Eczema treatment is the same for all patients, regardless of skin color. There is no cure for eczema but there are medications that can help relieve symptoms. An allergist’s specialized training can help patients to develop an eczema treatment plan. The goal is to enable patients to lead a life that is as normal and symptom-free as possible.
Eczema treatment starts with over-the-counter or prescription topical skin moisturizers and over-the-counter or prescription anti-inflammatory creams and ointments. These help protect the outer layer of the skin by sealing in moisture, combating dryness, keeping out allergens, irritants and bacteria and preventing flare-ups. They help soothe the skin for long-lasting hydration.
Doctors typically recommend applying a moisturizer at least twice a day, including once after a bath or shower. Patients are encouraged to develop a schedule so that moisturizing becomes part of a daily skincare routine.
For children with severe eczema, allergists may advise using the “soak and seal” treatment. Soak and seal can provide relief from the itching that comes with eczema. Here’s how it works:
- Bathe in lukewarm water at least once a day. (Doctors recommend short baths for eczema.)
- Use an unscented, dye- and fragrance-free cleaner for the skin. No soap.
- After bathing, gently pat the skin dry.
- Immediately apply moisturizer to “seal” in moisture.
Mild cases of eczema can also be treated with ointments such as petroleum jelly. These should be applied daily, even when the skin appears clear, to help prevent dryness.
In cases of moderate or severe eczema, an allergist may prescribe topical anti-inflammatory corticosteroids or calcineurin inhibitors. These medications are designed to reduce skin inflammation, relieve itch, combat dryness and prevent flares from reoccurring.
In 2016, the U.S. Food and Drug Administration (FDA) approved a new topical treatment for eczema: a PDE4 inhibitor called crisaborole. It’s approved for children 3 months of age and older and adults with mild to moderate eczema. Crisabarole targets the PDE4 enzymes deep within the skin to reduce swelling and inflammation. It’s well-tolerated with long-term use.
A special consideration for people of color is to avoid the overuse of high potency topical corticosteroids. These medications can cause hypopigmentation or lightening of the skin. Consider using topical calcineurin inhibitors instead.
If eczema is still difficult to control after topical treatments, then the next step may be an FDA-approved biologic medication called dupilumab. It’s indicated to treat serious, uncontrolled cases of eczema in patients 6 years of age and older.
Dupilumab is a twice-monthly injection under the skin. Patients can get the injection at the doctor’s office or take it at home. It can be used with or without topical corticosteroids.
Other Therapies
- Wet Wrap Therapy: Doctors recommend wet wrap therapy as an intervention for moderate-to-severe eczema. Here’s how it works: After the “soak-and-seal” bath and application of topical moisturizers or creams, wrap the patient’s eczema-damaged skin in wet cloth. Then top it with dry clothes such as pajamas, sweatshirt or tube socks. This therapy can help keep the skin hydrated, relieve inflammation and itching, protect the skin to allow healing and reduce the need for medication.
- Bleach Baths: Some doctors suggest putting a half-cup of household bleach or a cup of vinegar into the bath water. If properly diluted and used as directed, the bleach and vinegar can help kill bacteria and prevent infection. It’s most effective when combined with moisturizers and medications.
- Light Therapy: Also called phototherapy, light therapy is an in-office procedure that involves exposing eczema-damaged skin to ultraviolet (UV) light. It’s designed to reduce inflammation, lessen itch and boost the body’s bacteria-fighting ability in hard-to-control eczema. Light therapy may cause hyperpigmentation (darkening of the skin) in some people of color, so it’s important for doctors and patients to fully discuss benefits and side effects of this treatment.
Tried-and-True Eczema Management Tips
- Avoid wearing materials such as wool, which could irritate the skin.
- Moisturize skin at least twice a day.
- Take a warm bath daily. Some doctors suggest adding bath oil, salt, baking soda or uncooked oatmeal to help ease persistent itching.
- Use soap-free and detergent-free cleansers.
- Use a humidifier to add moisture to indoor air.
- Drink water often – hydration helps the skin.
- Wear gloves in cold weather to protect the skin.
- Cover itchy areas with bandages to avoid scratching them.
- If you must scratch, try pressing on the itchy area or stroking it using the top side of the hand instead of fingernails.
- Wear loose-fitting clothes that don’t rub against the skin.
© 2021 Allergy and Asthma Network
Last updated : 9/15/2021