Eczema is a chronic skin condition that causes intense itching, dryness, and inflamed patches that can disrupt sleep, daily activities, and emotional wellbeing. While there’s no cure, a combination of daily skincare routines, avoidance of triggers, and medical treatments can help most people manage their symptoms and reduce the frequency and severity of flare-ups.

Understanding Treatment Goals for Eczema

The main goal of eczema treatment is not to cure the condition, but to help people live comfortably with it. Treatment focuses on controlling symptoms, preventing flare-ups, and improving quality of life. Because eczema is a chronic condition that comes and goes in waves, people living with it need to learn how to manage it over the long term.^[1][2]

The approach to treating eczema depends on several factors, including the person’s age, how severe the symptoms are, where the rash appears on the body, and what triggers the flare-ups. For example, a baby with mild eczema on the cheeks might need only gentle moisturizers and careful bathing, while an adult with severe, widespread eczema that interferes with sleep and work may require prescription medications or advanced therapies.^[5][12]

Treatment plans are highly individual. What works well for one person might not help another, even if they both have the same type of eczema. This is why working closely with a healthcare provider is important. They can help identify what’s triggering the symptoms and create a treatment plan that fits the person’s specific situation.^[10]

Because eczema affects more than 31 million Americans and is especially common in children, medical societies and dermatology experts have developed standard treatment guidelines. These guidelines help doctors choose the most effective and safest treatments based on years of research and clinical experience. At the same time, researchers around the world are testing new therapies in clinical trials, offering hope for better treatment options in the future.^[1][2]

Standard Treatment Approaches

The foundation of eczema treatment rests on three main pillars: keeping the skin moisturized, using medicated creams or ointments when needed, and avoiding things that trigger flare-ups. These basic strategies work for most people with eczema, regardless of age or severity.^[13][21]

Daily Skin Care and Moisturizing

One of the most important parts of managing eczema is taking care of the skin every single day, even when it looks and feels fine. People with eczema have a weakened skin barrier, which is the outermost layer of skin that normally keeps moisture in and irritants out. When this barrier doesn’t work properly, skin loses water quickly and becomes dry, itchy, and vulnerable to irritants and germs.^[1][21]

Regular moisturizing helps repair and protect this damaged barrier. Dermatologists recommend a method called “Soak and Seal.” This involves bathing or showering in lukewarm (not hot) water for about five to ten minutes once a day. Short, warm baths help the skin absorb moisture without stripping away natural oils. After bathing, people should gently pat the skin until it’s slightly damp, not completely dry. Within three minutes of getting out of the bath, they should apply a thick moisturizer all over the body to lock in the water. Creams and ointments work better than lotions because they contain more oil and less water, which helps seal moisture into the skin.^[21]

It’s recommended to moisturize at least twice a day, and even more often if the skin feels dry. The best moisturizers for eczema are fragrance-free and dye-free, because added scents and colors can irritate sensitive skin. Some people find that petroleum jelly works very well after bathing. Moisturizers should be applied generously — many people don’t use enough to get the full benefit.^[18][21]

Topical Corticosteroids

Topical steroids are medications applied directly to the skin to reduce inflammation and itching during flare-ups. They are among the most commonly prescribed treatments for eczema and have been used safely for many years when used correctly. These medications work by calming down the overactive immune response in the skin that causes redness, swelling, and itching.^[12][14]

Topical steroids come in many different strengths, from mild (like over-the-counter hydrocortisone cream) to very strong (super-potent prescription steroids). They also come in different forms such as ointments, creams, lotions, gels, and even tape. Ointments are usually more effective because they help the medication penetrate the skin better and also provide moisturizing benefits.^[14]

Doctors choose the strength and type of steroid based on where the eczema appears, how severe it is, and the person’s age. Thinner, more sensitive skin areas like the face, eyelids, and genital area require milder steroids, while thicker skin on the hands and feet can tolerate stronger preparations. Children usually need milder steroids than adults.^[14]

When used as directed, topical steroids are very safe and effective. However, using them too often or for too long can cause side effects such as thinning of the skin, stretch marks, or changes in skin color. This is why doctors give specific instructions about how often to apply them and for how long. Typically, people apply topical steroids once or twice a day during a flare-up until the skin improves, then stop or reduce use. It’s important never to substitute one steroid for another without asking a doctor, because they vary greatly in strength.^[14][15]

