Topical Treatments for Eczema

Many treatments for atopic dermatitis, a type of eczema, can be applied directly to the skin. These are called topical treatments, or topicals. Some can be bought over the counter (OTC), while others require a prescription.^1,2

How do topical treatments work?

Topical treatments are absorbed into the skin to help relieve symptoms such as itching, redness, and inflammation. Topicals for eczema come in many forms, including:^1,2

• Lotions
• Moisturizers
• Creams
• Ointments
• Gels
• Shampoos
• Sprays

Topical corticosteroids

Topical corticosteroids, also called steroids, are a common treatment for people with eczema. They work by calming inflammation and reducing an overactive immune response.^2,3

Topical steroids are grouped from class 1 to class 7 according to strength. Classes 1 through 6 require a prescription.³

Read the directions on the label for use instructions or follow instructions provided by your doctor. Do not use topical steroids for longer than directed.^2,3

OTC topical steroids

The lowest-strength topical steroid is hydrocortisone. The 1 percent strength can be bought without a prescription. It helps reduce itching and inflammation with eczema.²

Hydrocortisone can be used over large areas. But even though it is mild, hydrocortisone may cause:²

• Itching
• Burning
• Skin color changes
• Acne
• Dry or cracked skin

Prescription topical steroids

The strongest topical steroids are used where skin is thickest, such as soles of the feet and palms of the hand. They are also used for severe eczema.³

However, strong steroids are not used on the face, where skin is thin, or where skin rubs together. Low- to medium-strength steroids are better suited for the face or areas of thin skin. Your doctor will help guide you.³

Other topical treatments

Topical treatments for eczema also include other prescription and OTC therapies that calm the immune system and moisturize the skin.

JAK inhibitors

One approach to treating eczema topically includes blocking the Janus kinase (JAK) family of proteins. Two JAK proteins, JAK1 and JAK2, are involved in the overactivation of the immune system. This leads to the inflammation and itch that comes with eczema.⁴

There is 1 topical JAK inhibitor drug approved by the US Food and Drug Administration (FDA) to treat atopic dermatitis – Opzelura™ (ruxolitinib). Opzelura cream works by blocking JAK1 and JAK2. Opzelura is intended for short-term use for mild to moderate eczema.⁴

Opzelura has a boxed warning, the strictest warning from the FDA. It has this warning because there is risk for serious infections, cancer, blood clots, and stroke. People taking Opzelura also have died from various causes, including heart failure.⁵

Calcineurin inhibitors

Calcineurin inhibitors also calm the immune system. They work by preventing immune cells called T cells from turning on. This then prevents some symptoms of eczema.^4,6

There are 2 FDA-approved calcineurin inhibitors for atopic dermatitis:^4,6

• Protopic® (tacrolimus) – Approved for people with moderate to severe atopic dermatitis. Different concentrations are given to children than to adults.
• Elidel® (pimecrolimus) cream – Approved for those with mild to moderate atopic dermatitis. It can be used by people aged 2 years and older.

Elidel has a boxed warning from the FDA. This is because doctors do not know whether the drug is safe to take over a long time. Some cases of cancer have been reported in people taking this drug.⁷

PDE4 inhibitors

Phosphodiesterase 4 (PDE4) inhibitors also calm an overactive immune system. They block the PDE4 enzyme, which helps promote inflammation. The only approved PDE4 topical inhibitor for atopic dermatitis is Eucrisa® (crisaborole). Eucrisa is an ointment that can be used by people aged 3 months and older.⁴

Moisturizers

Moisturizing the skin is often seen as a first step in treating eczema. But moisturizing should be your last step when you are using topical treatments that contain medicine.⁹

Apply your medicated topical treatment first, and allow it to absorb for 15 minutes. Then apply a thick layer of moisturizer. Moisturizers help maintain a barrier in the outermost layer of skin. This layer is often damaged in people with eczema.⁹

Moisturizer helps your skin retain moisture and medicine. Use one that does not have dyes or fragrances to help prevent irritation.⁹

What are the possible side effects?

Side effects can vary depending on the specific topical treatment you are using. They may range from slight burning or stinging to stretch marks and thinning of the skin.^1,2

One risk of using topical steroids is a condition known as topical steroid withdrawal (TSW). TSW can begin while you are using topical steroids or after you have stopped. It is commonly linked to using medium- to high-potency topical steroids too often or for too long.^10,11

TSW commonly occurs on the face or in the genital area. Symptoms include:^10,11

• Redness
• Burning
• Stinging
• Flaking
• Rashes spreading to new parts of the body

If your steroid cream seems to be getting less effective, talk to your doctor about other options.^10,11

These are not all the possible side effects of topical treatments for eczema. Talk to your doctor about what to expect when using these treatments. You also should call your doctor if you have any changes that concern you when using them.

Other things to know

Before beginning treatment for eczema, tell your doctor about all your health conditions, allergies, and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.