Eczema treatments

Emollients are the most common treatment for eczema and consist of creams, lotions or ointments which are applied as a protective film to the skin helping to soothe it and reduce water loss. They should be used every day, even on those days when your symptoms are fewer or your eczema appears under control.

Apply emollients liberally and often because their effects are short-lived and their benefits will be lost with washing or rubbing caused by clothes. A good time to use emollients is just after a bath, while the skin is still moist. Oils or washes are also available which can be used in the shower or added to bath water, but avoid scented bubble bath products, soaps or shower gels as these can cause skin sensitisation, dehydrate the skin and make your symptoms worse.

The degree of greasiness of emollients generally determines the amount of moisture-holding ability they will have. Greasier preparations will be better for dry, cracked and thickened skin. They can be applied thickly overnight to help hydrate the skin, but this can be messy. Thinner creams and lotions are absorbed into the skin more easily, but their benefits don’t tend to last as long.

You will need to apply large quantities of emollient on a regular basis throughout the day to keep your skin as hydrated as possible. Regular use of emollients should help to reduce the frequency and severity of eczema flares. Remember, it is not possible to overuse emollients and you should continue to use them, even if your healthcare professional decides that you need a prescription treatment in addition to help manage your condition. If you have any questions about emollients, including how often you should be using them, please speak to your healthcare professional.

Mild steroid creams (e.g. hydrocortisone) are used to calm the symptoms of an eczema flare up by suppressing the body’s inflammatory response (steroid drugs that reduce inflammation are also known as corticosteroids). You should seek advice from your pharmacist regarding the strength (potency) and length of treatment that is best for you. In the UK, steroid creams are graded into one of four groups according to their strength or potency as mild, moderately potent, potent and very potent. Patients are generally advised to use the weakest effective potency for the shortest duration of time to bring their ‘flare’ under control. Stronger, more potent steroids are only available on prescription (see below).

Stronger steroid creams (e.g. 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.

Topical immunosuppressants (e.g. 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.

Retinoid capsules (e.g. 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.

Steroid tablets (e.g. 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 (e.g. 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: 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 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.