Others Who Understand

MyEczemaTeam is the social network for people with eczema and their loved ones. On MyEczemaTeam, more than 38,000 members come together to ask questions, give advice, and share their stories with others who understand life with eczema.

Do you have questions about prescription topical treatments for eczema? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Emerging Treatment Options in Atopic Dermatitis: Topical Therapies — Dermatology
  2. An Overview of the Different Types of Eczema — National Eczema Association
  3. Correlation of Age-of-Onset of Atopic Dermatitis With Filaggrin Loss-of-function Variant Status — Scientific Reports
  4. Topical Corticosteroids — StatPearls
  5. Using Medication: Topical Medications — InformedHealth.org
  6. Side-Effects of Topical Steroids: A Long Overdue Revisit — Indian Dermatology Online Journal
  7. Topical Calcineurin Inhibitors (TCIs) — National Eczema Society
  8. Association Between Topical Calcineurin Inhibitor Use and Keratinocyte Carcinoma Risk Among Adults With Atopic Dermatitis — JAMA Dermatology
  9. Application of Topical Phosphodiesterase 4 Inhibitors in Mild to Moderate Atopic Dermatitis: A Systematic Review and Meta-analysis — JAMA Dermatology
  10. The Role of Phosphodiesterase 4 in the Pathophysiology of Atopic Dermatitis and the Perspective for Its Inhibition — Experimental Dermatology
  11. The Infectious Complications of Atopic Dermatitis — Annals of Allergy, Asthma & Immunology
  12. Oral and Topical Antibiotics for Clinically Infected Eczema in Children: A Pragmatic Randomized Controlled Trial in Ambulatory Care — Annals of Family Medicine
  13. The Arrival of JAK Inhibitors: Advancing the Treatment of Immune and Hematologic Disorders — BioDrugs
  14. Breaking news: FDA approves Opzelura™ (ruxolitinib) cream — National Eczema Society
  15. Emollients and Moisturisers for Eczema — Cochrane Database of Systematic Reviews

A MyEczemaTeam Member said:

Thank you so much for this. Although I have battled, literally battled eczema for years, I have been incrrasingly frustrated by the ever growing number if ointments and creams and never really… read more

posted 12 days ago

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Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Joan Grossman is a freelance writer, filmmaker, and consultant based in Brooklyn, NY. Learn more about her here.

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