Many people worry about using steroids on their skin, but avoiding them when needed can lead to worse eczema that’s harder to control. The key is using the right strength for the right amount of time, as prescribed by a healthcare provider.^[14]

Topical Calcineurin Inhibitors

Topical calcineurin inhibitors (TCIs) are non-steroid prescription medications that fight inflammation when applied to the skin. The two TCIs available are tacrolimus ointment (brand name Protopic) and pimecrolimus cream (brand name Elidel). These medications work differently than steroids but achieve a similar result: they calm the immune system response in the skin that causes eczema symptoms.^[12][14]

One important advantage of TCIs is that they don’t cause the side effects associated with long-term steroid use, such as skin thinning. This makes them particularly useful for treating sensitive areas like the face, eyelids, neck, and skin folds. They can also be used for longer periods without the same concerns about side effects that apply to topical steroids.^[14]

The most common side effect of TCIs is a temporary burning or stinging sensation when first applied to the skin. This feeling usually goes away after a few days of use as the skin gets used to the medication. Many people find that applying the medication right after moisturizing, or keeping it in the refrigerator before use, can reduce this burning sensation.^[14]

TCIs are approved for people aged two years and older. They’re typically applied twice a day during flare-ups and can be used alone or along with other eczema treatments as part of a comprehensive treatment plan.^[14]

Other Topical Medications

In addition to steroids and calcineurin inhibitors, other types of creams and ointments can help treat eczema. Topical PDE4 inhibitors are a newer class of non-steroid anti-inflammatory medications. Crisaborole (brand name Eucrisa) is approved for mild to moderate eczema in children as young as three months old and in adults. Like TCIs, these medications reduce inflammation without the side effects of steroids.^[14]

Another newer option is a topical JAK inhibitor called ruxolitinib cream, approved for people aged 12 and older whose eczema isn’t well controlled with other topical treatments. These medications work by blocking specific proteins called Janus kinases that play a role in the inflammation process.^[14]

Wet Wrap Therapy

For severe eczema or during intense flare-ups, doctors sometimes recommend wet wrap therapy. This technique involves applying medication and moisturizer to the skin, then wrapping the affected areas with wet bandages or clothing, followed by a dry layer on top. The moisture helps the skin absorb the treatments better and provides a barrier against scratching. Wet wraps are usually done for a few hours or overnight. They can be very effective for controlling severe itching and helping damaged skin heal more quickly.^[13][21]

Phototherapy

Phototherapy, also called light therapy, uses controlled exposure to ultraviolet (UV) light to reduce inflammation and itching. It’s typically recommended for people with moderate to severe eczema that hasn’t responded well to topical treatments. During phototherapy, people stand in a special booth and are exposed to UV light for a specific amount of time, usually starting with very short exposures and gradually increasing. Treatments are usually done two or three times per week at a clinic or hospital.^[13][15]

Different types of UV light can be used, including narrowband UVB, which is the most common type for eczema. Phototherapy can be helpful for people who have eczema covering large areas of their body. However, it requires a significant time commitment because people need to go for treatments several times a week for several weeks or months to see improvement.^[15]

Systemic Treatments for Severe Eczema

When eczema is severe and doesn’t respond to topical treatments and phototherapy, doctors may prescribe medications that work throughout the whole body, called systemic treatments. These include traditional immunosuppressant drugs that have been used for many years.^[15]

Cyclosporin is an oral medication that suppresses the immune system to reduce inflammation. It can be very effective for severe eczema, but it’s usually used for short periods (a few months) rather than long-term because it can affect kidney function and blood pressure. People taking cyclosporin need regular blood tests to monitor for side effects.^[15]

Other systemic immunosuppressants used for eczema include methotrexate, azathioprine, and mycophenolate mofetil. These medications also require regular monitoring with blood tests because they can affect the liver, blood cells, and other body systems. They’re reserved for people with severe eczema that significantly impacts their quality of life and hasn’t improved with safer treatments.^[14][15]

Biologic Medications

A newer type of systemic treatment called biologics targets specific parts of the immune system involved in eczema. Dupilumab (brand name Dupixent) was the first biologic approved for eczema. It’s a medication given by injection under the skin, usually every two weeks after an initial loading dose. Dupilumab blocks two proteins called interleukin-4 and interleukin-13 that play key roles in causing eczema inflammation.^[13][15]

