For most types of eczema, managing the condition and its symptoms comes down to these basic principles:
- Know your triggers;
- Bath and moisturize regularly;
- Consistent and prescribed use of over-the-counter (OTC) and/or prescription medications;
- Watch for signs of skin infection - pus-filled bumps, pain, redness or warmth.
Try not to scratch and rub the affected skin, and limit contact with materials or substances that may irritate the skin and anywhere symptoms may occur. Wear soft, breathable clothing and avoid itchy fabrics such as wool, as they can further irritate eczema. Avoid using fabric detergents that contain known allergens. Recognize stressful situations and events - and learn to use stress management techniques to avoid or cope with them. You can do this on your own or with the help of a trusted health care provider.
However, some people find that even though they do all the "right" things, their eczema still flares up. Eczema (sometimes called "atopic eczema") can be an unpredictable disease, and there's still a lot to know about it. It's common for eczema to appear suddenly, and it can happen despite your best efforts. An allergic reaction to an environmental trigger may also lead to an eczema flare-up (leading to "contact dermatitis" in some cases). As with all treatments, be sure to talk to your health care provider to weigh the benefits against the risks to determine if it is right for you.
Over-the-counter treatments for eczema
Over-the-counter eczema medications are topical and oral medications that can be purchased without a prescription. You can find a range of over-the-counter medications that can help relieve eczema symptoms such as itching, redness, irritation, or rash. Other over-the-counter medications can help prevent itching and aid sleep when itching at night keeps you awake. Many over-the-counter products are available in brand name or generic forms.
Precautions for OTC Products
The U.S. Food and Drug Administration (FDA) decides whether a drug is safe enough to be sold over the counter. However, there are still potential risks with using over-the-counter medications. Some may interact with other prescription or over-the-counter medicines, supplements, foods, or beverages. Others can cause problems for people with certain medical conditions. Always talk to your healthcare provider before taking any over-the-counter medication for eczema.
It is important to follow the directions for over-the-counter medications correctly and to be careful when giving them to children. You should never take over-the-counter eczema medications for a longer period of time or at a higher dosage than recommended on the product label.
Antihistamines and pain relievers
Atopic dermatitis (AD) is the most common form of eczema and is part of the atopic triad (eczema, allergy, and asthma). In fact, people with AD are more likely to have comorbid or related health conditions, namely asthma, hay fever, and food allergies. If you have allergies, your healthcare provider may recommend taking antihistamines to help relieve itching and reduce inflammation. Some antihistamines also contain sedatives that can help people sleep.
Examples of over-the-counter oral antihistamines include:
- Diphenhydramine (Benadryl, Siladryl, Unisom, Banophen, Sudafed);
- Chlorpheniramine (Chlor-Trimeton, Wal-Finate, Aller-Chlor);
- Cetirizine (Zyrtec, Aller-Tec, Alleroff, Cetiri-D);
- Loratadine (Claritin, Alavert, Wal-itin);
- Fexofenadine (Allegra, Aller-ease, Aller-Fex, Wal-Fex Allergy);
- Doxylamine (Unisom, Wal-Som, Ultra Sleep).
To address common eczema symptoms, such as burning, pain, and inflammation, your healthcare provider may also recommend over-the-counter pain relievers, such as:
- Acetaminophen (Tylenol);
- Nonsteroidal anti-inflammatory drugs, including ibuprofen;
- (Motrin, Advil) or naproxen (Aleve, Naprosyn).
topical hydrocortisone
Topical, over-the-counter hydrocortisone is a low-potency steroid that works on the skin by reducing irritation, itching, and inflammation. Over-the-counter steroids come in many forms, including ointments, creams, lotions, and gels. They are used to temporarily relieve the itching and rash caused by most types of eczema.
Over-the-counter hydrocortisone is usually used one to four times daily for up to 7 days. Follow the directions on the label carefully. Do not use over-the-counter steroids more often or for longer than recommended by the label or your healthcare provider.
Although hydrocortisone products are over-the-counter, they may cause side effects, including:
- Dry or cracked skin
- acne
- itching
- combustion
- Changes in skin color.
shampoo
Medicated over-the-counter shampoos containing ingredients such as ketoconazole, selenium sulfide, coal tar, and zinc pyrithione can help relieve seborrheic dermatitis of the scalp. (also called dandruff) symptoms. The active ingredients in over-the-counter anti-dandruff shampoos often help remove seborrheic dermatitis flakes from the scalp and/or provide antifungal treatment to combat Malassezia overgrowth. Malassezia is thought to cause seborrheic dermatitis.
