What Are the Best Medications for Treating Eczema?
Eczema treatment focuses on reducing inflammation and restoring the skin's protective barrier. The most common medications are emollients (moisturizers) and topical corticosteroids. For severe cases that don't respond to standard treatments, options include calcineurin inhibitors, oral immunosuppressants, biologics like dupilumab, and JAK inhibitors.
What Are the Treatment Goals for Eczema?
The primary goals of eczema treatment are to reduce skin inflammation, relieve itching, heal damaged skin, and restore the skin's natural protective barrier against irritants, dryness, and infections.
Eczema treatment varies based on several factors: the type of eczema you have, your age, where on your body the eczema appears, and how severe your symptoms are. A crucial part of successful treatment is learning to care for your skin properly with appropriate creams and ointments.
Types of medications used for eczema
Healthcare providers may prescribe different types of medications depending on your specific situation:
- Emollients (moisturizers) — the foundation of all eczema treatment
- Topical corticosteroids — anti-inflammatory creams and ointments
- Topical calcineurin inhibitors — steroid-free anti-inflammatory alternatives
- Oral immunosuppressants — tablets for severe cases
- Biologics — injectable medications targeting specific inflammatory pathways
- JAK inhibitors — newer oral medications
- Antibiotics — for infected eczema
- Antifungals — when fungal infection accompanies eczema
First-line treatment approach
For most people with eczema, the standard first-line treatment combines regular use of emollients to keep skin moisturized with topical corticosteroids applied to active eczema patches. Emollients help prevent new flares while corticosteroids reduce inflammation and itching in affected areas.
If you have dry or sensitive skin, regular emollient use even between eczema flares can significantly reduce how often you experience problems. Think of emollients as preventive care, not just treatment.
What Are Emollients and Why Are They Essential for Eczema?
Emollients are moisturizing products that help retain moisture in the skin, providing the moisture and fats that eczema-affected skin lacks. They form the foundation of eczema treatment and help prevent new flares when used consistently.
Emollients contain various ingredients that help keep moisture in the skin, including urea, propylene glycol, and glycerol. Propylene glycol also has antimicrobial properties against certain bacteria and fungi. Some emollients contain additional ingredients like sodium chloride or lactic acid that enhance moisture retention.
Available forms of emollients
Emollients are available in different formulations:
- Creams — balance of water and oil, good for daytime use
- Ointments — higher oil content, better for very dry skin and nighttime
- Lotions/Emulsions — lighter consistency, easier to spread over large areas
- Gels — water-based, good for hairy areas
How to apply emollients effectively
The key to emollient therapy is frequent and generous application. Apply emollients several times daily, including during periods when eczema is under control—this helps prevent flares from returning.
Best practices for emollient application:
- Apply generously—you'll use more than you might expect for whole-body application
- Massage into skin using your entire palm, not just fingertips
- Always apply after contact with water (bathing, swimming, hand washing)
- Apply to slightly damp skin after bathing for better absorption
- Consider keeping emollient in the refrigerator—cool application can help relieve itching
Storing your emollient in the refrigerator can provide additional itch relief. Many people find that cool emollients feel more soothing on irritated skin.
Possible side effects of emollients
Urea-containing emollients may cause stinging, warmth, redness, or prickling sensation when first applied. These effects are most common when skin is particularly damaged and sensitive. Symptoms typically decrease or disappear as the skin heals with continued use.
Common active ingredients in emollients
- Urea (various concentrations)
- Propylene glycol
- Glycerol (glycerin)
- Lactic acid
- Sodium chloride
Both over-the-counter and prescription emollients are available. Your healthcare provider can recommend the most suitable option based on your skin type and eczema severity.
How Do Corticosteroids Treat Eczema?
Topical corticosteroids (often called "steroids" or "cortisone") reduce inflammation and itching in eczema. They're applied directly to affected skin and come in four potency classes, from mild to extra strong.
Corticosteroids belong to the glucocorticoid drug class. They work by dampening the inflammatory response in the skin, which reduces redness, swelling, and itching. Regular application typically improves eczema significantly.
