Eczema: Management, Medications, & Treatment Options

Eczema is a skin condition  caused by an overactive immune system that results in dry, itchy skin. Many people experience flares that lead to red, scaly patches on the skin.¹ Your doctor or dermatologist may recommend different treatments to help target inflammation and clear your skin.

Depending on how severe your symptoms are, you may be prescribed a topical treatment that’s applied directly to affected areas of your skin or a systemic (whole-body) treatment that reduces immune system activity. These medications help stop the itch-scratch cycle, helping your skin heal fully. We also offer some tips on at-home remedies you can use alongside your prescribed treatments.

Topical Treatments for Eczema

Topical therapies are applied to skin affected by eczema.² There are several options available — your dermatologist will work with you to find the best option. Some topicals are only meant to be used short-term, while others can be used long-term for maintenance.

Topical Corticosteroids for Eczema

Corticosteroids are synthetic (laboratory-made) hormones that are similar to cortisol found in your body.³ They help reduce immune system function to limit inflammation contributing to skin symptoms. Corticosteroids are one of the most common atopic dermatitis treatments.^2,4

Examples of topical corticosteroids include:⁵

• Betamethasone (Luxiq®)
• Clobetasol propionate (Clobex®)
• Mometasone (Elocon®)
• Triamcinolone (Triderm®)
• Hydrocortisone — found over-the-counter

Topical corticosteroids are available at different concentrations. Your dermatologist will prescribe the most appropriate concentration depending on the skin that’s affected. For example, certain areas of your body — including skin folds, areas where skin rubs together, the face, and the genitals — absorb topical medications better than other areas, while thick-skinned areas like your palms, soles, and back may need stronger medications to be effective. Be sure to use only the prescribed amount to avoid unwanted side effects.

Side Effects of Topical Corticosteroids

Topical corticosteroids should only be used for short periods, so your dermatologist will guide you on when and how to stop them safely. If used for an extended period of time, topical corticosteroids can cause unwanted symptoms, including:^2,3

• Skin thinning (atrophy)
• Changes in skin color or pigmentation
• Stretch marks
• Visible blood vessels known as spider veins
• Increased hair growth

Topical Calcineurin Inhibitors for Eczema

Another type of topical medication used to treat eczema is topical calcineurin inhibitors (TCIs).⁶ They block your cells from making inflammatory proteins, which stops your immune cells from creating unnecessary skin inflammation. As a result, TCIs help treat skin itching and redness.

The U.S. Food and Drug Administration (FDA) has approved two TCIs for treating atopic dermatitis — tacrolimus (Protopic®) and pimecrolimus (Elidel®).^7,8 Tacrolimus is available as an ointment, while pimecrolimus is a cream. Both topicals are prescribed to adults with moderate-to-severe atopic dermatitis and children ages 2 years and older with mild-to-moderate atopic dermatitis.

TCIs are safe to apply to any area of skin on the body, including the face and areas with thin skin that aren’t ideal for corticosteroid treatment. Your dermatologist may prescribe a long-term TCI to help you manage your eczema.

Side Effects of Topical Calcineurin Inhibitors

The most common side effects of TCIs are burning or stinging sensations where the medication is applied. In 2006, the FDA put a black box warning on TCIs for the risk of developing a type of blood cancer known as lymphoma. If you’re concerned about this warning, talk to your dermatologist about what treatment options may be better for you.⁹

Crisaborole (Eucrisa®) for Eczema

Crisaborole (Eucrisa®) is currently the only FDA-approved phosphodiesterase 4 (PDE4) inhibitor for treating eczema. Specifically, it’s prescribed to treat adults and children ages 3 months and older with mild-to-moderate atopic dermatitis.¹⁰

Crisaborole works by blocking the PDE4 enzyme found in your immune cells. PDE4 is involved in producing inflammatory proteins, known as cytokines, that play a role in eczema. By blocking their production, crisaborole helps treat skin inflammation and symptoms.

Side Effects of Crisaborole

The most commonly reported side effects in clinical trials for crisaborole include:¹⁰

• Worsening eczema symptoms
• Skin infections
• Stinging or burning when applied to the skin

Ruxolitinib (Opzelura^TM) for Eczema

Ruxolitinib (Opzelura^TM) belongs to a class of medications known as JAK inhibitors. Ruxolitinib is a topical JAK inhibitor that treats eczema by targeting the JAK/STAT pathway in the immune system. It blocks JAK proteins from contributing to skin inflammation, which helps reduce irritation, rashes, and itchiness.¹¹

The FDA has approved ruxolitinib for short-term treatment of mild-to-moderate atopic dermatitis in adults and children ages 12 and older who have a healthy, functioning immune system.

