There is no cure for atopic dermatitis (eczema), but there are treatments that can help manage this common inflammatory skin condition. Mild eczema can often be controlled with emollient-rich moisturizers and over-the-counter hydrocortisone creams. Moderate to severe cases may require prescription drugs and specialist therapies. Regardless of the stage of the disease, self-care is important to alleviating current symptoms and preventing future episodes along with skin infections.

Eczema can be difficult to manage, so many patients find the need to try different treatment options or even change their treatment regimen over time. Your healthcare provider can help guide you and will likely use a step-wise approach, seeing if some options work before trying others that may have more risks.

In some cases, other specialists⁠—such as a dermatologist, allergist, or nutritionist⁠—may be needed to unlock the right combination of individualized treatments for you.

Home Remedies and Lifestyle

Eczema can be triggered or worsened by things you are sensitive to (like pollen, certain foods, or a change in weather—cold weather is often a trigger), as well as things you do (like scratching or getting stressed). Lifestyle and personal care choices play a central role in your ability to prevent or manage acute episodes of eczema, which are called flares.

Avoidance of Triggers

There are a wide variety of triggers that can instigate an eczema flare. These can vary from one person to the next and may include:

Stress

Very dry skin

Soaps and household cleaners

Fragrances

Food allergens

Metals, especially nickel

Cigarette smoke

Cold, dry weather

Hot, humid weather

Colds and flu

Abrasive fabrics, especially wool and polyester

Antibacterial ointments like neomycin and bacitracin

Unfortunately, it is often difficult to know which triggers are causing your flares. If this is the case for you, you may want to keep a trigger diary to record exposures to suspected triggers, especially when your eczema is starting to flare.

Avoiding triggers is often easier said than done. It involves buy-in from your family and a clear set of rules to avoid accidental exposures. This includes reading ingredient labels if you have sensitivities, dressing appropriately for the weather, and using stress-management techniques to reduce your risk of flares.

Skin Cleansers and Body Washes

If you have eczema, one of the worst things you can do is wash with traditional bar soaps. They are not only harsh but can strip away many of the skin's natural oils (known as a natural moisturizing factor, or NMF), which are meant to protect it.

Choose an eczema-friendly soap or cleanser designed specifically for dry, sensitive skin. There is an ever-expanding range available on store shelves, the best of which carry the seal of acceptance from the National Eczema Association.

For infants, toddlers, and young children, you can choose to avoid cleansing products and opt for plain water baths only. Older children, teens, and adults may also benefit from soaping the hands, armpits, and groin rather than the entire body.

Antibacterial gels are ideal for cleaning hands, since their alcohol base does not bind with NMF.

"Soak-and-Seal" Baths

Water constantly evaporates from the deeper layers of the skin, an effect known as transepidermal water loss (TEWL). When you oversaturate the skin, this effect is amplified, drawing out even more water and leaving it tight and dry.

For people with eczema, these concerns are more than cosmetic. Though bathing is clearly beneficial—loosening skin scales and reducing itch—it needs to be done safely in what is known as the "soak-and-seal" technique. To do this:

Draw a lukewarm (not hot) bath, soaking for no more than 10 minutes.

Use a mild cleanser rather than harsh soap.

Avoid scrubbing.

Towel off gently by blotting (not rubbing) the skin.

Apply any topical medications you may be using.

While the skin is still damp and porous, apply moisturizer.

Allow the moisturizer to absorb for several minutes before dressing.

If you are experiencing a severe flare, you may want to avoid cleansers altogether and just use water.

 Best Ways to Hydrate Skin If You Have Eczema

Bleach Baths

If your eczema is severe, a twice-weekly dilute bleach bath may help control symptoms, particularly if you have recurrent skin infections. Although research remains split on its efficacy, a bleach bath is generally considered safe and may help neutralize bacteria and other infectious agents on the skin.

A bleach bath can be made with 1/4-cup to 1/2-cup of 5% household bleach to 40 gallons of lukewarm water. You should soak for no longer than 10 minutes and moisturize immediately after rinsing and toweling off. Never submerge your head in a bleach bath, and rinse your eyes immediately if you get water in them.

