Let's Talk About Eczema Treatment
There may not be a cure (yet), but there are many effective ways to manage symptoms—so that you can get right back to doing regularly scheduled life.by Jennifer Tzeses Health Writer
You know that friend who sends back his order every. single. time. you go to dinner? Well, eczema is just as finicky. In the same way one symptom doesn’t fit all, eczema is not a one-treatment-fits-all condition either—so figuring out the best course for you can take some patience and persistence (Rome wasn’t built in a day, right?). Learn more about your options, here.
Our Pro Panel
We went to some of the nation's top experts in eczema to bring you the most up-to-date information about treatments possible.
Mary L. Stevenson, M.D.
Assistant Professor of Dermatology
Ronald O. Perelman Department of Dermatology at NYU Langone Medical Center
New York City
Alina G. Bridges, D.O.
Associate Professor of Dermatology and Laboratory Medicine and Pathology
John Anthony, M.D.
Sounds crazy, but adding bleach to bath water may decrease the number of bacteria on your skin, reducing your risk of skin infection and minimizing inflammation that can worsen eczema. Use a half cup of household bleach for a full tub of water—the equivalent to what you find in a swimming pool (do not swallow the water). Soak for 10 minutes, rinse off and apply moisturizer. Caution: If you have asthma, check with your doctor first, since fumes can worsen symptoms.
First, don’t panic: There is, in fact, a quick fix. Your doctor can prescribe an oral corticosteroid like prednisone, which can relieve symptoms like itching, redness, and rash within hours or days. However, these aren’t medications that can be used long term. They come with the risk of some serious side effects like high blood pressure, weight gain, cataracts, or glaucoma. They’re often prescribed for short periods of time and followed with a longer-term immunosuppressant to keep symptoms in check.
Because the itch that’s associated with eczema is not triggered by histamines (chemicals your immune system produces to get rid of allergens), antihistamines won’t reduce the itch, according to the American Academy of Allergy, Asthma & Immunology. However, some of them, such Benedryl (diphenhydramine), will increase your drowsiness so your scratching is less likely to keep you up at night.
Wet wrap therapy helps ease itching and irritation by keeping the skin moist, allowing topical medications penetrate better. Take a clean cotton cloth, soaked in warm water, and place it on your skin after showering and applying topical medication. Place a dry layer over the wet one and leave it for several hours. Wraps should be removed when they start to dry out. If you need to wrap your hands or feet, you can use cotton gloves or socks for the wet layer with vinyl gloves or food-grade plastic wrap as the dry layer.
A Quick Eczema Recap
Known as the itch you shouldn’t scratch or the itch that rashes, eczema is probably one of the most frustrating skin conditions out there for the over 30 million people in the U.S. who have it. That’s because it never goes away completely.
The often red, itchy, inflamed patches that come courtesy of this condition can vary—in appearance and location depending on your age—or really, just because they feel like it (what can we say, it’s shady like that). But don’t worry, there are many effective ways to calm things down and head off symptoms before they strike. From bathing and moisturizing to medicated topicals and light therapy, here is your guide to all the eczema care that’s out there.
Self-Care for Eczema
While (hopefully) you’re already taking time for some regular TLC, this kind of self-care is even more important when you have eczema because it can have therapeutic benefits—including easing the itch, irritation, and inflammation that come with the condition. And, for mild eczema, it could be enough to help keep symptoms under control.
Soaking your worries away once a day can not only do wonders for your mind, but also for your eczema (showers are fine, too, if baths aren’t your thing). But there’s a right way to do it.
Use lukewarm (read: not hot!) water and keep your bath short—five to 10 minutes—so you don’t end up drying out your skin instead.
Make sure you’re using a gentle cleanser like Cetaphil (no surfactant-pumped soaps, please) that’s applied with your fingers rather than a harsh washcloth (scrubbing is the enemy).
Once you step out, pat skin lightly with a towel.
Sure, a basic bath is fine, however, you could make it extra by adding a few ingredients to the water, which have been shown to alleviate eczema symptoms. These include:
Baking soda: A quarter-cup can help relieve itching.
Colloidal oatmeal: According to research, this kind of oatmeal that is ground into a fine powder tends to alleviate symptoms like itching. Grind it up yourself in a blender (if you’re good like that) and add a cupful to your water, or just buy a product that contains it, like Aveeno Soothing Bath Treatment.
Salt: We know this sounds all kinds of crazy (pouring salt on a wound?), but if a bath or shower causes your skin to sting, you can add a cup of table salt to the water to help reduce discomfort. Just make sure you don’t have any open lesions or it could sting even more.
Apple cider vinegar: To help kill bacteria on your skin that could cause an infection, add one cup to one pint of vinegar to your bath water but again, only if you don’t have any open wounds.
Repeat after us: The drier your skin, the more it will itch. Period.