Side Effects of Ruxolitinib

The most common side effects of ruxolitinib include:¹²

• Red skin rash or pimples
• Hives
• Signs of infection, such as runny nose, throat pain, or ear pain
• Diarrhea

Shampoos for Seborrheic Dermatitis

Seborrheic dermatitis is a type of eczema that mainly affects the scalp. It can cause dry, flaky skin (dandruff), crusts, and greasy scales on the scalp.¹³ The most efficient way to treat seborrheic dermatitis is by using medicated shampoos. Some you can find over-the-counter in the grocery store or pharmacy, while others are prescribed by your dermatologist.

Examples of active ingredients to look for in shampoo brands include:¹⁴

• Selenium sulfide (Selsun Blue, Head & Shoulders)
• Pyrithione zinc (Head & Shoulders, DermaZinc)
• Tar (DHS Tar, Neutrogena T/Gel)
• Salicylic acid (Neutrogena T/Sal, Denorex, DHS Sal)
• Ketoconazole 1 percent (Nizoral A-D)

Your dermatologist may have you wash with a medicated shampoo a few times a week to clear your skin, then once every few weeks for maintenance.

Oral Therapies for Eczema

If you have a moderate-to-severe case of eczema, your dermatologist may prescribe you medication to take by mouth that dampens inflammation throughout your entire body. Two types of oral therapies include corticosteroids and immunosuppressants. Oral JAK inhibitors have also been recently approved as an eczema treatment.

Oral Corticosteroids for Eczema

Prednisone is a commonly prescribed corticosteroid used to control body-wide inflammation in eczema. However, the benefits of treatment might not outweigh the risks, so your dermatologist will typically reserve them only for severe flares or to help control your symptoms until another medication begins working.¹⁵

Long-term use of corticosteroids can cause more unwanted symptoms than the topical versions, including weight gain, eye and stomach problems, high blood pressure, and loss of bone density.

Oral Immunosuppressants for Eczema

Immunosuppressants work just as their name implies — by suppressing the immune system. Many of these drugs are used to treat certain types of cancer or prevent the immune system from attacking and rejecting a newly transplanted organ. It’s important to note that many immunosuppressants aren’t FDA-approved for treating eczema and are instead prescribed “off-label.”¹⁶

Your dermatologist may prescribe a traditional immunosuppressant for the short term to get your eczema under control. Examples of medications include:

• Methotrexate (Trexall®)
• Mycophenolate mofetil (CellCept®)
• Cyclosporine (Sandimmune®)
• Azathioprine (Imuran^TM)

Some serious side effects that may be seen while taking a traditional immunosuppressant include:

• Nausea and vomiting
• Increased risk of infection
• Increased risk of developing certain types of cancer
• High blood pressure
• Increased risk of liver or kidney damage

Oral JAK Inhibitors for Eczema

Like topical JAK inhibitors, oral JAK inhibitors work by blocking JAK enzymes from contributing to inflammation. The FDA approved two JAK inhibitors in 2022 for treating moderate-to-severe atopic dermatitis — upadacitinib (Rinvoq®) and abrocitinib (Cibinqo^TM). Upadacitinib is approved for treating adults and children ages 12 and older, while abrocitinib is approved for treating adults only.^17,18

Commonly reported side effects during clinical trials include:

• Headache
• Cough
• Ache
• Upper respiratory tract infections
• Nausea, vomiting, and abdominal pain
• Flu-like symptoms (fatigue, muscle aches)
• Cold sores
• Urinary tract infections
• Skin rashes or infections

The FDA has also added black box warnings to both upadacitinib and abrocitinib for the increased risk of cancer, heart problems (blood clots, heart attack, stroke), and death.

Injectable Therapies for Eczema

In addition to topical and oral medications, moderate-to-severe atopic dermatitis can be treated with a class of injectable therapies known as biologics. Specifically, they are monoclonal antibody drugs, which are lab-engineered proteins that target a specific part of the immune system. Biologics must be injected under your skin or infused into your vein using a needle, as your stomach breaks down any proteins you eat.¹⁹

Currently, there are two FDA-approved biologics for treating eczema — dupilumab (Dupixent®) and tralokinumab-ldrm (Adbry^TM).

