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Eczema refers to both a family of skin conditions and a specific disorder within this family called atopic dermatitis (AD). Other members of the eczema family include contact dermatitis, dyshidrotic eczema, neurodermatitis, nummular eczema, and stasis dermatitis.
Atopic dermatitis is the most common type of eczema. According to the American Academy of Dermatology, atopic dermatitis occurs most often in children, with 90% of cases occurring before age five (AAD, n.d.). Common symptoms include dry, scaly, and itchy patches of skin. These are found most often on the cheeks, scalp, forehead, and other parts of the face. Adults can also develop atopic dermatitis, with up to 25% of adult cases thought to be new-onset AD. However, approximately 50% of children with AD have continued symptoms as adults (Lee, 2019).
If you have a rash that is concerning, talk to your healthcare provider. Other types of skin conditions, like as psoriasis and contact dermatitis (e.g., poison ivy), can look like atopic dermatitis. Your healthcare provider should make the diagnosis of eczema.
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Eczema treatment options
Unfortunately, there is no cure for eczema. However, there are treatments that can help eczema symptoms, decrease flare-ups, and improve quality of life. While many people with eczema may share common symptoms, the skin condition affects each person differently. Treatment focuses on improving the eczema symptoms, and therapy may vary for each person. Talk to your healthcare provider to determine which treatment plan is appropriate for your eczema.
One thing you will want to do is identify eczema triggers so that you can avoid them and hopefully prevent flare-ups. While triggers vary from person to person, common ones include (AAAI, n.d.):
- Skin irritants (dyes, perfumes, chemicals, soaps, etc.)
- Clothes (tight-fitting clothing, fabrics like wool or synthetic fibers)
- Sweat (avoid exercising for too long or in excessively hot environments)
- Dust mites
- Food allergies
In addition to avoiding triggers, treatment options include lifestyle changes, over-the-counter (OTC) remedies, prescription medications (topical, immunosuppressants, and biologic drugs), and phototherapy (NEA, n.d.).
Regardless of the severity of your eczema, there are specific lifestyle changes that you can incorporate in your skincare routines to help your skin be as healthy as possible. An easy one is to make sure to keep your fingernails short so that you minimize skin damage from scratching. Others include:
- Bathing: You should avoid long, hot showers or baths as the hot water can be irritating to your skin. Use lukewarm warm water and soak (or shower) for no longer than 10–15 minutes. Your provider may recommend that you add bleach, vinegar, salt, oatmeal, or baking soda to your bathwater, depending on your symptoms. Don’t scrub your skin and make sure you are using a gentle cleanser (not soap). Make sure to apply moisturizer within three minutes after bathing (NEA, n.d.).
- Moisturizing: If your skin gets too dry, your eczema can flare up. Unfortunately, people with eczema can have dry skin due to problems in the skin barrier (stratum corneum). This part of the skin keeps irritants out and moisture in, and when it does not work well, you have itchy dry skin. You can prevent this by moisturizing regularly and frequently, every time your skin comes into contact with water. Moisturizes do not have medications in them. They should be fragrance- and dye-free and have a high oil content, like ointments (petroleum jelly or mineral oil) or creams. The best time to moisturize is when your skin is slightly damp. Be sure to apply any topical medications before you use the moisturizer (NEA, n.d.).
- Wet wrap therapy: Your provider may recommend the use of wet wrap therapy, especially if you have severe eczema. After soaking in warm water and gently patting skin dry, apply topical medications (typically, steroids or other anti-inflammatory drugs) on the skin rash. Then, wrap a damp gauze or cotton clothing around the affected areas. Lastly, wear dry clothing over the top and keep in place for several hours or overnight (AAAAI, n.d.).
- Stress reduction techniques: Decreasing stress with massage, meditation, yoga, and other techniques may help with eczema symptoms.
What is eczema? The causes, symptoms, and treatments explained
Over-the-counter (OTC) medications
Low-dose topical corticosteroids (also called topical steroids or steroid creams), like hydrocortisone, are available over-the-counter and can help keep your eczema symptoms at bay. Depending on your symptoms, you might need to use these daily or weekly (Boguniewicz, 2018). Be sure to check with your provider because using topical corticosteroids too much can lead to skin thinning. Stronger topical steroids are only available by prescription. OTC oral antihistamines (allergy medications) like cetirizine (brand name Zyrtec), fexofenadine (brand name Allegra), and diphenhydramine (brand name Benadryl) may help some people control their itching symptoms. Antihistamines can cause drowsiness, so people often take them at night, especially if they have nighttime itching.
Sometimes lifestyle changes and over-the-counter medications are not enough, and you need prescription medicines. These can be topical (applied to the skin), oral (by mouth), or injectable. It is important to use these medicines as directed, as misuse can lead to serious side effects.
- Topical steroids: Topical steroids are some of the most commonly prescribed medications for eczema because they can decrease inflammation and reduce redness and itching. Prescription topical steroids are stronger than the ones available over the counter and may work better for your rash. However, they have a higher risk of side effects like skin thinning (NEA, n.d.).
- Topical calcineurin inhibitors: Topical calcineurin inhibitors are non-steroidal anti-inflammatory medications that help with both flare-ups and longer-lasting maintenance to prevent new rashes (Boguniewicz, 2018). Both tacrolimus (brand name Protopic) and pimecrolimus (brand name Elidel) are available by prescription. They do not cause thinning, but in the past, people thought these drugs might be linked to lymphoma (a type of cancer). However, studies do not actually support a link between these medications and cancer, and they are safe to use under the direction of your provider (Boguniewicz, 2018). You may experience some stinging or burning when you start using them.