Making sure your skin stays moist and hydrated is key to feeling comfortable, well, in your own skin. According to studies, routinely using a moisturizer can reduce symptoms of eczema.
The best types to use are ointment and cream formulas because they contain a higher concentration of oil and low to no water content. As a rule of thumb, the heavier the formula, the better it will be for your skin.
And in terms of ranking, ointments (known as occlusives) such as petroleum jelly and mineral oil have the highest content of oil and help maintain water content in the skin by creating a barrier that blocks water loss.
These are followed by creams (known as emollients in the scientific world), which help enhance skin hydration, smoothness, softness, and flexibility. A little shopping trick: Look at the ingredients on the back of your moisturizer, if water is the first ingredient listed, try something else.
While you can never moisturize too much if you have eczema, realistically, who’s got time to slather the day away? Doing so twice daily—in the morning and before bed—is a good way to get into a regular skin care routine. Look for products that are labeled “hypoallergenic” and “for sensitive skin.”
Gentle, fragrance-free formulas are your friend; the last thing you want to do is exacerbate the problem with a fancy perfumed lotion. The most effective time to apply a moisturizer is right after a shower or bath (within three minutes is recommended). This is because when skin is still moist (and therefore more permeable than when dry, thanks to warm water, which opens pores), the moisturizer will penetrate more effectively and get locked and loaded in your skin.
As you’re scoping the drugstore aisles, keep your eye out for moisturizers that contain the following ingredients, which have been proven to help alleviate symptoms:
Ceramides: These are lipids (fatty acids), found in the skin’s barrier, that aid in moisture retention. People with eczema lack certain fatty acids that help keep skin moisturized, and ceramides can help replace them.
Urea: A natural humectant produced by the skin, urea draws water into the skin to provide hydration and acts as an exfoliant by sloughing off the top layer of dead skin cells to reveal new, healthy skin underneath. It’s also been shown to help hold moisture, improve dryness, and reduce flareups.
Glycerol: A liquid that comes from plants, glycerol works like a sponge to soak up water from deep within your skin or the air and funnel it to your outer layers.
Colloidal oats: Colloidal oat extracts have been shown to have antioxidant and anti-inflammatory properties, which can help improve skin dryness, scaling, roughness, and itch intensity.
Hyaluronic acid: A naturally occurring substance in the skin, it retains water and helps skin stay plump and hydrated. As we age, hyaluronic acid decreases, so using a product rich in HA is important because it draws in and holds onto water, keeping skin better moisturized throughout the day.
Glycyrrhetinic acid: In one study, this natural anti-inflammatory agent derived from licorice root was found to be four times more effective than a placebo moisturizer for improving eczema.
If your regular skin care routine just isn’t cutting it and your eczema symptoms are on fire, talk to your doctor about medicated solutions to put out those flames. There are a variety of OTC and prescription topical steroid options that can ease the itch and alleviate flares. Here’s the 411 on what’s available:
Classified as low-to-moderate potency, these OTC anti-inflammatory medications such as Cortisone 10 (hydrocortisone) and Cort-Aid (hydrocortisone acetate) found in cream and ointment forms, can be very effective in relieving some symptoms like itching, swelling, and redness that accompany eczema.
Typically applied once or twice a day for two to four weeks, they can be used on areas where the skin is sensitive and thin, including the face, neck, back of the knees, insides of the elbows, groin and genital areas, and armpits.
If your eczema is more intense—on multiple parts of your body, very itchy, and affecting your daily life—your doctor may prescribe stronger, prescription-strength steroid creams such as fluocinolone 0.025%, triamcinolone 0.1%, betamethasone, or dipropionate 0.05%.
While these often work fast and are effective for relieve itching, redness, and soreness, they aren’t recommended for use for longer than two weeks because they can cause potential side effects such as skin thinning, stretch marks, and skin darkening, which is also why they shouldn’t be used on the face. They can be applied to many areas of the body, but are more effective than over the counter strengths in areas where skin is thicker, such as the palms of the hands and the soles of the feet.
For those with eczema that’s not responding to traditional treatments, topical calcineurin inhibitors may be prescribed.
These drugs work by preventing the part of your immune system that causes eczema symptoms, such as redness and itching, from switching on.
Doctors recommend this type of medication for sensitive areas such as the eyelids, face, underarms, or groin.
These nonsteroidal medications are applied to the affected skin areas twice daily to help reduce inflammation, improve itch, and combat dryness.
There are two topical medications currently available: Elidel (pimecrolimus), approved for the treatment of mild-to-moderate eczema and Protopic (tacrolimus), approved for moderate-to-severe eczema.
According to research, TCIs are safe for long-term use because they don’t carry the same risks for side effects as topical corticosteroids. The most common side effect reported is a temporary stinging or burning sensation that generally improves after a few days of use.