Dupilumab (Dupixent®) for Eczema

Inflammatory messenger proteins known as interleukins (ILs) are responsible for causing skin flares and eczema symptoms. Specifically, IL-4 and IL-13 are released during an eczema flare, causing skin inflammation and irritation. Long-term (chronic) inflammation from these proteins is responsible for causing the red, itchy patches on your skin. Duplimuab (Dupixent®) is a monoclonal antibody drug that binds to the IL-4 receptor on the surface of immune cells, preventing them from creating inflammation.²⁰

The FDA first approved dupilumab in 2017 for treating moderate-to-severe atopic dermatitis in adults as well as infants and children 6 months and older. Dupilumab is typically reserved for treating atopic dermatitis that hasn’t responded to topical corticosteroid or immunosuppressant therapy.²¹ However, your dermatologist may prescribe both dupilumab and a topical together to try to control your symptoms.

Dosing and Injections

A dupilumab injection is given under the skin (subcutaneously), with dosing depending on your age and weight. For adults and children ages 6 and older, the first dose (loading dose) is given as 2 injections to boost the effects of the medication. After the initial dose, dupilumab is given every 2 to 4 weeks, depending on age and weight.²²

When you or your child are first prescribed dupilumab, your doctor or dermatologist will teach you how to administer it. Dupilumab is available as a pre-filled syringe or a pre-filled pen. Both methods are safe and simple to use, but be sure to ask your doctor any questions you may have before administering them at home.²²

Side Effects of Dupilumab

The most common side effects of dupilumab include:²³

• Redness, swelling, and/or tenderness at the injection site (injection site reaction)
• Cold sores on your lips or in your mouth
• Trouble falling and/or staying asleep
• A high count of eosinophils (eosinophilia), a type of white blood cell
• Inflammation (redness, itching, swelling) of your eyes and eyelids that can cause blurry vision
• Signs of an infection (runny nose, sore throat, fever, cough)
• New or worsening joint pain

In rare cases, dupilumab may cause an allergic reaction. If you experience any of the following side effects, stop taking the medication and call your doctor immediately:²⁴

• Difficulty breathing or wheezing
• Swelling of the throat, face, tongue, mouth, or lips
• Fever
• Itchy skin rash or hives
• Swollen lymph nodes
• Fast pulse
• Stomach cramps
• Nausea or vomiting

Tralokinumab-ldrm (Adbry^TM) for Eczema

IL-13 is another inflammatory protein that is responsible for causing inflammation and skin barrier disruption in eczema. Researchers developed the monoclonal antibody drug tralokinumab-ldrm (Adbry^TM), which binds to the IL-13 receptor on the surface of immune cells to block inflammation.²⁵

In 2021, the FDA approved tralokinumab-ldrm, the second biologic for eczema. It’s prescribed to treat moderate-to-severe atopic dermatitis in adults 18 years and older whose condition hasn’t responded to topical therapies or if they’re not recommended. Your dermatologist may prescribe you tralokinumab-ldrm and a topical corticosteroid together. Clinical trials are also currently studying whether tralokinumab-ldrm is safe to give to children ages 17 and under.²⁵

Dosing and Injections

Like dupilumab, tralokinumab-ldrm is given as a subcutaneous injection with a pre-filled syringe. The initial loading dose is given as 4 injections — afterward, you’ll administer 2 injections at home every other week.²⁶

Atopic dermatitis is a chronic condition, and many people live with it their whole lives. You’ll likely have to use tralokinumab-ldrm for an extended period of time. However, if your skin is almost or completely clear after 4 months of treatment and you weigh less than 220 pounds, your dermatologist may have to lower your dose to just 2 injections every 4 weeks for maintenance.

Side Effects of Tralokinumab-ldrm

The most common side effects reported in clinical trials for tralokinumab-ldrm include:²⁵

• Injection site reaction
• Eosinophilia
• Conjunctivitis or “pink eye” causing redness, itchiness, and swelling of the outer layer of your eye

In rare cases, tralokinumab-ldrm can cause an allergic reaction. Stop taking the medication and call your doctor immediately if you notice any signs of a reaction occurring.

