What are Topical Corticosteroids?

Corticosteroids are medications that mimic hormones naturally produced by your adrenal glands. When applied directly to the skin, these “topical” corticosteroids help reduce inflammation and calm an overactive immune response. This makes them a key tool in managing eczema, where the skin’s reaction to irritants becomes exaggerated.

How Do Topical Corticosteroids Work in Eczema?

In eczema, your skin’s protective barrier is compromised, and the immune system can go into overdrive, causing redness, swelling, and itching. Topical corticosteroids work by calming the inflammation and suppressing the overactive immune response. They block the production of chemicals that cause inflammation, reducing redness and swelling. By dampening the immune signals in the affected area, these medications help stop the itch-scratch cycle, giving your skin a chance to heal. In short, they provide quick relief during flare-ups and help prevent further skin damage.

The Role of Topical Corticosteroids in Eczema Treatment

Topical corticosteroids are often the first treatment option recommended for eczema. They can be highly effective at reducing symptoms quickly. Many patients notice a decrease in itching and redness shortly after starting treatment. This also helps to stop the scratch cycle that can lead to more irritation or infection. With reduced inflammation, your skin has a better chance to rebuild its barrier and recover. Because eczema can vary widely from person to person, your doctor may adjust the strength and type of corticosteroid to suit your needs.

Potential Side Effects

While these medications are very effective, they can cause side effects—especially if used incorrectly or for long periods. Common side effects include:

• Skin Thinning: Prolonged use may cause the skin to become thinner.
• Stretch Marks: Especially in areas where the skin is more sensitive.
• Discoloration or Irritation: Some people may notice a change in skin color or mild irritation.
• Risk of Infection: A weakened skin barrier can sometimes increase the risk of bacterial or fungal infections.

Always use these medications as directed by your healthcare provider to minimize risks.

Topical Steroid Withdrawal

After long-term use of potent topical corticosteroids, some patients may experience what is known as topical steroid withdrawal (or red skin syndrome) when they stop using the medication suddenly. Symptoms can include:

• Severe Redness: The skin may become intensely red and inflamed.
• Burning Sensation: A feeling of burning or stinging may occur.
• Worsening Itch: Ironically, stopping the steroid can sometimes lead to increased itching before the skin starts to heal.

Two important things to remember about topical steroid withdrawal:

• While topical steroid withdrawal is real, millions of people use topical steroids without experiencing withdrawal syndrome
• In some cases, TSW can be very severe, resulting in hospitalization

If you suspect you’re experiencing topical steroid withdrawal, it’s important to work with your healthcare provider. They can help you taper off the medication gradually and explore alternative treatments to ease the transition.

Understanding Steroid Potency

Topical corticosteroids come in different strengths, ranging from very mild to super potent. Your doctor will decide which strength is right for you based on the area of the body, the severity of your eczema, and your treatment history. Here’s a quick reference table:

This table provides a general guide; your provider can discuss with you a tailored treatment plan based on your unique needs.

In Summary

Topical corticosteroids are a cornerstone in the treatment of eczema. They help reduce inflammation, soothe irritation, and give your skin a chance to repair itself. While they are very effective, understanding their proper use—and being aware of potential side effects and withdrawal symptoms—is key to managing your eczema safely and effectively. If you have any concerns about your treatment plan, be sure to discuss them with your healthcare provider.

What Are Topical Calcineurin Inhibitors?

Topical calcineurin inhibitors are non-steroidal medications designed to help control inflammation in eczema. Unlike corticosteroids, they don’t cause skin thinning, which makes them a popular choice for long-term use and for treating delicate areas of the skin. The two approved medications in this class are:

• Tacrolimus (available as an ointment)
• Pimecrolimus (available as a cream)

What role do Topical Calcineurin Inhibitors play in Eczema Treatment?

Eczema occurs when your skin’s immune system overreacts, leading to inflammation, redness, and itching. Topical calcineurin inhibitors work by blocking an enzyme called calcineurin, which is key to activating immune cells that drive inflammation. By inhibiting this enzyme, these medications help reduce inflammation and, as a result, control the itching that often leads to further skin damage through scratching. These treatments are particularly useful when steroids aren’t the best option. They provide an effective alternative for sensitive areas like the face, neck, and skin folds, where the skin is thinner and more delicate, and where long-term steroid use might not be safe. They can also serve as maintenance therapy to help prevent flare-ups after the skin has been cleared up with other treatments. Ultimately, your healthcare provider will work with you to determine if topical calcineurin inhibitors are the right option based on your overall condition and the specific areas of your eczema.