Prescription topic
What is a theme?
Topical treatments or "topics" for eczema are medications that are applied to the skin to control symptoms and reduce inflammation. There are several different types of topical medications for eczema. The most common include prescription steroids of varying strengths, calcineurin inhibitors, PDE4 inhibitors and Janus kinase (JAK) inhibitors.
Topical JAK inhibitors
The inflammation in atopic dermatitis (AD) is caused in part by increased immune system messengers called cytokines in the blood and skin. Several of these inflammatory cytokines act through an intracellular chemical signaling pathway called the JAK-STAT pathway (Janus kinase signal transducer and activator of transcription). There are four members of the JAK family - JAK inhibitors can target one or more of these family members to block these immune signals and inhibit the inflammatory effects of key cytokines involved in AD. The following topical medications work by specifically blocking JAK1 and JAK2, two enzymes involved in multiple cytokine pathways that contribute to skin inflammation, itching, and skin barrier function. Reducing the activity of JAK1 and JAK2 in atopic dermatitis may reduce and/or alleviate severe signs and symptoms by reducing itching, rash, and skin redness.
A topical JAK inhibitor may be used to treat eczema. Opzelura (ruxolitinib 1.5%) cream is an FDA-approved topical selective JAK inhibitor for the short-term and discontinuous treatment of mild to moderate atopy in non-immunocompromised (patients with an uncompromised immune system) adult and pediatric patients. dermatitis 12 years when topical prescription therapies do not adequately control the disease or their use is not recommended.
Topical calcineurin inhibitor
Topical calcineurin inhibitors (TCIs) are nonsteroidal medications that work by preventing certain cells of the immune system from "turning on," thereby preventing eczema symptoms such as redness, itching, and inflammation.
There are two TCIs used to treat eczema: tacrolimus ointment (Protopic® and generic) and pimecrolimus cream (Elidel® and generic). Tacrolimus is FDA-approved in two concentrations for the treatment of moderate to severe atopic dermatitis, one for children 2 to 15 years of age and one for adults. Pimecrolimus is FDA-approved for use in adults and children 2 years and older with mild to moderate atopic dermatitis. Your healthcare provider may also prescribe "off-label" TCIs to treat your eczema.
TCI can be applied to all affected areas of skin, including areas with finer or thinner skin, such as the face, eyelids, genitals, or skin folds, where short- or long-term use of topical steroids may not be appropriate. TCIs can be used long-term to control symptoms and reduce flare-ups. Common side effects of TCIs include a mild burning or stinging sensation when the drug is first applied to the skin.
In 2006, the FDA implemented a black box warning for TCIs regarding long-term safety and possible risk of lymphoma, a type of blood cancer. To date, a causal link between the use of TCIs to treat eczema and these cancers has not been proven. However, this risk should be discussed with your healthcare provider.
Topical PDE4 inhibitors
Phosphodiesterase 4 (PDE4) is an enzyme that produces various inflammatory cytokines within immune system cells. Cytokines are proteins produced by different immune system cells that contribute to normal immune responses. When cytokines are triggered incorrectly in the body, the resulting inflammation may lead to the development of certain diseases, including atopic dermatitis. Blocking PDE-4 blocks the production of several cytokines involved in inflammation in atopic dermatitis.
Currently, the FDA has approved a topical PDE4 inhibitor for the treatment of atopic dermatitis. Crisaborole (Eucrisa®) is an ointment indicated for adults and children 3 months and older with mild to moderate atopic dermatitis.
topical steroids
One of the most commonly prescribed medications to treat all types of eczema are topical corticosteroids, or steroids, which can reduce inflammation and itchiness so the skin can begin to heal.
Steroids are natural substances produced by our bodies to regulate growth and immune function. Corticosteroids have been used as topical medications for more than 60 years to treat a variety of inflammatory skin diseases, including eczema. Topical steroids are used to treat eczema in adults and children.