Dupilumab is approved for people aged six months and older with moderate to severe eczema. Clinical studies have shown that many people experience significant improvement in itching, sleep quality, and the extent of their rash. The most common side effects include eye irritation and injection site reactions. Unlike traditional immunosuppressants, dupilumab doesn’t require regular blood monitoring.^[15]

Another biologic medication, tralokinumab (brand name Adbry), also blocks interleukin-13 and is given by injection every two weeks. It’s approved for adults with moderate to severe eczema who haven’t responded well to other treatments.^[15]

Oral JAK Inhibitors

Oral JAK inhibitors are pills taken daily that block Janus kinase enzymes involved in the inflammatory process. Several are now approved for treating moderate to severe eczema in people aged 12 and older. These include abrocitinib (brand name Cibinqo), upadacitinib (brand name Rinvoq), and baricitinib (brand name Olumiant).^[14][15]

Oral JAK inhibitors can work quickly, with some people noticing improvement in itching within days. However, they require regular monitoring with blood tests because they can affect blood cell counts, cholesterol levels, and liver function. People taking these medications also need monitoring for infections and blood clots, though serious side effects are uncommon.^[14]

Treatment with these newer systemic medications typically continues as long as they’re working well and not causing problematic side effects. Regular follow-up with a doctor is essential to monitor how well the treatment is working and to watch for any problems.^[15]

Managing Infections

People with eczema are more prone to skin infections because the damaged skin barrier allows bacteria, particularly Staphylococcus aureus, to enter more easily. When skin becomes infected, it may appear more red and swollen, feel warm, develop pus or honey-colored crusts, or cause fever. Infected eczema requires treatment with antibiotic creams or pills. Some doctors recommend diluted bleach baths a few times per week to reduce bacteria on the skin and lower the risk of infection.^[8][21]

Treatment in Clinical Trials

While existing treatments help many people manage their eczema, they don’t work for everyone, and researchers continue to search for better options. Clinical trials are research studies that test new treatments to see if they’re safe and effective before they become widely available. These trials are happening around the world and offer hope for people whose eczema isn’t well controlled with current treatments.^[13]

Understanding Clinical Trial Phases

When scientists develop a potential new eczema treatment, it goes through several phases of testing before it can be approved for general use. Phase I trials involve a small number of people and focus mainly on safety — determining what dose is safe and what side effects might occur. Phase II trials include more people and focus on whether the treatment actually works to improve eczema symptoms while continuing to monitor safety. Phase III trials are large studies that compare the new treatment to existing treatments or placebo (an inactive substance) to confirm it works and is safe. These trials may involve hundreds or even thousands of people and take place in multiple locations, sometimes including sites in the United States, Europe, and other regions. After a treatment successfully completes Phase III trials, the company can apply for approval from regulatory agencies like the U.S. Food and Drug Administration (FDA). Phase IV trials happen after a treatment is approved and marketed, to gather more information about long-term safety and effectiveness in real-world use.^[13]

New Biologic Therapies in Development

Several new biologic medications are being tested in clinical trials for eczema. These work similarly to dupilumab and tralokinumab by targeting specific proteins involved in the inflammatory process, but each targets different molecules. Lebrikizumab is an injectable biologic that blocks interleukin-13 and is being studied in Phase III trials for people with moderate to severe eczema. Early results suggest it can significantly reduce symptoms and improve quality of life for many patients.^[15]

Other biologics in development target different parts of the immune system. Some block interleukin-31, a protein directly involved in causing itching in eczema. By blocking this specific itch signal, these medications may provide fast relief from one of the most troublesome symptoms of eczema. Others target interleukin-22, interleukin-33, or thymic stromal lymphopoietin (TSLP), which all play roles in triggering and maintaining eczema inflammation.^[13]

Innovative Topical Treatments Being Tested

Researchers are also developing new types of creams and ointments that work in novel ways. Some experimental topical JAK inhibitors different from ruxolitinib cream are being tested to see if they can provide effective relief without the potential risks associated with systemic JAK inhibitors. Because these medications are applied only to affected skin rather than taken as pills, they may have fewer side effects while still providing good symptom control.^[13]

Other topical treatments being explored include medications that help repair the skin barrier more effectively than current moisturizers. Since the damaged barrier is a fundamental problem in eczema, treatments that directly address this could prevent flare-ups rather than just treating them after they occur.^[13]

