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Severe Eczema: Treatments and Managing Symptoms

Medically reviewed by Kevin Berman, M.D., Ph.D.
Written by Nyaka Mwanza
Posted on February 2, 2022

Medication, skin care, and trigger management can often help treat severe eczema (atopic dermatitis). Lifestyle changes and other at-home approaches may also help bring your symptoms under control.

Symptoms of eczema — including itchy, dry, cracked skin — can limit your quality of life if they’re not well controlled. Fortunately, many treatments are available to address eczema symptoms. Currently, there are more new treatment options available for eczema than ever before, and several more are in development or clinical trials.

Severe eczema generally requires a combination of tactics and therapies to control its symptoms and limit the frequency of eczema flares. Not all treatments work well for people with eczema, and all medications have a risk of side effects. Finding the right combination of medication and lifestyle changes often takes some trial and error with the guidance of your dermatologist.

When Is Eczema Considered Severe?

Doctors will often use the Eczema Area and Severity Index (EASI) to assess eczema severity. The EASI takes into account where, how much, and how severely a person’s skin is affected by eczema. The index helps doctors calculate your eczema severity as a score from 0 to 72 based on:

  • The amount of skin in four distinct regions of the body — face and neck, torso, lower limbs, and upper limbs — that has signs of eczema inflammation
  • How intense the inflammation is in those areas of the body, measured on a four-point scale of four indicators: redness, thickness, scratching, and lichenification

EASI does not consider dryness and itchiness. However, in assessing the severity of your eczema, your doctor may also factor in the impact your eczema symptoms (for example, itchiness) may have on your day-to-day life. For many people, itching at night leads to decreased sleep, which can lead to poor performance in school and work and can affect mental well-being and relationships.

Prescription and Over-the-Counter Medications for Severe Eczema

Currently available eczema treatments include over-the-counter (OTC) or prescription drugs and therapies. These treatments may be used orally, injected subcutaneously, or topically. For the best results, you should use any OTC or prescription medications exactly how your doctor has prescribed them.

Oral and Injectable Treatments

There are many OTC and prescription medications taken orally (by mouth) that can help manage eczema symptoms. For instance, OTC pain relievers may help with burning, and antihistamines may help relieve itchiness and promote sleep.

Treatment for severe eczema may also include prescription drugs such as biologics. Biologics work by controlling the immune system’s abnormal functioning, the underlying cause of eczema’s inflammatory response. Dupixent (dupilmaub) is an injectable biologic drug approved by the U.S. Food and Drug Administration (FDA) for treating severe eczema. The FDA also is on the verge of approving newer injections, as well as a new class of oral medications known as Janus kinase (JAK) inhibitors.

Phototherapy

Phototherapy (light therapy) is often used in cases of eczema that don’t respond well to standard topical treatments. Types of light therapy include exposure to natural sunlight and the use of artificial ultraviolet A and ultraviolet B rays. Long-term light therapy can have harmful effects such as increased skin cancer risk and premature skin aging. Phototherapy should be administered under the supervision of a dermatologist who is monitoring your UV radiation exposure.

Learn more about phototherapy.

Topical Treatments

Topical treatments such as creams, ointments, and gels are applied to the skin of affected areas. Topicals are available OTC as well as by prescription. Some topicals used to treat eczema include:

Ways To Manage Severe Eczema on Your Own

If you have severe eczema, medication may be an important part of your treatment plan. Taking additional steps may also help you manage your eczema symptoms. Work closely with your health care providers and eczema treatment team (which may include a dermatologist or a doctor specially trained in immunology) to find the best treatment plan for your eczema.

Learn Your Triggers

Triggers may lead to eczema flare-ups. Learning what triggers your eczema allows you to avoid or minimize exposure, which can help reduce the frequency and severity of flare-ups. Common eczema triggers include:

  • Allergens
  • Laundry detergents
  • Dust mites
  • Harsh soaps and cleansers
  • Perfumes
  • Pet dander
  • Stress
  • Weather
  • Hot water
  • Prolonged water exposure

Minimize Skin Damage

It may be tempting, but don’t scratch. Scratching can lead to long-term or permanent scarring. Broken skin also comes with a higher risk of developing a skin infection. Signs of infection to watch for include pus-filled bumps or blisters, redness, heat, or pain. It may help to keep your fingernails trimmed and short.

If you find yourself scratching while you sleep, wear a pair of light gloves to bed. Gloves may be a great solution for eczema in infants and young children, for whom controlling scratching may be more challenging.

Skin Care

An important part of controlling your eczema is managing dryness and itchiness. Keep your sensitive skin hydrated with rich, unscented lotions or moisturizers, and humidifiers. Wet wraps applied over a topical medication may be especially helpful for eczema that’s severe. A skin care plan for severe eczema involves a consistent routine for your body, especially when it comes to bathing and moisturizing.

You Are Not Alone

MyEczemaTeam is the social network for people living with eczema. More than 40,000 members come together to ask questions, give advice, and share their experiences with others who understand life with eczema.

Do you have severe eczema? What’s helped you manage your symptoms? Share your experience in the comments below or by starting a discussion on MyEczemaTeam.

Posted on February 2, 2022
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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.
Nyaka Mwanza has worked with large global health nonprofits focused on improving health outcomes for women and children. Learn more about her here.

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