Available forms
Topical corticosteroids come in various formulations:
- Ointments — highest potency delivery, best for dry or thick skin
- Creams — versatile, good for most areas
- Gels — good for hairy areas or scalp
- Lotions/Solutions — best for scalp and hair-bearing areas
Potency classes
Corticosteroids are classified into four potency groups based on their strength:
| Potency Class | When Used | Example Areas | Availability |
|---|---|---|---|
| Group I (Mild) | Sensitive areas, children, maintenance | Face, neck, skin folds, genitals | Over-the-counter available |
| Group II (Moderate) | Mild to moderate eczema | Body (short-term in skin folds) | Prescription only |
| Group III (Strong) | Moderate to severe eczema | Body, hands, feet | Prescription only |
| Group IV (Extra Strong) | Severe eczema, thick plaques | Palms, soles, severe patches | Prescription only |
The percentage on the package does NOT indicate potency. A 0.01% strong corticosteroid may be more potent than a 1% mild one. The strength depends on the specific active ingredient, not the concentration.
Choosing the right potency
Your healthcare provider selects the appropriate potency based on:
- Type and severity of your eczema
- Location on your body
- Your age
- Duration of treatment needed
A common approach is to start with a stronger corticosteroid to rapidly control inflammation (usually within days), then switch to a milder one for ongoing management. This approach minimizes side effect risk while effectively treating the eczema.
In skin folds (armpits, groin, under breasts) and on thin-skinned areas (face, neck, genitals), corticosteroids penetrate more easily. This increases both effectiveness and side effect risk, so milder preparations are typically used in these locations.
How to apply corticosteroids correctly
When using both corticosteroids and emollients:
- Best practice: Apply at different times (e.g., emollient in morning, corticosteroid at night)
- If applying together: Apply corticosteroid FIRST, then emollient
- Applying emollient first can reduce corticosteroid absorption and effectiveness
When to stop treatment
Don't stop corticosteroid treatment prematurely—this is a common cause of eczema returning. Continue until:
- The eczema has completely healed
- Itching has fully resolved
- Then continue for approximately one additional week on facial areas or two weeks on other body areas
Inflammation often persists beneath the skin surface even when the skin appears healed. Gradual tapering (using less frequently or switching to milder potency) helps prevent rebound flares. Your healthcare provider will guide you on how to taper appropriately.
After stopping corticosteroids, continue regular emollient use. Skin may take up to six months to fully restore its natural protective barrier.
Possible side effects
When used as directed, corticosteroid side effects are uncommon. However, prolonged use or using too-strong preparations can cause:
- Skin thinning (atrophy) — especially with long-term use of strong preparations
- Skin discoloration — areas may become lighter; usually temporary
- Acne or rosacea — particularly on the face
- Perioral dermatitis — rash around the mouth (from facial use)
- Secondary infections — occasionally bacterial or fungal
Risk increases with stronger potencies and longer treatment duration. Following your healthcare provider's instructions minimizes these risks.
When eczema doesn't improve
If eczema isn't improving despite daily treatment, common reasons include:
- Undertreatment — applying too little or using too mild a preparation
- Secondary infection — infected eczema needs antibiotic treatment
- Contact allergy — reaction to an ingredient in treatment or other product
Contact your healthcare provider if your eczema isn't responding to treatment so they can reassess and adjust your treatment plan.
When Are Calcineurin Inhibitors Used for Eczema?
Topical calcineurin inhibitors (tacrolimus and pimecrolimus) are steroid-free anti-inflammatory medications ideal for sensitive areas like the face and neck, or when corticosteroids should be avoided. They don't cause skin thinning.
Calcineurin inhibitors work by modifying the immune response in the skin, reducing inflammation without the skin-thinning effects of corticosteroids. This makes them valuable alternatives, especially for:
- Eczema on the face or neck
- Eczema around the eyes
- Long-term maintenance treatment
- Situations where corticosteroid side effects are a concern
These medications are available by prescription only, typically prescribed by dermatology specialists. They are not recommended for children under 2 years of age.
