Effective Eczema Treatment: Topical and Oral Options

Eczema is a long-term condition where an overactive immune response causes skin inflammation (swelling) and irritation.

Eczema leads to dry, itchy patches of skin that may ooze and become thicker over time. The patches usually look red or discolored. They may flare up and get better in cycles.

There’s no cure for eczema yet, but treatment options, such as home remedies, over-the-counter treatments, and topical or oral medications, can help relieve symptoms.

If you have mild eczema, an over-the-counter (OTC) treatment may help relieve your symptoms. OTC treatments for eczema include:

• Antihistamines: Certain types of eczema, like contact dermatitis, may flare up during an allergic reaction. Antihistamines help control allergic reactions. They can also make you sleepy, which may help if itching keeps you awake at night. Common OTC antihistamines include Benadryl (diphenhydramine), Zyrtec (cetirizine), and Claritin (loratadine).
• Pain relievers: Pain-relief medications can help reduce pain, burning, and inflammation. Common OTC pain relievers include Tylenol (acetaminophen), Advil (ibuprofen), and Aleve (naproxen).
• Hydrocortisone cream: These creams contain a low dose of corticosteroids, which can help reduce inflammation and itching. It’s important to use this cream only for as long as your healthcare provider recommends.
• Calamine lotion: This topical treatment contains zinc oxide, which can soothe irritated or itchy skin.
• Medicated shampoo: Shampoos that contain medical-grade coal tar can help reduce eczema symptoms on your scalp. These symptoms often result from a type of eczema called seborrheic dermatitis.

All medications carry possible risks and can interact with other drugs. Talk to your healthcare provider about the potential risks of using OTC medications for eczema.

Applying a topical medication to your skin can help relieve your symptoms, lock in moisture, and keep out germs that could lead to infection. Many topical medications are available by prescription.

Corticosteroids

These topical medications are a go-to treatment for an eczema flare-up. Steroids reduce inflammation by lowering your body’s immune response. Prescription steroids may come as ointments, creams, or oils. Your provider may prescribe one for you based on how severe your symptoms are and where they occur on your body.

Topical corticosteroids come in different potencies (strengths). The United States Food and Drug Administration (FDA) has approved many topical steroids to treat eczema, including:

• Low potency: Aclovate (alclometasone dipropionate)
• Medium potency: Sernivo (betamethasone dipropionate)
• High potency: Topicort (desoximetasone)
• Super-high potency: Diprolene (betamethasone dipropionate, augmented)

Steroid creams may cause skin thinning and spider veins (visible blood vessels under the skin). This risk may be higher if you use them on your face. To reduce the risk of side effects, it’s important to use topical steroids exactly as your provider prescribes them.

Calcineurin Inhibitors

Calcineurin inhibitors also reduce inflammation and lower immune responses. They may be a good option for mild to moderate eczema because they don’t have the same side effects as steroids. However, researchers are looking into whether they increase the risk of lymphoma, a type of cancer.

Calcineurin inhibitors approved to treat eczema include Protopic (tacrolimus) and Elidel (pimecrolimus).

Phosphodiesterase 4 (PDE4) Inhibitors

Topical PDE4 inhibitors also block the immune response to decrease inflammation and irritation. They may be a gentler option for people with sensitive skin or who prefer not to use steroids.

Two topical PDE4 inhibitors are FDA-approved to treat eczema: Eucrisa (crisaborole) and Zoryve (roflumilast).

JAK Inhibitors

Janus kinase (JAK) inhibitors help reduce inflammation, itch, and redness by blocking cytokines (chemical messengers) from telling the immune system to react. Your provider may prescribe a JAK inhibitor cream if other topicals have not controlled your symptoms.

The FDA has approved one topical JAK inhibitor to treat eczema: Opzelura (ruxolitinib).

Aryl Hydrocarbon Receptor (AHR) Agonists

Like other prescription topical drugs, AHR agonists calm the immune system. They work by activating aryl hydrocarbon receptors (AHRs), proteins that regulate genes that control the production of immune cells. Research suggests this medication can help reduce inflammation and itch and improve the skin barrier.

AHR agonists may be a good alternative to steroids because you can use them long-term and on thinner skin, like the skin around your eyes. The FDA has approved Vtama (tapinarof) to treat atopic dermatitis (the most common type of eczema) in adults and children over age 2.