Topical steroids are classified by their strength (or potency), ranging from "super potent" (Category 1) to "least potent" (Category 7). There are many different types of topical steroids and different concentrations and dosage forms (ointments, creams, lotions, sprays). Apply steroids to areas of skin affected by eczema only as often as prescribed by your doctor. Moisturizers can be used on the basis of steroids. Certain areas or types of skin (face, genitals, skin folds, rough or thin skin, and areas that rub together, such as under the breasts, buttocks, or between thighs) absorb more of the drug, and care must be taken when using steroids in these areas. field.
Once inflammation is under control, follow your doctor's instructions to reduce or stop using steroids. If you are taking high-potency steroids and/or have been using steroids for a long time, talk to your healthcare provider to avoid the risk of "rebound" after stopping the medication.
As with any medication, there may be side effects from using topical steroids. The risk of side effects is related to the potency, site and duration of use of the steroid. Many potential side effects disappear after you stop using topical steroids. Common side effects of topical steroids include:
- Thinning (atrophy) of the skin
- Stretch marks (stretch marks)
- Spider veins (telangiectasia)
- Perioral dermatitis (around the mouth)
- Acne or rosacea-like rash.
Rare side effects of topical steroids may include:
- hypothalamic-pituitary-adrenal axis inhibition;
- Growth retardation in young children;
- Glaucoma (damage to the optic nerve of the eye);
- Cataracts (clouding of the crystalline lens);
- Topical steroid withdrawal.
Corticosteroids, including topical corticosteroids (TCS), are associated with a potentially serious condition called topical steroid withdrawal (TSW). TSW is considered rare but can be debilitating in some patients. Because clear diagnostic criteria do not yet exist, they may not be recognized by all health professionals.
Prescription Injections – Biologics
What are biologics?
Biological drugs, or "biologics," are among the most targeted therapies available today because they essentially use human DNA to treat certain diseases at the level of the immune system. Biologics, taken subcutaneously (through the skin) or intravenously (into the vein), are genetically engineered drugs that contain proteins from living tissue or cells grown in a laboratory.
How do biologics work?
The immune system produces certain types of protein chemical messengers called interleukins (abbreviated as IL), which help our bodies fight harmful viruses and bacteria. But in people with inflammatory conditions like atopic dermatitis, the immune system overreacts and triggers the release of certain white blood cells, which cause inflammation. This chronic inflammation can cause itchy skin, red spots, and other symptoms common to many types of eczema.
Biologics used to treat atopic dermatitis prevent certain interleukins from binding to their cell surface receptors, thus preventing or limiting this part of the immune system response. A calm immune system means lower or milder inflammation and therefore fewer symptoms of atopic dermatitis.
Dupixent® (dupilumab) is an FDA-approved biologic drug for use in adults and children 6 months and older who have moderate to severe atopic dermatitis for whom topical treatment is not effective or is not recommended.
Adbry (tralokinumab-ldrm) is an FDA-approved biologic drug for use in adults (18 years and older) with moderate to severe atopic dermatitis whose disease is not treatable through the skin with prescription topical therapies (topical therapy) be adequately controlled, or are not recommended when these therapies are adequately controlled. Frequently asked questions about Adbry can be found here.
Oral prescription
immunosuppressants
While the exact cause of eczema is unknown, researchers know that the immune system is involved. In eczema, the immune system overreacts and creates inflammation, leading to symptoms such as itching, irritation, and skin barrier problems.
If you have moderate to severe eczema, your doctor may prescribe medications called immunosuppressants, which help control or suppress the immune system to slow eczema symptoms.
Immunosuppressants are used to treat moderate to severe atopic dermatitis (AD) in children and adults. They can be used to help stop the scratch-scratch cycle of eczema, allowing the skin to heal and reducing the risk of skin infection. There are a number of immunosuppressants available to treat eczema, including traditional systemic drugs and steroids
AS inhibitors
The inflammation in AD is caused in part by increased immune system messengers called cytokines in the blood and skin. Several of these inflammatory cytokines act through an intracellular chemical signaling pathway called the JAK-STAT pathway (Janus kinase signal transducer and activator of transcription). There are four members of the JAK family - JAK inhibitors can target one or more of these family members to block these immune signals and inhibit the inflammatory effects of key cytokines involved in AD. The following oral medications work by selectively blocking JAK1, a member of the JAK family involved in multiple cytokines and other pathways that contribute to inflammation and itch in AD.