Potential Side Effects

Like all medications, topical calcineurin inhibitors can cause side effects. Some people may experience:

• Burning or Stinging: A temporary burning or tingling sensation at the application site, especially during the first few days of use.
• Redness or Irritation: Some users might notice mild redness or irritation.
• Sensitivity: Your skin might become more sensitive, so it’s important to protect it from excessive sun exposure.

It’s important to use these medications as directed by your healthcare provider. They are generally well tolerated, but if you experience any severe or persistent side effects, be sure to discuss them with your doctor.

A Quick Comparison of Topical Calcineurin Inhibitors

Here’s a table summarizing the two most common topical calcineurin inhibitors used for eczema:

This table provides a general overview. Your healthcare provider will help choose the best option based on your specific needs and the severity of your eczema.

In Summary

Topical calcineurin inhibitors offer a steroid-free option for managing eczema, especially in sensitive or delicate areas of your skin. By targeting specific immune signals, they help reduce inflammation and control itching without the risk of skin thinning. As with any treatment, it’s important to follow your healthcare provider’s instructions and discuss any concerns or side effects you might experience.

What Are Biologics?

Biologics are a type of medicine made from living cells. They’re designed to target specific parts of your immune system that are involved in causing inflammation. Unlike traditional treatments that affect large areas of your body, biologics work in a very focused way. This makes them an exciting option for treating moderate to severe eczema that hasn’t responded well to other treatments.

What Role Do Biologics Play in Eczema Treatment?

In eczema, your immune system becomes overactive, sending signals that lead to inflammation, redness, and itching. Biologics work by blocking these specific signals. For example, some biologics target proteins like interleukin-4 (IL-4) and interleukin-13 (IL-13), which are key players in the inflammation seen in eczema. By stopping these proteins from doing their job, biologics help reduce swelling, calm the skin, and break the cycle of itching and scratching. Biologics are generally reserved for patients with moderate to severe eczema, especially if other treatments such as topical creams haven’t worked well enough. These medications are usually given as injections under the skin every few weeks. By targeting the root causes of inflammation, biologics can significantly improve your symptoms and quality of life. Your healthcare provider will work with you to decide if a biologic is the right option based on your specific condition and overall health.

Potential Side Effects

Like all medications, biologics can cause side effects. Some of the most commonly reported include:

• Injection Site Reactions: Redness, swelling, or discomfort where the shot is given.
• UEye Issues: Some patients may experience conjunctivitis (red or irritated eyes) or other eye-related symptoms.
• Sore Throat or Cold-like Symptoms: A few people might notice mild upper respiratory symptoms.

While serious side effects are rare, it’s important to talk with your provider about any concerns. Your doctor will monitor you closely to ensure the treatment is both safe and effective.

Which Biologics Are Available for Treating Eczema?

Below is a table that summarizes some of the biologics currently used or under study for treating eczema:

As always, this table only provides a general overview. Your provider will discuss with you the best option based on your personal situation.

What Are JAK Inhibitors?

JAK inhibitors are a newer class of medications that work by blocking specific enzymes in your immune system called Janus kinases (or JAKs). These enzymes are part of a signaling pathway that tells your immune cells to produce inflammation. By slowing down these signals, JAK inhibitors can help reduce the redness, swelling, and itching that often come with eczema.

What's The Role of JAK Inhibitors in Eczema Treatment?

Eczema involves an overactive immune response that contributes to skin inflammation. JAK inhibitors help by:

• Blocking Inflammatory Signals: When your immune system sends out inflammatory messages, JAK enzymes are a key part of that communication. JAK inhibitors stop these messages from being delivered, which means less inflammation and fewer flare-ups.
• Reducing Itch and Irritation: By calming down the inflammatory response, these medications can help ease the itchiness and discomfort, allowing your skin to begin healing.

JAK inhibitors are typically considered for patients with moderate to severe eczema, especially when other treatments haven’t provided enough relief. They are available in different forms. Some are taken by mouth (oral formulations) and others are applied directly to the skin (topical formulations).

