Prescription medicines

Although eczema cannot be cured, there are a number of things which can be done to help manage and control it. The aims of eczema treatment should be to heal or clear the skin, keep it in good condition and manage the symptoms of an attack or ‘flare’ when they appear.

If emollients and mild steroids are not sufficient to bring your condition under control, there are a number of other treatments that your healthcare professional may consider prescribing for you. They will advise you on how and when to use these medicines. Be patient, it may take time before you and your healthcare professional find the best treatment for you.

Please be aware that you should not use a combination of these products at the same time, unless instructed to do so by your healthcare professional, as this may be harmful. It is, however, acceptable and advisable to continue to use emollients whilst receiving these prescribed products.

Always read the pack leaflet carefully for any product you are prescribed and follow the instructions it contains. If you are unsure about any of the information contained in the leaflet or anything else about your treatment, ask your doctor or pharmacist to explain.

Prescription medicines

Stronger steroid creams

Stronger steroid creams (eg betamethasone) are used to reduce the inflammation of the skin associated with eczema ‘flare ups’. As with mild steroid creams, the lowest effective potency cream should be selected and applied sparingly. Use of high-potency steroids for prolonged periods is to be avoided as it can be associated with thinning of the skin and other side effects. You should consult your healthcare professional regularly and follow their advice carefully to minimise the risk of these effects.

Retinoid capsules

Retinoid capsules (eg alitretinoin) are used to treat patients with severe long-standing eczema of the hands which has not adequately responded to treatment with stronger, more potent, steroid creams. Chemically related to vitamin A, these capsules have been shown to have beneficial effects on both the inflammatory and immunological aspects of eczema. Retinoid therapy can be associated with birth defects when used in pregnant women, so special precautions to avoid pregnancy are required when using this class of drugs in women who are of child-bearing potential.

Topical immunosuppressants/Topical immunomodulators (TIMs)

Topical immunosuppressants (eg tacrolimus, pimecrolimus), sometimes called topical immunomodulators or TIM’s, are available as ointments or creams which, like steroids, are applied directly to the skin. Like steroids, they help to reduce local inflammation, but they have a different mechanism of action and are not associated with skin thinning. They are reserved for use in the management of eczema flare ups in patients with moderate to severe eczema and are prescribed only if steroid treatments have not worked, or if the patient cannot use other treatments because of side effects.

Steroid tablets

Steroid tablets (eg prednisolone) are sometimes used to treat severe eczema where topical treatments are not effective to calm down the body’s immune response, and are only suitable for use over short periods of time because of the potential side effects of such therapy.

Immunosuppressant tablets/ capsules

immunosuppressant tablets/ capsules (eg ciclosporin, azathioprine) are prescribed like oral steroid tablets to dampen down the body’s immune responses, and may be used for somewhat longer than oral steroids, depending on how well they are tolerated. These products are associated with side effects and patients using them will require regular blood tests and visits to the hospital during treatment.

Antibiotics

Antibiotics: If your doctor believes that your eczema has become infected (redness, weeping or blisters) as a result of bacterial invasion of damaged skin, they may decide to give you a short course of oral antibiotics and/ or an antibiotic cream or ointment to clear up the infection. Some topical products may combine a steroid cream with an antibiotic to reduce inflammation and fight infection at the same time.

Antihistamine tablets

Antihistamine tablets may sometimes be prescribed for short periods of time to help reduce the itch of eczema at night and help break patterns of sleeplessness. Antihistamines that have a sedative effect are generally taken just before bedtime and may cause some drowsiness the next day. This should be taken into account when driving or operating machinery. Antihistamine creams are not effective in eczema treatment and should be avoided as some contain ingredients which make the eczema worse.