- Topical PDE4 inhibitor: Topical phosphodiesterase 4 (PDE4) inhibitors are another class of non-steroid anti-inflammatory drugs. There is currently only one topical PDE4 inhibitory approved by the FDA for the treatment of atopic dermatitis: crisaborole (brand name Eucrisa). Crisaborole is effective in treating the red, itchy skin of a flare-up. It has not been studied with regard to its ability to prevent future skin rashes (Boguniewicz, 2018).
- Topical or oral antibiotics: Some people with eczema develop a skin infection of their raw, irritated skin. If this is the case, your provider may recommend an oral or topical antibiotic medication to fight off the infection.
- Oral or injectable steroids: Oral or injectable steroids are sometimes used for the short-term treatment of severe episodes of eczema that do not improve with other therapies (Sidbury, 2014). In general, you should not be using these medications to treat AD for more than 2–3 weeks (Boguniewicz, 2018). Talk to your provider about other treatment options and make sure that you do not stop steroids abruptly and without the guidance of your healthcare provider, as this can lead to other medical problems.
- Immunosuppressants: Immunosuppressants are medications that dampen your immune system response to try to keep your eczema symptoms under control. These are potent medications and are often reserved for people who have failed other treatment options. They are not FDA-approved for the treatment of atopic dermatitis, so their use is considered “off-label.” These drugs were initially approved as chemotherapy medications or for use after an organ transplant (Boguniewicz, 2018). Examples include cyclosporine A, methotrexate, mycophenolate, mofetil, and azathioprine.
- Biologics: One biologic drug has recently been FDA-approved to treat atopic dermatitis: dupilumab (brand name Dupixent). Dupilumab works by stopping interleukins (chemicals key to the inflammation process) from working, thereby decreasing the redness, itching, and inflammation of eczema (Boguniewicz, 2018). This drug is an injection you can give yourself every two weeks and may be an option for long-term control of hard-to-treat eczema.
Is eczema contagious? What you need to know
Phototherapy (or light therapy) can help with not only atopic dermatitis but all types of eczema. In phototherapy, a specialized machine emits ultraviolet light type B (UVB) rays, a part of natural sunlight, onto your skin. Treatment with phototherapy typically involves 2–6 sessions per week for 1–3 months; however, they can vary depending on your response to treatment. Some people will need continued treatment 1–2 times a week to prevent flare-ups (NEA, n.d.). Others may be able to stop treatment for a time. These UVB rays can calm itching as well as decrease inflammation, thicken the skin barrier, and reduce the number of bacteria on the skin (Boguniewicz, 2018). According to the National Eczema Association, approximately 70% of people with eczema get better with phototherapy (NEA, n.d.). For some, phototherapy keeps their eczema “quiet” even after the end of the treatment (NEA, n.d.).
Even though there is no cure for eczema, many treatments are available to help you maintain a good quality of life. Talk to your healthcare provider about your treatment options. You may benefit from a combination of lifestyle, over-the-counter, and prescription therapies.
- American Academy of Allergy Asthma and Immunology (AAAAI). (n.d.). Eczema (Atopic Dermatitis). Retrieved Feb. 20, 2020 from https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/eczema-(atopic-dermatitis)-overview
- American Academy of Dermatology Association (AAD). (n.d.). Childhood Eczema. Retrieved Feb. 20, 2020 from https://www.aad.org/public/diseases/eczema/childhood
- Boguniewicz, M., Fonacier, L., Guttman-Yassky, E., Ong, P., Silverberg, J., & Farrar, J. (2018). Atopic dermatitis yardstick: Practical recommendations for an evolving therapeutic landscape. Annals Of Allergy, Asthma & Immunology, 120(1), 10-22.e2. doi: 10.1016/j.anai.2017.10.039. Retrieved from https://www.annallergy.org/article/S1081-1206(17)31260-7/fulltext
- Lee H. H., Patel, K. R., Singam, V., Rastogi, S., Silverberg, J. I. (2019). A systematic review and meta-analysis of the prevalence and phenotype of adult-onset atopic dermatitis. Journal of the American Academy of Dermatology, 80(6):1526-1532.e7. doi: 10.1016/j.jaad.2018.05.1241. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29864464/
- National Eczema Association (NEA). (n.d.). Eczema treatment. Retrieved Feb. 20, 2020 from https://nationaleczema.org/eczema/treatment/
- Sidbury, R., Davis, D., Cohen, D., Cordoro, K., Berger, T., Bergman, J., Chamlin, S. L., Cooper, K. D., Feldman, S. R., Hanifin, J. M., Krol, A., Margolis, D. J., Paller, A. S., Schwarzenberger, K., Silverman, R. A., Simpson, E. L., Tom, W. L., Williams, H. C., Elmets, C. A., … Eichenfield, L. F. (2014). Guidelines of care for the management of atopic dermatitis. Journal Of The American Academy Of Dermatology, 71(2), 327-349. doi: 10.1016/j.jaad.2014.03.030. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24813298
Dr. Mike is a licensed physician and the Director, Medical Content & Education at Ro.