Tips for Administering Injectable Therapies for Eczema

Giving an injection to yourself or your child can feel overwhelming at first. Here are some tips to ensure it goes smoothly:²⁷

• Rotate the injection site each time — the most common are the thighs and stomach (be sure to stay 2 to 3 inches away from the belly button)
• Don’t inject into red, bruised, or tender skin
• Take your pen or syringe out of the fridge at least 30 minutes before use — injecting cold medications can be uncomfortable
• Check the medication before injecting — you don’t want to inject any medication that’s cloudy, discolored, or has crystals/particles floating inside
• Use an ice pack on the injection site a few minutes beforehand to numb the area
• Wash your hands with warm water and soap, then clean the injection site with an alcohol wipe and let it air dry — don’t blow on it after wiping, as this introduces bacteria
• Avoid rubbing your skin after the injection

At-Home Remedies for Eczema

If you find yourself needing extra relief during an eczema flare, you can try an at-home remedy to help. Be sure to keep using the medications prescribed by your dermatologist to manage your condition. Here, we offer tips on how to treat eczema at home with bathing tips to decrease inflammation, redness, itchiness, and dry skin.

Tips for Bathing and Showering with Eczema

Your skin is especially sensitive when living with eczema — the disrupted skin barrier makes it hard for your skin to hold onto moisture, leading to dry skin. Harsh soaps, lotions, cold and windy weather, and dry air can make it even worse. Use your shower and bath time wisely to lock in moisture and prevent your skin from drying out more.²⁸

Here are some tips to follow:

• You may enjoy the hot water, but your skin doesn’t — choose a lukewarm water temperature and limit your time in the bath to 15 minutes maximum
• Shower or bathe at least once a day to remove any dirt, pollen, and irritants from your skin
• Avoid vigorously scrubbing your skin with a loofah or washcloth to prevent irritation
• Try choosing a gentle cleanser over soaps or body washes with harsh chemicals (solvents, alcohol, etc.)
• During more severe eczema flares, use cleansers sparingly

The Soak and Seal Method

To help manage an eczema flare, try the “Soak and Seal” method. After your bath or shower, gently dry your skin, leaving some moisture behind. Your skin should feel damp to the touch. Apply your prescription topical (corticosteroid or immunosuppressant) onto your skin, then apply a generous layer of moisturizer within 3 minutes. Allow the moisturizer to soak into the skin for a few minutes, then apply a wet wrap or dressing.²⁸

A wet wrap is also a great way to add moisture and relieve painful, itchy eczema flares. This method uses damp pieces of fabric or gauze applied over the affected area. After the wet layer is applied, a dry layer is set over it to avoid getting your clothes wet. Many people use plastic wrap as a dry layer to prevent the wrap from losing moisture. Leave the wraps on for several hours (overnight is best).²⁹

Colloidal Oatmeal Bath for Eczema

Oatmeal isn’t just a breakfast food — it’s also been used since ancient Roman times as a soothing skin treatment. Colloidal oatmeal is a specific form of oatmeal that works best for treating skin conditions like atopic dermatitis, dry skin, and chickenpox. It mixes well with water for bathing.

Research shows that colloidal oatmeal forms a protective barrier on the skin, shielding it against irritants. If you’re interested, you can make your own colloidal oatmeal by blending oatmeal into a fine, dry powder. When it’s added to water, it should turn a similar color and consistency of milk. Add 1 cup of powder into lukewarm bath water and soak for 15 minutes.³⁰

Bleach Bath for Eczema

Incredibly, a very dilute bleach bath can actually help treat an eczema flare. Bleach kills bacteria that live on your skin — these bacteria increase inflammation and your risk of infection. When done properly, a bleach bath can provide relief. The American Academy of Dermatology (AAD) recommends this method for anyone with moderate-to-severe eczema.³¹

It’s important to follow your dermatologist’s instructions on how to safely take a bleach bath. Be sure to use only 6 percent (regular-strength) bleach diluted in water. Measure the appropriate amount, then add it to your lukewarm bath as it’s running. Don’t get into the tub until it’s filled to avoid irritating your skin. Soak for 5 to 10 minutes, then rinse off with water and towel-dry your skin.

The Future of Eczema Treatments

As doctors and researchers learn more about eczema and the role that the immune system plays, they continue to develop new treatments. Many of them are currently being investigated in large studies known as clinical trials to ensure they’re safe and effective.