Managing Eczema: A Guide to Topical Treatment Options

Atopic dermatitis, also known as eczema, is a common skin condition that affects millions of people worldwide. This chronic and relapsing skin disease is characterized by a rash and intense itch that can significantly impact one’s quality of life. In this article, we provide information on the various established and newer topical treatment options available for eczema.

Preserving the Skin Barrier

Individuals with eczema have impaired skin barrier function, making it crucial to moisturize the skin to prevent eczema flares. Products containing petroleum jelly (eg, Vaseline) are highly effective moisturizers, as they trap moisture in the skin and help reduce moisture loss. For optimal effectiveness, it is recommended to apply a thin layer of petroleum jelly onto slightly damp skin after showering and gently patting the skin dry.

Fighting Off Inflammation

An overactive immune system is another component to eczema, so topical anti-inflammatory agents are commonly recommended. Topical corticosteroids are among the most studied and utilized agents. One topical corticosteroid, hydrocortisone 1%, is a formulation that is commonly found over the counter. Other topical corticosteroid formulations include desonide (eg, DesOwen), triamcinolone (eg, Kenalog), betamethasone (eg, Diprolene), fluocinonide (Vanos), and clobetasol (eg, Clobex). These agents typically require a prescription and vary in strength. Side effects include skin thinning and skin color discoloration with prolonged use.

Topical calcineurin inhibitors were first approved by the US Federal Drug Association (FDA) for eczema in the early 2000s. There are currently two formulations: tacrolimus ointment (Protopic) and pimecrolimus cream (Elidel). Side effects include burning and itching that typically lasts for minutes for the first few days of treatment.

In recent years, two newer classes of anti-inflammatory topical agents have been approved: crisaborole ointment (Eucrisa), which was approved by the FDA in 2016, and ruxolitinib cream (Opzelura), which was approved by the FDA in 2021. These formulations are prescribed less often as their long-term effects are still being studied.

Special Considerations

Several factors should be considered when deciding on the right topical formulation, including the person’s age, rash and itch severity, percentage of total body skin affected, location of affected skin, cost, and tolerability.

If you have eczema, it’s important to consult with a dermatologist to explore your treatment options and determine the most appropriate regimen for you.

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