If topical treatments don’t help your eczema symptoms, your provider may prescribe an oral medication. These treatments are systemic (working throughout your body) and help change or suppress your immune system response. 

Immunosuppressants and Immunomodulators

Oral corticosteroids such as Deltasone (prednisone) are a common immunosuppressant treatment (treatment that decreases the immune response) for eczema flares. They may help calm inflammation very quickly. However, their long-term use can lead to health effects like weight gain and osteoporosis.

Healthcare providers may also prescribe other systemic immunomodulators (drugs that change your immune response) off-label for eczema flares. “Off-label” means the FDA has not approved these drugs specifically to treat eczema, but providers may use them for that reason. Providers may commonly prescribe:

• Deltasone (prednisone)
• Neoral (cyclosporine)
• Trexall (methotrexate)
• CellCept (Mycophenolate mofetil)
• Imuran (azathioprine)

Because both steroids and these other systemic drugs can cause serious health problems if used over a long period, your provider will likely recommend switching to topical treatments as soon as your symptoms are under control.

JAK Inhibitors

JAK inhibitors are another oral treatment for eczema. Like topical JAK inhibitors, these systemic drugs block chemical messengers from causing inflammation. Providers typically prescribe them if other treatments haven’t worked, and they may prescribe them only for short periods.

Commonly prescribed oral JAK inhibitors include:

• Rinvoq (upadacitinib)
• Cibinqo (abrocitinib) 
• Olumiant (baricitinib)

Biologic drugs are made from living components to target the immune system. You or a healthcare provider may administer these medications subcutaneously (under the skin) or intravenously (into a vein). They are generally safe and effective for long-term use.

If you have moderate to severe eczema that topical treatments don’t help control, your provider may prescribe a biologic drug such as:

• Dupixent (dupilumab)
• Adbry (tralokinumab)

During phototherapy, a healthcare provider shines different types of ultraviolet (UV) light on your skin, which can help reduce inflammation and itching. This treatment usually requires going to a treatment center a few times per week. Sometimes, you may be able to give phototherapy to yourself at home.

Types of phototherapy for eczema include:

• Narrowband UVB (NB-UVB)
• Ultraviolet A1 (UVA1)
• Psoralen plus UVA (PUVA)

You can take steps at home to help relieve eczema. These involve skin care, avoiding triggers, and changing your diet.

Skin Care and Moisturizing

In general, keeping your skin moisturized is key for at-home treatment of eczema. Consider these strategies:

• Take no more than one shower or bath per day. Try to keep them under 10 minutes.
• Use lukewarm water and gentle soaps when you bathe.
• Apply an emollient (thick cream or ointment) right after you get out of the shower or bath.
• Apply emollients to the affected area at least twice per day.

Avoid Triggers

You might tend to have eczema flares in response to certain triggers, like stress or harsh soaps. Staying away from known triggers is important. Your eczema triggers may differ, but ways to avoid common eczema triggers include:

• Avoid allergens, harsh soaps, fragrances, tobacco smoke, and other triggers.
• Be gentle with your skin. Don’t scratch, scrub, or rub.
• Wear breathable, soft clothing made from natural fibers.
• Keep your home at a comfortable temperature, and use a humidifier if necessary.
• Use sunscreen when out in the sun.
• Manage your stress levels.

Adjust Your Diet

Making certain dietary changes may improve your eczema symptoms. Research on diet and eczema is mixed, but helpful tips may include:

• Avoid foods you’re allergic to.
• Follow an anti-inflammatory diet.
• Avoid less-nutritious foods and eat plenty of fruits, vegetables, and whole grains.
• Add more omega-3 fish oil and vitamin D to your diet.
• Eat more foods with probiotics (such as yogurt and fermented foods) and prebiotics (such as onions and garlic).
• Limit alcohol.

Several treatments may help reduce eczema symptoms and help resolve flares. If topical treatments don’t relieve your symptoms, your healthcare provider may prescribe a systemic (oral or injectable) medication until a flare passes.

Keeping your skin hydrated, avoiding possible triggers, and being mindful of your diet may also help keep eczema under control. Always talk to your healthcare provider before starting a new medication or changing your diet.