Cibinqo (abrocitinib) is an FDA-approved oral JAK1 inhibitor for adults and children 12 years and older with refractory moderate to severe atopic dermatitis whose disease is refractory to other systemic drug products, including biologics. preparations) are adequately controlled, or when the use of these therapies is not recommended. The FDA approved Cibinqo in January 2022.
Rinvoq (upadacitinib) is an FDA-approved oral JAK1 inhibitor for adults and adolescents 12 years of age and older with moderate to severe AD whose disease is not adequately controlled with other systemic drug products, including biologics. , or when the use of these therapies is not advisable. The FDA approved Rinvoq for AD in January 2022.
traditional systemic medication
The most common traditional systemic medications used to treat eczema include:
- Azathioprine is an oral drug first given to transplant patients to prevent the body from rejecting the transplanted organ.
- Cyclosporine is an oral or injected drug first given to transplant patients to prevent the body from rejecting the transplanted organ.
- Methotrexate is an oral or injected drug commonly used to treat psoriasis and different types of arthritis. It is a chemotherapy drug first used in cancer patients.
- Mycophenolate mofetil is used in transplant patients and other immune system disorders.
These drugs are considered "off-label," meaning they are not approved by the U.S. Food and Drug Administration (FDA) to specifically treat atopic dermatitis and other forms of eczema. Immunosuppressants can have serious side effects, including:
- Increased risk of infection;
- Stomach upset and vomiting;
- increased risk of certain types of cancer;
- Cyclosporine causes an increase in blood pressure;
- Cyclosporine and methotrexate increase the risk of kidney damage;
- Methotrexate carries a risk of liver damage.
Your healthcare provider will determine what baseline and ongoing monitoring exams and/or tests are needed when considering and using these medications.
Generally, immunosuppressants are used short-term to control eczema and then tapered or switched to topical medications for long-term eczema management. For many people, improvements in eczema with immunosuppressants are helpful with long-term use of topical medications to control symptoms.
Steroid
Steroids are also immunosuppressants, and in severe cases of eczema, oral steroids (such as prednisone) may be prescribed to control inflammation. However, many health care providers do not recommend them because of the "rebound effect," in which eczema symptoms return, often more severely, when the medication is stopped. Long-term use (more than a month) of systemic steroids may cause serious side effects, including:
- increased bacterial, fungal, and viral infections;
- thinning skin, stretch marks, and acne;
- hair loss;
- weight gain;
- glaucoma or cataracts;
- hypertension;
- gastrointestinal problems;
- Osteoporosis;
- Growth retardation in children;
- Irregular menstruation.
According to the American Academy of Dermatology's Clinical Guidelines for the Treatment of Atopic Dermatitis, systemic steroids should be avoided for the treatment of atopic dermatitis if possible. Their use should be reserved for acute, severe exacerbations and as a short-term bridge therapy to other systemic, steroid-sparing therapies.
If you are taking oral steroids for short-term treatment of eczema, it is important to work with your doctor on their use and subsequent reduction of this therapy in favor of a longer-term treatment regimen.
Prescription light therapy
Phototherapy, also called light therapy, refers to treatment with ultraviolet (UV) light of different wavelengths. It can be used to treat many forms of eczema in adults and children and helps reduce itching and inflammation.
Phototherapy is often used to treat systemic (widespread) eczema or localized eczema (such as hands and feet) that does not improve with topical treatments. The most common type of phototherapy used to treat eczema is narrowband ultraviolet B (NB-UVB) light, but your healthcare provider may recommend other options, including phototherapy that uses ultraviolet A (UVA) light. Phototherapy treatments use special machines to emit UVB or UVA light.
What should I expect from light therapy ?
During your visit, you'll have moisturizing oil applied to your skin and stand naked in a large cabinet, wearing only underwear and goggles to protect your eyes. The light machine will be activated for a short period of time—usually just seconds to minutes—and it will either treat the entire body or just certain exposed areas. It may take one to two months of stable treatment with light therapy to start seeing improvement in your eczema symptoms, at which point it is sometimes possible to reduce the frequency of visits or stop for a period of time to see if the eczema resolves.
Potential side effects of light therapy include:
- Sunburn and skin tenderness (common);
- Premature skin aging (common);
- photosensitive rash;
- non-melanoma skin cancer;
- Cataracts (from UVA treatment).
