Maybe you’ve tried over-the-counter and prescription creams for your eczema. And you're careful to avoid things that might trigger your eczema. But these first-line treatments seem to have stopped working -- or never worked that well in the first place.
Perhaps you've even tried an oral or injected medication (sometimes called systemic treatments, since they work throughout your body.) Yet your eczema still isn't under control. What should you do next?
First, know that no one eczema treatment works for everyone. Many people need to use more than one, or try different types over time. There's no cure for eczema, so you can have flare-ups even with the most effective treatments.
If you haven't done so already, see a dermatologist. These doctors specialize in skin care, and are knowledgeable about the latest eczema treatments.
Some of the treatments you and your doctor might try include:
Steroids: When you’re in a severe flare, your doctor may prescribe a steroid cream, solution, foam, shot, or pill. Because steroids are good at easing inflammation, they’ll make you feel better quickly. But they can cause side effects, including insomnia and irritability. Be sure to take them for the full prescribed time, as other problems can occur by stopping abruptly.
Be aware that once the steroids clear your system, your symptoms may come back. You can help prevent this by taking good care of your skin.
Antihistamines: These drugs won’t stop a flare, but they may be able to relieve itching. Diphenhydramine ( Benadryl), which you can buy at the store, is a good choice. So are cyproheptadine (Periactin) and hydroxyzine (Atarax), which your doctor can prescribe. Take them at night, as all of these will make you sleepy.
Systemic immunomodulators: Some steroid-free drugs can stop your immune system from overreacting and attacking your skin. Cyclosporine, methotrexate, and mycophenolate are pills taken by mouth to ease itching and give your skin a chance to heal. But they do come with side effects like increased blood pressure and an upset stomach. They also put you at an increased risk for infections and cancer.
Topical PDE4 inhibitor: Crisaborole (Eucrisa) is an ointment that targets enzymes in your skin cells called phosphodiesterase-4, or PDE4. These enzymes help your body regulate inflammation. You might feel some burning or stinging where you apply the cream.
Calcineurin inhibitors: Pimecrolimus (Elidel), and tacrolimus (Protopic) are creams or ointments that can treat itching and rashes caused by eczema. Because there may be a rare link between these drugs and skin cancer, you should only use them for short periods of time. They should never be given to people with chronic health problems or to children younger than 2.
Biologics: If you have moderate to severe eczema and other treatments haven't done the trick, your doctor may prescribe a biologic drug called dupilumab (Dupixent). You get a shot of it every 2 weeks. You can use it alone or with a steroid cream. It stops inflammation by calming your immune system. Ruxolitinib (Opzelura) cream for ages 12 and up used twice daily can rapidly help with itch. Side effects include folliculitis. But this type of drug can be expensive, and your insurance may not cover it. Possible side effects include pinkeye and cold sores.
Wet wraps: This is another way to treat eczema that hasn't responded to other treatments. You take a warm bath then "seal" the moisture in your skin with a moisturizing cream. Then, you wrap the affected skin in a layer of wet cloths. You can cover that layer with dry clothes, like a sweatshirt or tube socks. Don't try this without talking to your doctor first.
Phototherapy: If your doctor suggests “light therapy,” you’ll sit under a special machine that emits UVB light. UVB rays are the type that can give you a sunburn. But when you’re exposed to very small amounts, they actually help heal your skin.
UVB rays can reduce itching and inflammation. They can also help your skin resist bacteria that can cause infections. Up to 70% of people with stubborn eczema see their symptoms improve after about a month of light therapy.
Antibiotics: Antibiotics won’t relieve your itching or skin redness. Still, you may take them if your eczema gets infected.
Talk therapy: Having eczema can make you feel anxious, angry, or hopeless. The stress you feel can make your skin worse. Talking to a therapist or counselor can help you realize that you do have some control over your health -- or at least how you react to it.
You can also join a support group with others who have eczema and are dealing with many of the same feelings.
Stress reduction: If you’re not at ease talking with a therapist, there are other ways to ease your stress.
Hypnosis, guided imagery, and meditation have all been shown to help ease eczema symptoms. You can also try biofeedback. During a treatment session, sensors attached to your body will measure your heart rate, muscle tension, and brain waves. Once you learn what it feels like when your body is upset or stressed, you can learn to calm yourself.
Diet changes: A certain food is likely not the only cause of your eczema, but it could play a part.
Certain foods may trigger a change in your skin within minutes or cause a flare days later. If you’re having a hard time clearing up your eczema with medicines, your doctor could suggest you try a food-elimination diet. You may also need to be tested for food allergies. This can confirm which foods are making your skin worse so you know to avoid them.