There is no cure for eczema, but treatment can help protect the skin and control itching, inflammation and infection. Treatment for moderate to severe eczema requires a customized approach based on recognizing the nuances of patients’ clinical presentation, identifying triggers and common problems that accompany eczema. A comprehensive treatment strategy seeks to:
- Restore the damaged skin barrier: Every patient with eczema should use moisturizers regularly to improve the damaged skin barrier in eczema. Thicker moisturizers work better at sealing in the skin’s moisture. Some eczema creams contain ceramides (a type of lipid) and other ingredients that aim to restore the skin’s barrier function.
- Decrease the inflammation:
- Topical steroid creams and calcineurin (T-cell) inhibitors are typically the first choice in anti-inflammatory treatments.
- When topical creams are not strong enough, systemic treatments can be used to get better short-term control of the inflammation, such as:
- Phototherapy (both UV and PUVA)
- Corticosteroid pills, liquids or injections
- Other immunosuppression medications
- Target the itch:
- Antihistamines: Antihistamines have long been used as the primary treatment for itch. While they do help patients sleep better through the night, there is little evidence that they actually reduce itch.
- Neuroactive medications: Neuroactive medications were shown to improve itch in controlled clinical trials.
- Other medications: There are a number of other medications that can treat the itch caused by eczema. If your itch is not well controlled, please ask your physician about other treatment options.
- Prevent infection: Oral antibiotics kill the bacteria that cause infections. Always finish a prescription for antibiotics unless otherwise directed by your physician.
- Lifestyle changes: There are strategies you can use at home to try to control outbreaks, including:
- Avoiding allergens
- Wet dressings with corticosteroid cream