Topical PDE4 Inhibitors
A newer topical nonsteroidal medication, Eucrisa (crisaborole), was approved by the U.S. Food and Drug Administration in 2016 for mild-to-moderate eczema.
It works by blocking an enzyme called phosphodiesterase 4 (PDE4). PDE4 is produced by your immune system and controls proteins that can trigger the inflammation that leads to eczema.
One study found that nearly one-third of people who used it for a month showed almost twice as many improvements in symptoms as those who used a placebo. It comes as a 2% topical ointment that’s applied twice a day. Side effects are mild (only some minor skin irritation has been reported) and it can be used anywhere on the body.
Oral and Injectable Medications
When all else fails and eczema is unresponsive to topical treatments, oral immunosuppressant medications, such as cyclosporin, azathioprine, and methotrexate may be prescribed. These block the body’s immune system from sending an inflammatory response to the skin, which results in less itching, redness, and rash.
Azathioprine and cyclosporine are traditionally used in transplant patients to prevent their bodies from rejecting a new organ, while methotrexate is a chemotherapy drug that’s also used for autoimmune diseases like rheumatoid arthritis. These medications are considered “off-label,” which means that they’re not approved by the FDA to specifically treat eczema.
They also carry potentially serious side effects like high blood pressure and kidney damage, and they make you more vulnerable to infection. As a result, most dermatologists do not like to prescribe for prolonged periods of time. They are available in varying strengths and are typically taken once or twice daily.
In one study, dupilumab was shown to improve the signs and symptoms of atopic dermatitis, including itching. It’s considered a biologic drug, which means it’s made from proteins derived from living cells or tissues. It works by preventing two proteins that trigger eczema from binding to cell receptors, which stops the immune system from causing an inflammatory reaction.
Although effective, dupilumab is incredibly expensive ($37,000 a year without insurance!), involves giving yourself a shot every other week, and can cause side effects like redness around the shot site and, more rarely, pink eye and cold sores.
Sometimes, a little light can go a long way in treating people who have severe eczema. Phototherapy utilizes narrowband ultraviolet B (UVB) light from special lamps to target and suppress overactive immune system cells on the skin, which can cause eczema to flare.
This helps minimize itching and inflammation and bolsters bacteria-fighting systems. It’s typically administered (in a doctor’s office) with the patient standing upright in a booth-like enclosure, for precisely selected intervals, over the course of weeks to months. It also has the advantage of being able to treat large areas of the body at once with minimal side effects. While generally safe in the short term, long-term use can cause premature aging of the skin and a predisposition to certain skin cancers later in life.
We know how itchy eczema can be and how raw it can make your skin feel, but with so many great treatments now available, you’re likely to find at least one option that can make you feel better.
Hydration Help: Cochrane Database. (n.d.) “Emollients and Moisturizers for Eczema.” cochrane.org/CD012119/SKIN_emollients-and-moisturisers-eczema
Treating Atopic Dermatitis: Journal of the American Academy of Dermatology. (2014). “Guidelines of care for the management of atopic dermatitis.” jaad.org/article/S0190-9622(14)01887-8/fulltext
The Benefits of Moisturizer: Clinical Medicine and Research. (2017). “The Role of Moisturizers in Addressing Various Kinds of Dermatitis.” ncbi.nlm.nih.gov/pmc/articles/PMC5849435/
Topical Eczema Treatments: Informed Health Online. (2017). “Eczema: Steroids and Topical Medications.” ncbi.nlm.nih.gov/books/NBK424899/
Atopic Dermatitis A to Z: UptoDate. (2019).“Treatment of Atopic Dermatitis (Eczema).” uptodate.com/contents/treatment-of-atopic-dermatitis-eczema
The Wonders of Wet Wrap Therapy: National Jewish Health. “Wet Wrap Therapy.” nationaljewish.org/conditions/eczema-atopic-dermatitis/eczema-treatment/wet-wrap-therapy
Managing and Treating Eczema: Cleveland Clinic. “Eczema Management and Treatment.” my.clevelandclinic.org/health/diseases/9998-eczema/management-and-treatment
Benefits of Moisturizing for Managing Eczema: National Eczema Association. “Controlling Eczema by Moisturizing.” nationaleczema.org/eczema/treatment/moisturizing/
Benefits of a Bleach Bath: Mayo Clinic. “Eczema bleach bath: Can it improve my symptoms?” mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/expert-answers/eczema-bleach-bath/faq-20058413
Bath Time Basics: National Eczema Association. “Eczema and Bathing.” nationaleczema.org/eczema/treatment/bathing/
Colloidal Oatmeal Effectiveness: Journal of Drugs in Dermatology. (2015). “Anti-inflammatory activities of colloidal oatmeal contribute to the effectiveness of oats in treatment of itch associated with dry, irritated skin.“ ncbi.nlm.nih.gov/pubmed/25607907