Potential Side Effects

One reason JAK inhibitors are considered a later line treatment is their potential for serious side effects. While most side effects with JAK inhibitors are mild and manageable, few patients experience critical or life-threatening side effects, such as serious infections. JAK inhibitors typically carry a so-called black-box warning on their FDA label which alerts to these side effects. That said, most side effects can be managed at home and with proper monitoring. Some of the most common include:

• Acne
• Headaches
• Upper respiratory infections, like a cold or flu
• An increased risk of infections, since the medication dampens your immune system
• Possible changes in blood counts or cholesterol levels

It’s important to remember that not everyone experiences these side effects, and many patients use JAK inhibitors safely under the guidance of their healthcare provider.

What JAK Inhibitors Are Available for Treating Eczema?

Different JAK inhibitors vary in how they’re administered and their specific targets within the immune system. Below is a table summarizing some examples currently used or under study for eczema:

This table is a general guide for educational purposes. Your healthcare provider can discuss with you the best option based on your individual situation and local approvals.

What Are Immunosuppressants?

Immunosuppressants are medications that help tone down your body’s immune response. In eczema, the immune system can become overactive, leading to inflammation, redness, and itching. By reducing this overactivity, immunosuppressants can help control severe eczema flare-ups. These medications are usually considered when other treatments haven’t provided enough relief.

What's The Role of Immunosuppressants in Eczema Treatment?

In eczema, an overactive immune system sends signals that cause skin inflammation and irritation. Immunosuppressants work by interfering with these signals. They slow down the activity of certain immune cells that contribute to the inflammation. In simple terms, these medications “dial down” your immune system so that it doesn’t react as strongly to triggers, giving your skin a chance to calm down and heal.

Which Immunosuppressants Are Used for Eczema?

There are several immunosuppressant medications used to manage severe eczema. The choice of medication depends on your specific condition, where in the world you are, and your doctor’s experience. Here’s a quick look at some common options:

Potential Side Effects

While immunosuppressants can be very effective in reducing severe eczema symptoms, they do come with potential side effects. Because these medications lower your immune system’s activity, you may be more prone to infections. Other side effects can include:

• Kidney or Liver Issues: Some drugs require regular blood tests to check how well your liver and kidneys are working.
• High Blood Pressure: Particularly with cyclosporine, which can affect blood pressure.
• Gastrointestinal Upset: Nausea or stomach discomfort may occur with certain medications.

It’s important to use these medications under the close supervision of your healthcare provider, who will monitor you with regular check-ups and blood tests to keep any risks in check.

In Summary

Immunosuppressants offer a powerful option for managing severe eczema by reducing the overactive immune response that causes inflammation and skin irritation. While they can provide significant relief, they also require careful monitoring due to potential side effects. If you’re considering or already using immunosuppressants for your eczema, regular communication with your healthcare provider is key to ensuring that you benefit from the treatment while staying safe.

What Are Allergies and How Do They Relate to Eczema?

Allergies occur when your immune system overreacts to substances that are normally harmless—like pollen, dust mites, pet dander, or specific foods. This overreaction can lead to the release of chemicals, such as histamine, which cause inflammation, redness, and itching.

Many people with eczema have an underlying allergic component, meaning that exposure to allergens can trigger or worsen their skin symptoms. While not every case of eczema is driven by allergies, the overlap is common, especially in individuals with a family history of allergic conditions like asthma, hay fever, or food allergies.

When you’re exposed to an allergen, your immune system can become activated and release histamine along with other inflammatory chemicals. In someone with eczema, this process can:

• Increase Itching: The histamine release makes your skin feel itchy, which often leads to scratching.
• Worsen Inflammation: The resulting inflammation can intensify the redness, swelling, and irritation already present with eczema.
• Perpetuate the Itch-Scratch Cycle: Scratching further damages the skin barrier, allowing more allergens to penetrate and fueling ongoing irritation.

Because of these effects, managing allergies can be a key part of an overall strategy to reduce eczema flare-ups.

What Are Antihistamines and How Do They Work?

Antihistamines are medications designed to block the effects of histamine, a chemical released during allergic reactions. By preventing histamine from attaching to its receptors on your skin and other tissues, antihistamines help to:

• Reduce Itching: Less histamine means less itchiness, which can help break the cycle of scratching.
• Ease Discomfort: Lower levels of histamine can also reduce redness and swelling, providing overall relief.
• Improve Sleep: For many people, the itchiness associated with allergies and eczema can disrupt sleep. Antihistamines, particularly those that cause drowsiness, can help you get a better night’s rest.