How Participating in Clinical Trials Works

People interested in trying experimental treatments can look for clinical trials recruiting participants. Trials have specific eligibility requirements, such as age ranges, eczema severity levels, and whether participants are currently using other treatments. Some trials are looking for people who have tried many treatments without success, while others may accept people earlier in their treatment journey. Participants in clinical trials receive the experimental treatment at no cost and are monitored closely by medical professionals. They also contribute valuable information that helps researchers understand whether new treatments work and are safe. Many clinical trial websites provide information about studies recruiting participants in different locations, including options in the United States and other countries.^[13]

Most Common Treatment Methods

• Daily skin care and moisturizing
  • Bathing in lukewarm water for 5-10 minutes daily using gentle, fragrance-free cleansers
  • Applying thick, oil-based moisturizers within 3 minutes after bathing to lock in moisture
  • Moisturizing at least twice daily, even when skin appears healthy
  • Using petroleum jelly or fragrance-free, dye-free creams and ointments rather than lotions
  • Special bathing treatments including oatmeal baths, diluted bleach baths, or bath oils to relieve symptoms and reduce bacteria
• Topical corticosteroids
  • Available in strengths from mild (over-the-counter hydrocortisone) to super-potent prescription steroids
  • Come as ointments, creams, lotions, gels, or tape
  • Applied directly to affected skin once or twice daily during flare-ups
  • Work by calming immune system overreaction and reducing inflammation
  • Safe when used as directed, but prolonged use can cause skin thinning
• Topical calcineurin inhibitors (TCIs)
  • Non-steroid anti-inflammatory medications including tacrolimus ointment and pimecrolimus cream
  • Safe for use on face, eyelids, neck, and sensitive areas without causing skin thinning
  • Can be used for longer periods than topical steroids
  • May cause temporary burning sensation when first applied
  • Approved for people aged 2 years and older
• Other topical medications
  • Topical PDE4 inhibitors like crisaborole for mild to moderate eczema in children and adults
  • Topical JAK inhibitors like ruxolitinib cream for people aged 12 and older
  • Wet wrap therapy combining medications with damp bandages to enhance absorption and prevent scratching
• Phototherapy (light therapy)
  • Uses controlled ultraviolet light exposure to reduce inflammation
  • Treatments done 2-3 times per week at medical facilities
  • Narrowband UVB is the most common type used for eczema
  • Helpful for moderate to severe eczema covering large body areas
  • Requires weeks to months of regular treatments to see improvement
• Systemic immunosuppressants
  • Cyclosporin for short-term use in severe cases
  • Methotrexate, azathioprine, and mycophenolate mofetil for long-term management
  • Work throughout the body to suppress immune system activity
  • Require regular blood tests to monitor for side effects on liver, kidneys, and blood cells
  • Reserved for people with severe eczema not controlled by topical treatments
• Biologic medications
  • Dupilumab injection blocking interleukin-4 and interleukin-13, approved for ages 6 months and older
  • Tralokinumab injection blocking interleukin-13 for adults
  • Given by injection under the skin every two weeks after initial loading dose
  • Target specific immune system proteins involved in eczema inflammation
  • Most common side effects include eye irritation and injection site reactions
• Oral JAK inhibitors
  • Pills including abrocitinib, upadacitinib, and baricitinib for people aged 12 and older
  • Block Janus kinase enzymes involved in inflammatory process
  • Taken daily with potentially rapid improvement in itching
  • Require regular blood tests to monitor for effects on blood counts, cholesterol, and liver function
  • Need monitoring for infections and blood clots
• Treatments for complications
  • Antibiotic creams or pills for skin infections
  • Diluted bleach baths 2-3 times per week to reduce bacteria and prevent infections
  • Antihistamine medications to help control itching, especially at night

Avoiding Triggers and Preventing Flare-Ups

An essential part of managing eczema is identifying and avoiding things that trigger symptoms or make them worse. Triggers are substances or conditions that cause the immune system to overreact and start a flare-up. Triggers vary from person to person, so what bothers one individual might not affect another.^[1][9]

Common eczema triggers include harsh soaps, detergents, and cleaning products with strong chemicals or fragrances. Switching to gentle, fragrance-free products for washing skin, hair, clothes, and dishes can reduce irritation. Wool and synthetic fabrics can irritate the skin, so wearing soft, breathable cotton clothing is often better. All new clothes should be washed before wearing to remove chemicals added during manufacturing.^[1][20]

Temperature and humidity changes can trigger flare-ups. Cold, dry winter air pulls moisture from the skin, while excessive heat and sweating can cause itching. Using a humidifier indoors during winter, wearing layers that can be removed if overheating occurs, and keeping bedrooms cool at night can help. Taking a cool shower after exercise to remove sweat quickly can prevent irritation.^[9][19]

