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Treatments for Eczema

Posted on August 29, 2018

Article written by
Kelly Crumrin

Medically reviewed by
Dr. Kevin Berman

Although some children outgrow eczema, for many people it is a chronic condition that can be difficult to treat. It usually requires trying several different treatments before finding one that is effective for managing symptoms.

Eczema is often managed with topical medications. In cases where eczema is severe or widespread, systemic medications may be needed. Some people experience improved symptoms when they use phototherapy or make lifestyle changes. Read more details about eczema treatments in Treatments A-Z.

Topical Treatments for Eczema

The effects of topical treatments are limited mainly to the skin. Topical treatments for eczema can come in a variety of forms, including ointment, cream, spray, foam, shampoo, solution, and lotion. Different forms of topical medication are better for different parts of the body or different types of eczema. For instance, medicated shampoos and solutions work well for the scalp.

Some topical medications are available over the counter in pharmacies without a doctor's prescription. Two examples are Cortizone 10 Intensive Healing Eczema Lotion and Exederm Flare Control Cream. The active ingredient in both products is Hydrocortisone, a mild corticosteroid. Along with thicker moisturizing creams, mild eczema may be controlled with these over-the-counter medications. Because dry skin leads to worsening eczema, daily moisturizer is a key part of the treatment.

Corticosteroids

Corticosteroids, or simply steroids, are among the most frequently used treatments for eczema. Corticosteroids are synthetic hormones that suppress immune system response. Corticosteroids are believed to work by inhibiting or blocking inflammatory responses within the body. Stronger steroids such as Elocon (Mometasone), Betamethasone, Triamcinolone, and Temovate (Clobetasol) are available by prescription only.

Stronger corticosteroids should be used for limited periods of time to avoid side effects, such as stretch marks, changes in pigmentation, allergic reactions, and skin atrophy — which thins skin and may cause indentations or wrinkles. Used over large areas of skin for long periods of time, powerful topical steroids can absorb into the bloodstream and cause systemic problems, including Cushing's syndrome, a metabolic disorder that involves weight gain, muscle weakness, high blood pressure, and high blood sugar.

Antibiotics and Immunosuppressants

Topical antibiotics may be prescribed in cases where eczema and scratching of the skin has led to a skin infection. Other prescription topical medications for eczema include topical immunosuppressants, such as Protopic (Tacrolimus), and Elidel (Pimecrolimus), and Eucrisa (Crisaborole).

Side effects from topical eczema treatments are usually limited to the skin. Some cause redness, sensitivity to sunlight, or other skin reactions, especially when treatment first begins.

Systemic Treatments for Eczema

Oral medications are prescribed in cases of severe or widespread eczema, or when topical drugs fail to control eczema. Some oral drugs prescribed for eczema are types of immunosuppressants, such as Cyclosporine, Mycophenolate mofetil (sold under the brand names CellCept and Myfortic), and Methotrexate. In cases where eczema has led to a skin infection, oral antibiotics may be given. Oral corticosteroids, such as Prednisone, may be given for short periods of time during flare-ups of eczema. Long-term use of systemic steroids has many unwanted side effects.

Unlike topical medications, the effects of oral eczema medications are not limited to the skin. They have effects — and cause side effects — on a systemic basis throughout the body. Side effects such as Cushing's syndrome are more likely to develop when taking steroids orally, especially over longer periods of time.

Dupixent (Dupilumab) is an immunomodulator drug prescribed for moderate to severe atopic dermatitis. Dupixent is the first biologic drug — a genetically engineered molecule — approved for eczema. More specifically, it is an interleukin-4 (IL-4) receptor alpha antagonist. Dupixent is believed to work by blocking IL-4 and IL-13, chemical messengers involved in autoimmune attacks. Dupixent prevents IL-4 and IL-13 from signaling the immune system to attack the tissues. Dupixent is administered by injection every other week. In rare cases, Dupixent can cause eye problems. It is currently approved for people with eczema ages 6 and up, and is also used to treat asthma.

Antihistamines such as Benadryl (Diphenhydramine) may help manage itching. Antihistamines are believed to work by blocking the action of histamines (chemicals associated with allergic reactions) in the body. Antihistamines make some people drowsy.

Lifestyle Changes

Moisturizers can help soothe itching, redness, and dryness and prevent your eczema from getting worse. Moisturizers work by trapping water in the skin and maintaining the skin’s natural barrier. The regular application of moisturizers can promote healing in skin affected by eczema. Moisturizers should always be applied after bathing. Thicker creams that contain ceramides will be more effective at maintaining the barrier of the skin.

Most people with eczema can identify products, mental and physical states, and situations that trigger eczema flare-ups for them. Eczema triggers are different for everyone, and it may not be possible to avoid all of them. However, doing your best to identify your eczema triggers and avoid exposure to them may help minimize flares as much as possible.

Exercise helps fight inflammation and reduce stress, both of which contribute to eczema flares. Anxiety and depression are also common in people with eczema, and physical activity can improve mood. For these reasons, exercise is an important part of staying healthy for people with eczema.

Some people find their eczema symptoms worsen when they eat certain foods. Eczema triggered or worsened by specific foods may be caused by an allergic reaction or another type of immune-related sensitivity. Since food allergies are common among those with eczema, it may be useful to receive allergy testing to determine whether your eczema is connected with food allergies. For people with diagnosed food allergies, avoiding the allergenic food is recommended.

However, recent studies have shown that some people whose eczema is caused by food allergies develop more serious systemic reactions — including life-threatening anaphylaxis — after strictly avoiding the allergenic food for a period of time. Some researchers theorize that some level of continued exposure to the trigger food may result in a level of tolerance that, while it contributes to eczema, may prevent dangerous immune reactions. Each individual case is different. Always follow your allergist’s guidance.

Other Treatments

Some people whose eczema does not respond to medication may benefit from phototherapy treatment using specific types of light. Types of phototherapy range from natural sunlight to medically supervised treatments with specialized ultraviolet B light or ultraviolet A light combined with Psoralen for PUVA therapy. Some of these therapies may increase the risk of skin cancer.

Some people with eczema participate in clinical trials to potentially access new treatments for eczema.

Complementary and alternative therapies are popular with many people who have eczema. Natural or integrative treatments that have shown potential for improving eczema symptoms in clinical trials include acupuncture, mind-body practices, massage, herbal preparations, and nutritional supplements. If you choose to try one or more alternative treatments, it is important to maintain the traditional drug regimen established by your doctor. These treatments have been proven effective in rigorous, scientific trials. It is also vital to check with your doctor before beginning a natural or complementary regimen so that they can warn you about any potential interactions and correctly interpret any side effects.

Is There a Cure for Eczema?

Some children eventually outgrow their eczema, but there currently is no cure.

Condition Guide

References

  1. Eczema Treatment — National Eczema Association
  2. Eczema (Atopic Dermatitis) — National Institute of Allergy and Infectious Diseases
  3. Atopic dermatitis (eczema) — Mayo Clinic
  4. Eczema: Overview — Informed Health
  5. Elimination Diets in Eczema — A Cautionary Tale — The Journal of Allergy and Clinical Immunology

Kelly leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.

Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Learn more about him here. Review provided by VeriMed Healthcare Network.

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