It’s important to note that while antihistamines help with the itch and some allergy-related symptoms, they are not a cure for eczema. They work best when used as part of a broader treatment plan that includes skin care and other therapies.

What Anthistamines Can I use?

Antihistamines come in different types, and their effects can vary. Here’s a quick look at the two main categories

In Summary

What Are Natural Remedies?

Natural remedies are treatments derived from ingredients found in nature, such as plants, minerals, and honey, that are used to improve health. For eczema, these remedies typically focus on moisturizing your skin, reducing inflammation, improving the skin barrier, and fighting microbes to prevent infection. They are generally free from synthetic chemicals, cost less than prescription medications, and are available at your local store.

How Do Natural Remedies Work in Eczema?

Eczema is often driven by a combination of a weakened skin barrier and inflammation. Natural remedies can help by:

• Hydration: Oils and butters lock in moisture, keeping the skin soft and reducing dryness.
• Anti-Inflammatory Effects: Ingredients like turmeric and certain plant oils can help calm inflammation, reducing redness and itchiness.
• Antimicrobial Properties: Some natural products, such as manuka honey, have antimicrobial effects that can lower the risk of skin infections.
• Nutrient Support: Minerals like zinc are vital for skin repair and immune function, potentially speeding up healing.

Using these remedies as part of a comprehensive skin care routine might help reduce flare-ups and improve overall skin health.

What Common Natural Remedies Are Used for Eczema?

Below is a table summarizing some popular natural remedies, their common forms, and their potential benefits for eczema:

Using Natural Remedies Safely

While natural remedies can offer relief, they’re not free from potential issues. Look for products that are pure and free of added chemicals. They should come from a trusted and well-reviewed source. Natural remedies are best used alongside other treatments and proper skin care routines, not as a sole therapy for severe eczema. Always test a new remedy on a small area of skin to check for any adverse reactions before applying it more widely.

In Summary

Natural remedies offer alternative ways to soothe and manage eczema symptoms. They work by moisturizing the skin, reducing inflammation, and even fighting off infection, all of which contribute to a healthier skin barrier. While many people find these remedies beneficial, it’s important to use them safely. For most patients they are only one element of their broader treatment plan.

What Are Supplements?

Supplements are products you take, usually by mouth, to add nutrients to your diet. They come in many forms, such as capsules, tablets, oils, or powders. For people with eczema, supplements may help address underlying issues like inflammation, nutrient deficiencies, or imbalances in the body that could affect your skin’s barrier.

How Can Supplements Help Manage Eczema?

Eczema is a complex condition where a weakened skin barrier and an overactive immune system both play roles. Some supplements may help by:

• Reducing Inflammation: Certain vitamins and fatty acids have anti-inflammatory properties that can help soothe irritated skin.
• Supporting the Skin Barrier: Nutrients like Vitamin D3 and essential fatty acids (Omega-3 and Omega-6) may aid in maintaining a healthy skin barrier.
• Boosting Immune Function: Probiotics and some vitamins can help balance your immune response, which is often overactive in eczema.
• Improving Overall Skin Health: A well-rounded nutritional approach can contribute to better skin repair and hydration.

It’s important to remember that while supplements can be helpful, they’re usually best used as part of a broader treatment plan that includes good skin care and medications when needed. That said, I’ve heard from many patients whose eczema has vanished once they started on probiotics, Vitamin D, or Omega-3.

What Are Some Popular Supplements for Eczema?

Below is a table that summarizes some popular supplements for eczema, their common forms, and potential benefits:

Using Supplements Safely

While supplements can offer additional support, they should be used wisely. Consult your provider before major changes, especially if you’re already taking medications. Choose high-quality products from reputable brands - it’s worth digging into reviews and the research (sign up to get notified once our guide to the best brands for eczema is available). As with any treatment, it’s always a good idea to keep track of how your skin and overall health respond. For one, you want to adjust dosages as needed. And two, you don’t want to spend money on stuff that doesn’t work for you.