A bleach bath should never be used in children without your pediatrician's approval. People with severe cracking may want to avoid bleach baths, since they can be painful if skin is broken.

Sun Exposure

Many people with eczema claim that sunlight helps improve mild to moderate symptoms of the disease. It is believed that doing so increases the production of vitamin D in the skin, which, in turn, releases anti-inflammatory compounds (called cathelicidins) that reduce local redness and swelling.

Natural sunlight is generally considered safe if limited to no more than 10 to 30 minutes of exposure several times per week. When first starting out, five minutes may be enough to gauge how well you tolerate sunlight. If there is no redness, tingling, or pain, you can gradually increase your time in the sun over the course of days and weeks.

When it comes to sun exposure, more is not always better. Too much sun can have a contradictory effect, triggering an eczema flare while increasing the risk of sun damage and skin cancer.

When outdoors, always wear sunscreen with an SPF rating of 15 or higher. This allows enough ultraviolet (UV) radiation to penetrate the skin to have a therapeutic effect, but not enough to cause burning.

There is some evidence that the zinc oxide used in some mineral sunscreens may be beneficial to eczematous skin. If your skin condition is severe, use sunscreen intended for sensitive skin or babies.

 Home Remedies for Eczema You Should Try

Over-the-Counter Therapies

The most important over-the-counter (OTC) therapy for eczema is moisturizer. Daily moisturizing is essential to eczema treatment, regardless of the severity of your case.

The addition of a medication may be recommended if moisturizing alone doesn't improve your skin. Mild to moderate eczema can often be managed with OTC medications.

Moisturizers

Itching and dry skin (xerosis) characterize eczema at every stage of the disease. At the same time, dry skin can trigger a flare if left untreated.

Not only is dry skin itchier, but it compromises the barrier function of the skin, allowing bacteria, fungi, and viruses easy access to vulnerable tissues. Even if these microbes do not establish an active infection, they can incite the inflammation needed to trigger a flare.

Routinely moisturizing with the right ointment, cream, or lotion can help rehydrate the skin and restore its barrier function:

Ointments tend to be the best choice for all, and especially severe, cases of eczema, since they are "greasier" and provide a longer-lasting moisture barrier. Many contain ingredients like petrolatum or mineral oil.

Creams are good for people with mild to moderate eczema and are preferred by many because they absorb better than ointments.

Lotions (composed primarily of water) may be sufficient for those with mild eczema.

Among the broad categories of skin moisturizers you can select from:

Moisturizers for scaly eczema are a good choice if you have flaking but no breaks or cracks in the skin. They can cause stinging if the skin is broken.

Emollient moisturizers are ideal if you are in the middle of an acute flare. They are non-irritating and form a water-tight seal on the outermost layer of skin cells.

Ceramide moisturizers tend to be more costly but are excellent options because they smooth skin and promote healing.

Studies have also shown that moisturizers with ceramides and urea may be beneficial to people with eczema, because they appear to enhance hydration and the healing of an active eczema rash.

Whatever option you use, avoid moisturizers with fragrances and dyes, which can be irritating. In addition, while healing, avoid cosmetics or choose products that are fragrance-free and hypoallergenic. Moisturize before applying makeup and reapply moisturizer when needed.

Moisturize at least three times daily, applying the product in a thick layer and rubbing in a downward motion. Avoiding rubbing in circles or up-and-down, because this can generate heat and irritate inflamed skin.

 8 Best Moisturizers for Treating Eczema

Hydrocortisone Cream

If your eczema isn't improving with moisturizing creams, a low-potency OTC hydrocortisone cream can help treat rashes and reduce skin inflammation. Hydrocortisone is a type of topical steroid that helps reduce itching and swelling by suppressing inflammatory chemicals produced by the immune system.

OTC hydrocortisone is sold at drugstores in strengths of 0.5% and 1%. After cleansing, a thin layer is applied to the affected skin and gently rubbed in. A moisturizer can then be applied to lock in moisture.

