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3 Types of Prescription Eczema Treatments and Their Side Effects

Medically reviewed by Meredith Plant, M.D.
Updated on January 2, 2024

  • Dermatologists may prescribe topical, injectable, or oral medications to treat moderate to severe or resistant eczema.
  • Some medications work faster than others, and some are designed for either short-term or long-term use.
  • Your doctor will help minimize the risk of side effects when deciding on a treatment plan for your eczema.

If you’ve been diagnosed with eczema, you might wonder how soon you’ll find relief from the flaking, scaling, and itching caused by this chronic skin condition. Some eczema treatments work faster than others, and it’s important to allow enough time before you decide whether a treatment is working for you.

In addition to lifestyle changes, prescription eczema treatments can be highly effective. However, most treatments come with side effects. Educating yourself on the various options and asking questions will enable you to partner with your dermatologist on treatment decisions and assume a more active role in your health care.

1. Topicals

People with eczema are often prescribed medicated creams to help reduce skin inflammation, improve symptoms, and repair the skin barrier. Topical medications are usually the first line of treatment for eczema symptoms. Your doctor will provide special instructions on how to apply them.

Some topical medications work to bring down inflammation overall (like corticosteroids), while others target specific pathways of the immune system.

The following list contains types of topical prescriptions for eczema.

  • Corticosteroids such as hydrocortisone ointment reduce inflammation and itching during a flare-up.
  • Calcineurin inhibitors, such as tacrolimus ointment (Protopic) and pimecrolimus cream (Elidel), help treat eczema by lessening inflammation and regulating the immune response.
  • Phosphodiesterase 4 (PDE4) inhibitors such as crisaborole (Eucrisa) suppress an enzyme (PDE4) that helps regulate the immune system.
  • Janus kinase (JAK) inhibitors such as ruxolitinib (Opzelura) target specific inflammatory pathways in the immune system.

It’s important to apply these topical medications only to the areas prescribed by your medical team and wash your hands after placing them on your skin to avoid getting more medication than you need.

What To Expect and Potential Side Effects

You should start to see and feel improvement in your eczema symptoms after the first week of topical treatment. You may notice less redness, dryness, and itchiness.

Topical Corticosteroids

Often, topical steroids are more potent (stronger) in ointment form, so be sure to ask your provider if an ointment is the right choice for you. It’s not unusual to feel a slight stinging or burning sensation the first few times you use a topical treatment, especially if you have sensitive skin. Storing the ointment in a refrigerator or another cool place might help reduce stinging.

Topical steroids are very effective but come with the risk of several side effects. Side effects worsen if you use the product for a long time or if it’s a potent concentration.

Common side effects can include thinning skin and stretch marks, spider veins, rosacea or acne, and dermatitis. Some people with eczema can be at risk for steroid withdrawal or rebound effects when stopping the medication. That’s why it’s important to talk to your doctor about a safe way to taper off rather than suddenly stopping it on your own.

Calcineurin Inhibitors and PDE4 Inhibitors

More targeted topical prescriptions, like calcineurin inhibitors and PDE4 inhibitors, can be used for a longer time than steroids. They’re also more suitable for sensitive areas, like the face or genitals. Some people feel burning or stinging during application, but this side effect should go away once your body adjusts to the medication, and keeping it in the refrigerator can also be helpful.

Cortisone creams and calcineurin inhibitors can increase your skin’s sensitivity to the sun. Once you’ve started treatment, you’ll need to wear sunscreen, sun-protective clothing, or a hat and avoid tanning.

Topical JAK Inhibitors

The JAK inhibitor cream ruxolitinib is meant to be used continuously for around eight weeks. Side effects include nausea, headaches, ear infections, and a higher risk of getting sick from the common cold, urinary tract infections, or bronchitis. However, there’s a lower chance of side effects when applying topical JAK inhibitors versus taking this type of medication in a pill form.

​​It’s rare but possible to have an allergic reaction to a topical corticosteroid or other skin cream. A mild reaction may consist of a rash and irritation that could last a while after your flare has healed. A severe reaction may cause serious side effects like wheezing and chest tightness. If you experience symptoms that suggest a severe allergic reaction, stop using the medication, and call your doctor or seek emergency services immediately.

2. Injectables

Injectable biologic medications are prescribed for people with more severe eczema that doesn’t respond to topical treatments. These include dupilumab (Dupixent) and tralokinumab (Adbry). Unlike topical treatments, biologics attempt to treat eczema from the “inside out.” They bind to certain antibodies in the immune system to help reduce inflammation. Dupilumab is approved for children and adults over 6 months of age. Tralokinumab is meant for adults over 18.

Injecting medications can feel intimidating, especially if you don’t work in the health care field. Your doctor may suggest you get your first dose in their office so that they can show you how to administer the injection properly. If you feel comfortable, you can administer the remaining doses to yourself at home — typically every two weeks. Injectable medications should also come with an information sheet and a video tutorial to help reinforce your health care provider’s guidance.