In Summary

Supplements like Vitamin D3, Vitamin B12, Omega-3, Omega-6, and probiotics offer promising support for managing eczema by reducing inflammation, supporting your skin barrier, and balancing your immune system. While they’re not a cure-all, these nutrients can be an important part of your overall eczema management strategy. If you’re considering adding supplements to your routine, be sure to consult with your healthcare provider to ensure you choose the right ones for your needs.

What Is Phototherapy?

Phototherapy is a treatment that uses controlled exposure to ultraviolet (UV) light to help manage skin conditions like eczema. It’s typically used for moderate to severe cases of eczema that haven’t responded well to standard treatments. There are a few different types of phototherapy, including:

• Narrowband UVB: The most common type used for eczema.
• Broadband UVB: An older form, used less often now.
• PUVA: Combines a light-sensitizing medication (psoralen) with UVA light; this option is typically reserved for more severe cases.

The difference between the types is the wavelength of the light and the intensity. Narrowband UVB light works at 311-312 nm, while broadband UVB light works at 270-350 nm. Narrowband UVB is more effective for eczema and tends to result in longer periods of remission.

How Does Phototherapy Work?

Phototherapy works by using ultraviolet light to directly affect the cells in your skin that play a key role in the immune response. When your skin is exposed to this controlled light, the energy from the UV rays penetrates the layers of your skin and interacts with immune cells such as T lymphocytes. These cells are responsible for producing the signals that lead to inflammation and irritation in eczema. The UV light causes subtle damage to the DNA in these overactive immune cells, which then triggers a process called apoptosis—a form of programmed cell death. This reduction in the number of active T cells helps lessen the intensity of the inflammatory response.

In addition to causing some immune cells to die off, phototherapy also alters the way your skin produces and responds to chemical signals known as cytokines. These cytokines are like messengers that tell your body how strongly to react. With phototherapy, the balance shifts, resulting in fewer inflammatory signals and more signals that promote healing and calm. Over time, this rebalancing of the immune response leads to reduced redness, itching, and swelling, allowing the skin to gradually improve.

What Should I Expect During Treatment?

During treatment, you can expect to begin with an initial consultation with your dermatologist, who will evaluate your eczema and determine whether phototherapy is an appropriate option for you. If you move forward, you will typically attend sessions in a clinic or dermatologist’s office where you are exposed to a controlled dose of ultraviolet light. The treatment starts with a low dose that gradually increases based on your skin’s response. Sessions are generally scheduled two to three times per week over a period of several weeks or months, depending on how your eczema responds. Throughout the process, safety measures are in place: you will receive special goggles to protect your eyes, and your skin will be regularly monitored for any signs of irritation or adverse reactions.

If your Eczema is localized, e.g., on your hands and arms, it's also possible to do phototherapy at home. Devices are available for purchase with a prescription. Make sure to always follow the instructions of your healthcare provider to not expose yourself to inadvertent skin damage.

Benefits of Phototherapy

Phototherapy offers several significant benefits for managing moderate-to-severe eczema. Many patients find that this treatment can be a game changer when conventional therapies haven’t provided sufficient relief. One of its major advantages is that it is non-invasive, meaning it doesn’t involve injections or oral medications. Over time, numerous individuals report long-term improvements in their skin condition, including fewer flare-ups and a reduction in overall symptoms. This combination of effective symptom control and a gentle treatment approach can lead to clearer, more comfortable skin and an enhanced quality of life.

Potential Side Effects

While phototherapy can be very effective, it does come with some risks:

• >Skin Redness or Irritation: Mild redness or a sunburn-like feeling can occur after treatment.
• Dry Skin: Some people experience dryness or peeling, so moisturizing is important.
• Increased Risk of Skin Aging: Long-term exposure to UV light may contribute to premature aging of the skin.
• Rare Risk of Skin Cancer: Although the risk is low when phototherapy is properly administered, long-term or excessive exposure to UV light can increase the risk.

It’s important to discuss these risks with your healthcare provider to weigh the benefits and potential side effects based on your individual situation.

In Summary

Phototherapy offers a promising treatment option for those with moderate-to-severe eczema who haven’t found sufficient relief from traditional therapies. By using controlled exposure to UV light, this treatment can reduce inflammation, soothe itchy skin, and help restore your skin’s natural barrier. While it does carry some risks—such as skin irritation and the potential for long-term effects—it is generally safe when administered under professional supervision.