In the United States, topical steroids are classified by potency levels from 1 (highest) to 7 (lowest). Both 0.5% and 1% hydrocortisone belong to Class 7.

Common side effects include stinging, burning, redness, and dryness. Acne, folliculitis ("hair bumps"), stretch marks, discoloration, and skin atrophy (thinning) may also occur, especially when hydrocortisone is overused.

While technically safe to use on the face, OTC hydrocortisone cream is only intended for occasional, short-term use and should be used with extreme caution around the eyes. Most people won't experience any side effects if a low-potency hydrocortisone cream used for less than four weeks.

 How to Use Topical Steroids in Children

Antihistamines

Despite what some might tell you, antihistamines do not inherently relieve itching in people with eczema. Antihistamines work by blocking a chemical known as histamine that the immune system produces when confronted with an allergen (like pollen or pet dander). Since histamine is not a major player in an eczema itch, the benefits of antihistamines can vary from one person to the next.

For example, if eczema is triggered or exacerbated by an allergy (such as a food allergy or hay fever), an antihistamine may avert a flare or reduce its severity. On the other hand, if an allergy is not involved, an antihistamine may have no effect.

Antihistamines are most often recommended if itching is keeping you up at night. Older-generation antihistamines like Benadryl (diphenhydramine) have a sedating effect that can help you rest and may temper systemic inflammation.

If an antihistamine is needed during the day, a non-drowsy formulation should be used, such as:

Allegra (fexofenadine)

Claritin (loratadine)

Zyrtec (cetirizine)

Topical antihistamines should be avoided, since they can irritate the skin and provoke an eczema flare.

 When OTC Eczema Treatments Stop Working

Prescriptions

In some cases, prescription medications may be appropriate as the first treatment you try. In others, they are considered only if eczema symptoms worsen or fail to respond to conservative treatment. These drugs are sometimes used on their own or in combination with other treatments.

Topical Steroids

Topical steroids are intended for the short-term treatment of acute eczema symptoms. They are not used to prevent flares or as a substitute for a moisturizer.

These drugs are available as ointments, lotions, and creams, as well as specialized solutions for the scalp and beard areas.

The choice of a topical steroid is directed by the location of eczema, the age of the user, and the severity of the rash. Lower-potency steroids are typically used where the skin is thinnest (like the face and back of the hands), while a high-potency steroid may be needed for thick skin (such as the feet).

The following are examples of commonly used topical steroids (class 6 is the weakest, and class 1 the strongest):

Potency Class 6: Desonex gel (0.05% desonide)

Potency Class 5: Dermatop cream (0.1% prednicarbate)

Potency Class 4: Synalar (0.025% fluocinolone acetonide)

Potency Class 3: Lidex-E cream (0.05% fluocinonide)

Potency Class 2: Elocon ointment (0.05% halobetasol propionate)

Potency Class 1: Vanos cream (0.1% fluocinonide)

These drugs should always be used in the lowest effective potency for the shortest amount of time to avoid side effects. If used inappropriately, you may be at a higher risk for side effects, including skin atrophy, easy bruising, stretch marks, and spider veins (telangiectasia). As such, stronger topical steroids are typically only prescribed in the first-line treatment of moderate to severe eczema.

The overuse or prolonged use of topical steroids can have potentially serious consequences, including irreversible skin atrophy, pustular psoriasis, and corticosteroid withdrawal.

Topical Calcineurin Inhibitors

If topical steroids fail to provide relief, a class of drugs called topical calcineurin inhibitors (TCIs) may be prescribed. TCIs work by blocking a protein called calcineurin that stimulates the production of inflammatory cytokines.

Elidel (pimecrolimus) and Protopic (tacrolimus) are the two TCIs currently approved for use in the treatment of eczema. They are used as second-line therapy for moderate to severe eczema in adults or children 2 years of age and older.

Unlike topical steroids, Elidel and Protopic are not absorbed into deeper tissues and do not cause skin thinning or discoloration. As such, they can be used safely on the face and other delicate skin. Common side effects include skin redness, headache, acne, nausea, folliculitis, and flu-like symptoms.

