What Over-the-Counter Treatments Are There For Atopic Dermatitis?

Over-the-counter (OTC) medications are those available for purchase without needing a prescription. There are several OTC topical corticosteroids that people with atopic dermatitis or other forms of eczema may use to relieve their symptoms, including itching, redness, and rash.

What are topical corticosteroids?

Topical corticosteroids are recommended as a treatment for atopic dermatitis flares. Corticosteroids are available in a range of potency, with more potent medications being available only by prescription. The topical corticosteroids that are available over-the-counter are milder. Topical corticosteroids that are available OTC range from 0.5 percent to 1.0 percent hydrocortisone. However, using OTC medications still has some risks. All medications, including those available OTC, may interact with other drugs, supplements, or foods. It is important to tell your doctor about any and all medications you are using.1,2

Corticosteroids for eczema

Corticosteroids, also called steroids, are similar to substances that naturally occur in the body. They are different than the steroid compounds that some athletes abuse. Corticosteroids decrease inflammation and reduce the activity of the immune system. In atopic dermatitis and other forms of eczema, the immune system responds abnormally, causing an abundance of chemicals that cause inflammation, redness, and swelling. Corticosteroids reduce the production of the chemicals that cause inflammation.3

Over-the-counter topical corticosteroids

OTC topical corticosteroids come in different preparations, including ointments, creams, and lotions. The preparation affects the potency of the product.

Corticosteroid ointments

Ointments provide more lubrication and are more potent than cream formulations. Ointments are occlusives, which contain a high level of lipid (oil) and create a hydrophobic film on the skin. Some people do not like ointments because they feel greasy. Because of their occlusive properties, ointments provide more lubrication and improve the absorption of corticosteroids.

Corticosteroid creams

Creams are a mixture of water and oil and are more readily absorbed into the skin. Cream corticosteroids are less potent than ointments of the same strength, and they frequently include preservatives, which may irritate some people.

Corticosteroid lotions and solutions

Lotions and solutions are the least greasy and usually penetrate the skin easily. As the least occlusive preparation, they have the lowest potency and are less moisturizing. Topical corticosteroids in lotions and solutions are usually beneficial for hairy areas of the skin or scalp.2,4

Topical corticosteroid dosage

OTC topical corticosteroids are for short-term relief and should be used as described on the packaging. Most preparations are recommended for once or twice daily application for a brief period of time. These medications are most effective when applied after bathing. Although corticosteroid preparations provide lubrication, these products should not be used as a moisturizer. Topical corticosteroids should be applied only to affected areas of skin, and a moisturizer should be applied on top of the medication.1,4

Side effects of over-the-counter topical corticosteroids

To be available over-the-counter, medications have been approved by the U.S. Food and Drug Administration (FDA) as safe. However, OTC medications like topical corticosteroids still have risks. OTC topical corticosteroids should be used as directed and should not be used more than the label, or your doctor recommends.

Common side effects of topical corticosteroids include thinning of the skin (atrophy), stretch marks, dilated blood vessels, or lightening or darkening of the skin. Side effects are rare with proper medication use and are more common with higher doses and prolonged usage.1

Coal tar

Coal tar is a byproduct of coal and has been used for centuries to treat psoriasis and atopic dermatitis. Coal tar reduces the rate of skin cell growth and softens the upper layer of skin. It is available in soaps, gels, creams, shampoos, and ointments.5

You should speak with your doctor before using an OTC coal tar product. Dosing varies greatly depending on the type of product and whether it is being used on an adult or a child.6

Side effects of coal tar

Coal tar makes the skin more sensitive to the sun so direct sunlight should be avoided for 72 hours after use. Coal tar should not be applied to infected, blistered, raw, or oozing skin and can stain skin or clothing.6

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Written by Emily Downward | Reviewed December 2020