What To Expect and Potential Side Effects

It can take months to get results from biologics. Staying consistent with treatment for at least six months will help you determine if it’s a good fit for you.

The most common side effects of dupilumab are cold sores, conjunctivitis (pink eye), and infections at the injection site. Tralokinumab can produce similar side effects and may also cause upper respiratory infections and high white blood cell counts. Most side effects resolve within 16 weeks of treatment. Some injectable medications need blood work to monitor their effects — be sure to ask your medical team if they are considering these medicines for you.

3. Oral Medications

There are several types of oral prescription medications for eczema as well. They work with the immune system to help stop itching and give the skin barrier a chance to heal. Along with topical formulations, steroids and JAK inhibitors can also be taken as a pill. Abrocitinib (Cibinqo) and upadacitinib (Rinvoq) are oral JAK inhibitors approved to treat atopic dermatitis.

There’s also a variety of systemic immunosuppressants, such as azathioprine, cyclosporine, methotrexate, and mycophenolate mofetil. Doctors may prescribe these drugs “off-label” to help treat eczema. That means they’re approved to treat other conditions, but can be prescribed for eczema if your doctor thinks they’ll help with your symptoms.

What To Expect and Potential Side Effects

Many prescription oral medications, including cyclosporine, methotrexate, and upadacitinib, require ongoing blood work. It’s a good idea to set reminders on your calendar for upcoming lab work and dermatology appointments.

Oral medications may work faster in some people than in others. According to the results of clinical trials for upadacitinib, some people experience itch relief after just two days of treatment. The full effects of oral medications like upadacitinib and methotrexate may take a few months. Cyclosporine generally helps improve eczema symptoms within one to two weeks.

Everyone responds differently to eczema treatment, so try to be patient if you don’t see significant improvements after a week or two. Your provider might suggest other therapies to keep your symptoms from getting worse while you’re waiting for pills to reach their maximum effect.

Oral Corticosteroids

Systemic steroids are reserved for severe cases of eczema and shouldn’t be used for more than a month. Systemic means that the medication works throughout your body. Frequently, discontinuing oral steroids can trigger an eczema flare-up, so be sure to talk with your team about tapering off these medicines to avoid bad flares. Oral steroids should be a last resort for severe eczema rather than a routine treatment. Using them for longer than a month comes with the risk of serious side effects, including:

  • Acne
  • Bacterial, viral, and fungal infections
  • Digestive problems
  • Glaucoma or cataracts
  • Hair loss
  • High blood pressure
  • Irregular periods
  • Osteoporosis
  • Stretch marks
  • Stunted growth (in children)
  • Weight gain

Oral JAK Inhibitors

Side effects affecting more than 1 percent of those taking abrocitinib in clinical trials included:

  • Acne
  • Allergic skin rashes
  • Bacterial skin infection
  • Cold sores
  • Common cold, flu, stomach flu
  • Dizziness, headaches
  • High blood pressure
  • Increased blood level of creatinine phosphokinase
  • Low platelet count
  • Mouth and throat pain
  • Nausea, stomach pain, and vomiting
  • Shingles
  • Tiredness
  • Urinary tract infection

Many of these side effects are similar for upadacitinib. Additional possible side effects include weight gain, folliculitis, and upper respiratory tract infections.

Immunosuppressants

Systemic immunosuppressants have a range of potential side effects, such as an upset stomach, high blood pressure, higher risk of certain types of cancer, kidney and liver damage, and greater risk for infection. Your doctor may recommend regular blood work to monitor how your body responds to the drug.

You may also need to take special precautions to avoid getting sick because these meds reduce your body’s natural immune response. Ideally, oral immunosuppressants are a short-term treatment for eczema. Once your skin is under control, your doctor can suggest switching to long-term treatment options.

Eczema can be treated with different prescription medications, each with its own way of working and possible side effects. These drugs include corticosteroids, calcineurin inhibitors, and newer options like PDE4 inhibitors and JAK inhibitors. If you have eczema, it’s important to talk to your doctor to figure out the best treatment for your situation. Be sure to keep an eye on any side effects, and work closely with your health care provider to manage them effectively.

Talk With Others Who Understand

Because eczema is an ongoing condition, and your treatment journey may have ups and downs, it can be helpful to talk to other people who understand what you’re going through.

MyEczemaTeam is the social network for people with eczema (such as atopic dermatitis) and their loved ones. Here, more than 50,000 members from around the world come together to ask questions, offer support and advice, and connect with others who understand life with different types of eczema.

What are some eczema treatments you’ve tried? How long did it take until you noticed the results? Did you have any side effects? Share your experience in the comments below, or start a discussion on your Activities page.

Updated on January 2, 2024
All updates must be accompanied by text or a picture.

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Meredith Plant, M.D. specializes in mental health, including prevention measures and treatment of ADHD, depression, and anxiety. Learn more about her here
Anastasia Climan, RDN, CDN is a dietitian with over 10 years of experience in public health and medical writing. Learn more about her here

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