In 2006, the FDA issued a black box warning advising health professionals and consumers that Elidel and Protopic may increase the risk of skin cancer and lymphoma. However, this warning is somewhat controversial, because the majority of recent large-scale studies do not provide evidence to support the relationship.

Oral Steroids

On rare occasions, a short course of oral steroids may be prescribed to control a severe eczema flare. These are generally only recommended if eczema symptoms are resistant to other therapies or when other treatment options are limited. Few healthcare providers will ever consider using an oral steroid in children with eczema, no matter how severe.

Extreme caution should be exercised in all cases of oral steroid use, because the prolonged use of steroids (30 days or more) can increase the risk of sepsis, thromboembolism, and bone fracture. It can also cause a "rebound effect" in which symptoms will re-emerge violently once the treatment is stopped. To avoid this, the steroid dose would be gradually tapered down over the course of weeks or months.

Prednisone, hydrocortisone, and Celestone (betamethasone) are among the oral steroids healthcare providers may consider. They work by suppressing the immune system as a whole and are only intended for short-term use.

Stronger oral immunosuppressants like cyclosporine, methotrexate, and Imuran (azathioprine) have also been tried, although there is little solid evidence to support their use for this purpose.

Antibiotics

In some cases, eczema can compromise the skin and allow bacteria to establish an infection. Secondary bacterial skin infections are common among people with eczema (most especially Staphylococcus aureus infections) and can be treated with topical or oral antibiotics.

Topical antibiotics are usually enough to treat minor local infections, while oral antibiotics may be needed for infections involving larger areas of skin. Cephalosporins, nafcillin, and vancomycin are among the antibiotics most commonly used.

The duration of therapy can vary depending on the severity of symptoms but generally does not exceed 14 days due to the risk of antibiotic resistance.

Antibiotics can only treat bacterial infections. Fungal infections like ringworm can be treated with antifungal drugs (like miconazole cream), while viral infections like herpes simplex can be treated with antivirals (like acyclovir).

The risk of secondary skin infections can be greatly reduced by washing your hands thoroughly before applying topical treatments or moisturizers to the skin.

Leukotriene Inhibitors

Leukotriene inhibitors, such as Singulair (montelukast) or Accolate (zafirlukast), are less commonly used in the treatment of eczema but may be considered if symptoms are severe and resistant to any other form of therapy.

As suggested by their name, leukotriene inhibitors work by blocking an inflammatory compound known as leukotriene, which causes the redness and swelling characteristic of dermatitis. They are more commonly used to treat asthma and severe seasonal or year-round allergies.

Taken once daily by mouth, leukotriene inhibitors may cause fever, headache, sore throat, nausea, stomach pain, diarrhea, and upper respiratory infection. Although they may be used off-label for the treatment of eczema, the benefits of such use have yet to be established.

JAK Inhibitors

In September 2021, the FDA approved OPZELURA (ruxolitinib) for the treatment of mild to moderate atopic dermatitis. It is recommended for those whose symptoms do not properly respond to topical prescription therapies. OPZELURA is the first and only Jak inhibitor approved for atopic dermatitis treatment in the United States, making it the first treatment of its kind. The drug works by selectively blocking pathways that cause many of the symptoms of atopic dermatitis, including inflammation and itching.

Specialist-Driven Procedures

There are a handful of procedures that may benefit people with severe, recurrent, or treatment-resistant eczema symptoms. These are not used on their own but are typically combined with other therapies.

Phototherapy

Phototherapy, also known as light therapy, functions similarly to sun exposure and involves controlled bursts of UVA or UVB radiation delivered either in a dermatologist's office or specialized clinic. Phototherapy is typically added to the treatment plan when topical therapies prove less than effective.

Phototherapy can reduce itch and inflammation associated with eczema and usually requires multiple treatments. Common side effects include skin dryness, redness, and mild sunburn. In rare cases, phototherapy can cause skin eruptions, liver spots (lentigines), and the reactivation of a herpes infection.