How to apply
Apply a thin layer to affected areas. These medications often work quickly, with improvement typically seen within one to two weeks.
Do not use calcineurin inhibitors on infected eczema. Any infection must be treated first, then you can begin calcineurin inhibitor therapy.
Possible side effects
Common initial side effects include:
- Stinging or burning sensation
- Redness at application site
- Itching
These effects typically decrease with continued use as the skin improves.
Available calcineurin inhibitors
- Tacrolimus (available in different strengths for adults and children)
- Pimecrolimus
What Oral Medications Treat Severe Eczema?
For adults with severe eczema that doesn't respond to topical treatments, oral immunosuppressant tablets such as azathioprine or methotrexate may be prescribed by dermatology specialists.
Oral immunosuppressants work systemically to calm the overactive immune response throughout the body. They're reserved for severe cases when topical treatments provide inadequate control.
Monitoring requirements
Because these medications affect the immune system throughout the body, regular monitoring is essential:
- Regular blood tests to check liver function and blood counts
- Monitoring for signs of infection
- Regular follow-up appointments with your dermatologist
Possible side effects
- Gastrointestinal upset (nausea, stomach discomfort)
- Increased susceptibility to infections
- Effects on liver function
Available oral immunosuppressants
- Azathioprine
- Methotrexate
- Ciclosporin (cyclosporine)
- Mycophenolate mofetil
These medications require specialist supervision and are prescribed only when the benefits clearly outweigh the risks for your specific situation.
What Are Biologic Medications for Eczema?
Biologics are injectable medications made from antibodies or proteins that target specific inflammatory pathways. They're approved for patients aged 12 and older with moderate to severe atopic dermatitis who haven't responded adequately to other treatments.
Biologic medications work by binding to specific proteins in the body that drive inflammation, blocking their activity. Unlike traditional immunosuppressants that broadly suppress the immune system, biologics precisely target the inflammatory pathways most involved in eczema.
How biologics are administered
Biologics are given as subcutaneous (under-the-skin) injections. Many patients learn to self-inject at home after initial training from healthcare providers. Injection frequency varies by medication—some are given every two weeks, others monthly.
Who can receive biologics
Biologics may be considered when:
- You're 12 years or older
- You have moderate to severe atopic dermatitis
- Other treatments (topicals, phototherapy) haven't worked well enough
- Other treatments aren't suitable for you
These medications are prescribed by dermatology specialists and require proper authorization.
Possible side effects
- Injection site reactions — redness, swelling, or itching where the injection was given (common)
- Headache
- Eye symptoms — including red eyes, itching, or conjunctivitis (particularly with dupilumab)
Available biologics for eczema
- Dupilumab — blocks IL-4 and IL-13 signaling
- Tralokinumab — specifically targets IL-13
More biologic options continue to be developed and approved as research advances in understanding eczema's inflammatory mechanisms.
How Do JAK Inhibitors Work for Eczema?
JAK (Janus kinase) inhibitors are a newer class of oral medications that work inside cells to block inflammatory signaling pathways. Unlike biologics that work between cells, JAK inhibitors act within the cells themselves.
JAK inhibitors represent a significant advancement in eczema treatment. They're taken as tablets, making them more convenient than injectable biologics for some patients. By targeting the JAK signaling pathway, they interrupt the inflammatory cascade that drives eczema symptoms.
Available forms
JAK inhibitors for eczema are available as oral tablets. Some topical JAK inhibitors are also being developed for mild to moderate eczema.
Who prescribes JAK inhibitors
Like biologics, JAK inhibitors are prescribed by dermatology specialists for patients with moderate to severe eczema who haven't responded adequately to other treatments.
Monitoring and precautions
JAK inhibitors require careful monitoring, including:
- Regular blood tests
- Screening for certain infections before starting
- Assessment of cardiovascular risk factors
- Regular follow-up appointments
How Is Infected Eczema Treated?
