Eczema can be a frustrating skin condition. Some people get regular flare-ups while others may have itching and a rash only a few times a year.
Eczema cannot be cured, so it's important to work closely with your doctor to come up with a plan that will help you manage symptoms when they arise.
The four main aims of treatment are:
- Controlling itching
- Healing skin
- Preventing flare-ups
- Preventing infections
Different people will need different treatments depending on several factors, including age, medical history and how severe their symptoms are.
Sometimes a combination of treatments or approaches will be needed. Plus, there are things you can do yourself to help keep your skin healthy and clear.
Eczema medication can relieve your symptoms and help the skin heal when you take them as recommended. The treatments may not have the same effects on everyone, though. So, you and your doctor - or dermatologist (skin specialist) - may need to try different options to see what works best for you.
These are steroids applied directly to the skin to reduce inflammation and irritation. They can come in the form of lotions, gels, creams, mousses or ointments and are available in different strengths from mild to very strong.
Mild corticosteroids can often be bought over the counter from pharmacies, while stronger types will need a doctor's prescription.
- Mild strength medication includes hydrocortisone
- Moderate strength medication includes clobetasone butyrate
- Higher strength medication includes mometasone
Different types of corticosteroids may be needed depending on symptoms and how thick the scales on your skin are at the time. Treatment will need to be monitored by your GP to make sure it is working well.
Make sure topical corticosteroids are used as recommended to help avoid side effects, which may include thinning of the skin, skin colour changes, acne and extra hair growth.
It is rare for these to be prescribed for atopic eczema but a short course of treatment may be recommended to control severe flare-ups.
Ciclosporin is an immunosuppressant drug that can be prescribed short-term for severe, persistent eczema.
Azathioprine is another immunosuppressant drug. It is not licensed to treat eczema and can only be prescribed by dermatologists 'off licence' for people with severe eczema. It interferes with the growth of certain types of white blood cells that are involved in creating inflammation.
Methotrexate – another strong, off-licence immunosuppressant only prescribed for eczema by a dermatologist.
Alitretinoin – a drug to treat severe hand eczema in adults.
If steroid treatment isn't working you may be prescribed topical calcineurin inhibitors (TCIs) such as pimecrolimus and tacrolimus. These are relatively new treatments and help control flare-ups and dampen down the immune system.
Some of these drugs are very powerful and require constant monitoring with regular blood tests to ensure they are not having an adverse effect on other parts of your body, including your kidneys. You will need to discuss possible side effects with your doctor.