Phototherapy can be extremely effective in some people, but its use is often limited by cost, availability, and convenience. Coal tar or light-sensitizing drugs like psoralen are sometimes used to enhance the effects of phototherapy.

Wet Wrap Therapy

Wet wrap therapy is sometimes recommended for people with severe, difficult-to-treat eczema. The aim of wet wrap therapy is to help rehydrate the skin while enhancing the absorption of topical drugs. A bottom wet layer provides steady hydration, while a top dry layer helps lock in moisture.

The skin is soaked in warm water for 15 to 20 minutes and patted dry.

Topical medications are applied.

The skin is wrapped with a layer of wet gauze and covered with an elastic bandage or other dry fabric.

The wrap is left in place for two to six hours.

While wet wrap therapy can be performed at home, it should always be used as directed by a healthcare provider or dermatologist. It is not appropriate for everyone, particularly those with broken skin in whom the risk of bacterial infection is high.

Immunotherapy

Immunotherapy is meant to minimize the effects of allergy. Most types of eczema are not allergies, but symptoms can flare when you're around allergens that can trigger an allergic reaction.

Immunotherapy works by desensitizing you to allergens that trigger attacks. By exposing you to incrementally increasing doses, your immune system "learns" not to react excessively. After allergy symptoms are controlled, ongoing treatments may be needed to maintain control.

There are two types of immunotherapy:

Allergy shots have been shown to be a modestly effective add-on approach and may help reduce the frequency or severity of eczema flares. The procedure typically requires once or twice weekly shots for several months, followed by maintenance shots every two to four weeks.

Allergy drops, also known as sublingual immunotherapy, are generally less effective than shots but may be suitable for people who are scared of needles. The procedure to administer them is more or less the same as allergy shots but is mostly used off-label since it is not formally approved by the U.S. Food and Drug Administration (FDA).

To determine what shots or drops you need, an allergist will conduct a skin prick test to identify your specific allergens. Allergy shots cannot treat food allergies.

Though sometimes used in the treatment of eczema, a 2016 review of studies published in the Cochrane Database of Systematic Reviews could find no convincing evidence that allergy shots or drops were effective in reducing symptoms of the condition in children or adults.

Complementary and Alternative Medicine

Although there's not a lot of scientific evidence to support the use of complementary and alternative therapies for eczema, there are few that have shown promise.

Coconut Oil

Coconut oil is sometimes used as a natural moisturizer for eczema and appears to have an occlusive effect (meaning that it seals off water molecules so they are retained in the skin). It is also gentle on the skin and has anti-inflammatory and antimicrobial properties that may be useful in treating the disease.

A 2014 study published in the International Journal of Dermatology found that children with eczema experienced improved skin hydration and fewer symptoms after applying coconut oil to the skin for eight weeks.

A number of other plant oils, such as sunflower oil and shea butter, also have moisturizing qualities. Olive oil, on the other hand, may dry the skin and further diminish its barrier function.

Vitamin D

Vitamin D plays a central role in the effects of sun exposure on eczema. It makes sense, then, that vitamin D supplements taken orally may also help relieve eczema symptoms.

A 2016 review of studies published in the journal Nutrients supported this hypothesis, demonstrating that vitamin D deficiency was more common in people with eczema and that supplementation in those with a deficiency resulted in a roughly 40% improvement in symptoms.

While other studies have shown little benefit to supplementation, high rates of vitamin D deficiency in the United States (hovering around 40%) mean that it may be beneficial even if it does not directly improve eczema symptoms.

Probiotics

Probiotics are live bacteria sold in supplement form and found naturally in fermented foods like yogurt, miso, and kefir. They help support healthy gut flora and aid with digestion.

According to a review of studies published in JAMA Pediatrics, the use of probiotic supplements for at least eight weeks improved eczemas in children 1 year of age and older. Supplements containing mixed bacterial strains proved more effective than those with a single strain.

While other studies have shown little or no effect, the use of probiotics does not appear to cause any harm and may even help improve milk allergy symptoms (a common eczema trigger) in some children.