For some people, allergens such as dust mites, pet dander, pollen, or certain foods can worsen eczema. If allergies seem to trigger symptoms, doctors can perform allergy testing to identify specific allergens. Reducing exposure to identified allergens — such as using dust mite covers on mattresses and pillows, vacuuming frequently, or avoiding specific foods — may help reduce flare-ups.^[3][9]

Stress is another common trigger. While stress doesn’t cause eczema, it can make existing eczema worse. Finding ways to manage stress through exercise, meditation, deep breathing, yoga, or enjoyable hobbies can help reduce the frequency of flare-ups. Getting enough sleep is also important, though eczema itself often disrupts sleep because of itching.^[18][19]

Living with Eczema: Daily Management Tips

Successfully managing eczema requires more than just using medications when symptoms appear. It involves developing daily habits and routines that protect the skin and prevent problems before they start.^[16][18]

The single most important habit is moisturizing regularly, even when skin feels fine. Many people make the mistake of only applying moisturizer when their skin is actively itchy or flaky. However, keeping skin well-hydrated all the time strengthens the skin barrier and makes flare-ups less likely to occur.^[18][21]

Managing the itch is crucial because scratching damages the skin further and can lead to a cycle where itching causes scratching, which causes more inflammation, which causes more itching. When skin feels itchy, applying cold moisturizer or a cool compress can help. Keeping fingernails short and smooth prevents causing as much damage if scratching does occur. Some people find wearing light cotton gloves to bed helpful for preventing unconscious scratching during sleep.^[19]

Creating a consistent routine helps. Going to bed and waking at the same time each day, establishing a calming bedtime routine, and keeping the bedroom cool, dark, and comfortable can improve sleep quality despite itching. Applying medication and moisturizer at the same times each day makes it easier to remember and ensures the skin gets consistent care.^[18]

Exercise is beneficial for overall health and stress management, but sweating can irritate eczema-prone skin. Wearing moisture-wicking fabrics during exercise, staying cool, and showering promptly afterward can allow people with eczema to enjoy physical activity without triggering flare-ups. Swimming can be relaxing, but chlorine in pools can dry and irritate skin. Applying a layer of moisturizer before swimming and showering with gentle cleanser immediately after, followed by generous moisturizer application, can help protect the skin.^[16][18]

Eczema can significantly affect emotional wellbeing and self-esteem, especially when visible rashes appear on the face, hands, or other areas people can see. Children and teenagers may feel self-conscious at school, and adults may feel uncomfortable in work or social situations. Living with chronic itching, sleep disruption, and visible skin changes can lead to anxiety and depression. Studies show that people with eczema are more likely to experience these mental health challenges. Seeking support from friends, family, support groups, or mental health professionals can make a real difference in coping with the emotional aspects of living with eczema.^[17][18]

Many people find it helpful to connect with others who have eczema through online communities or local support groups. Sharing experiences, tips, and encouragement with people who truly understand the challenges can reduce feelings of isolation and provide practical advice for managing difficult situations.^[17]

What to Expect from Treatment

Eczema is a long-term condition, and most people will need to manage it throughout their lives. However, the good news is that symptoms often improve over time, especially for people who developed eczema as children. Nearly half of all infants with eczema will outgrow it or experience significant improvement as they get older, though their skin may remain sensitive.^[1][2]

For those whose eczema persists into adulthood, the condition typically follows a pattern of flare-ups and calmer periods. The goal of treatment is to extend the calm periods, make flare-ups less severe when they do occur, and maintain quality of life. Finding the right combination of daily skincare, trigger avoidance, and medications often takes time and patience. What works well for several months might become less effective, requiring adjustments to the treatment plan.^[10][16]

Most people with mild to moderate eczema can manage their condition successfully with proper skincare and topical treatments. For those with more severe eczema, newer systemic treatments including biologics and oral JAK inhibitors have provided life-changing relief. Many people who struggled for years with constant itching, sleepless nights, and widespread rashes have experienced dramatic improvement with these newer medications.^[13][15]

Regular follow-up with a healthcare provider, whether a primary care doctor or dermatologist, is important for monitoring how well treatment is working and making adjustments when needed. People shouldn’t hesitate to speak up if their current treatment isn’t controlling symptoms adequately, as better options may be available.^[10]