Infected eczema requires antibiotic treatment in addition to standard eczema care. Signs include worsening despite treatment, spreading, weeping or oozing, yellow crusting, or small fluid-filled blisters.
Staphylococcus bacteria are commonly present on skin and frequently cause infections in eczema. The damaged skin barrier makes it easier for bacteria to cause infection.
Signs your eczema may be infected
- Eczema worsening despite usual treatment
- Spreading to new areas
- Changed appearance
- Weeping, oozing, or increased moisture
- Yellow crusting
- Small pus-filled blisters
- Increased pain (rather than just itching)
- Fever or feeling unwell
Treatment options for infected eczema
Your healthcare provider may prescribe:
- Topical antibiotic-corticosteroid combinations — cream or ointment containing both antibiotic and corticosteroid
- Oral antibiotics — tablets for more extensive infections
- Antiseptic washes or baths — to reduce bacterial load on skin
Once the infection is controlled, you can continue with your regular eczema treatment regimen.
Potassium permanganate baths
For eczema with significant weeping or blistering, potassium permanganate soaks may be recommended. This antiseptic solution, diluted in lukewarm water, helps combat bacteria, reduce inflammation, and relieve itching. You may soak affected areas (hands, feet) or take a full bath depending on how widespread the eczema is. These can be done at home following your healthcare provider's instructions.
What Helps Severe Eczema Itching?
Severe itching can be helped with sedating antihistamine tablets, which can make it easier to sleep. Both children and adults can receive these by prescription.
Eczema itching can be especially troublesome at night, interfering with sleep. Poor sleep worsens eczema in a vicious cycle. Sedating antihistamines can help break this cycle by promoting sleep.
How sedating antihistamines help
Sedating antihistamines don't directly stop eczema itching but make you drowsy, which helps you sleep through the night without scratching. Better sleep supports skin healing.
You may feel drowsy the following day after taking a sedating antihistamine. Also be aware that some children may have a paradoxical reaction and become restless or hyperactive instead of drowsy.
Other itch-relief strategies
- Keep skin well-moisturized with emollients
- Use cool emollients from the refrigerator
- Keep nails short to minimize scratch damage
- Wear soft, breathable cotton clothing
- Keep bedroom cool at night
- Consider wet wrap therapy (ask your healthcare provider)
How Should I Apply Eczema Medications Correctly?
Proper application technique maximizes treatment effectiveness. Apply corticosteroids before emollients, use generous amounts of moisturizer, and continue treatment until fully healed plus a tapering period.
Application order matters
- Best approach: Apply at different times of day
- Example: Emollient in the morning, corticosteroid in the evening
- If applying both at once:
- Apply corticosteroid FIRST
- Wait a few minutes
- Then apply emollient
Common application mistakes to avoid
- Using too little — be generous, especially with emollients
- Stopping too soon — continue corticosteroids until fully healed, then taper
- Forgetting prevention — keep using emollients even when eczema is clear
- Wrong strength for location — use milder preparations on face/folds
- Applying emollient first — this reduces corticosteroid absorption
Learning proper technique
Many healthcare facilities offer eczema education sessions where you can learn:
- Correct application techniques
- Which products are best suited for your skin
- Triggers to avoid
- How to recognize and manage flares early
What Special Considerations Apply to Facial Eczema?
Facial and neck skin is thinner and more susceptible to corticosteroid side effects. Use only mild (Group I) corticosteroids on these areas, or consider calcineurin inhibitors as a steroid-free alternative.
Why facial eczema needs special care
The skin on the face, neck, and around eyes is thinner than elsewhere on the body. This means:
- Medications absorb more readily
- Side effects are more likely
- Skin thinning is a greater concern
- Cosmetic side effects are more noticeable
Treatment options for facial eczema
- Mild corticosteroids only — Group I preparations for limited periods
- Calcineurin inhibitors — preferred for longer-term facial treatment as they don't thin skin
- Gentle emollients — fragrance-free products designed for sensitive facial skin
Do not use moderate, strong, or extra-strong (Group II-IV) corticosteroids on the face unless specifically instructed by your dermatologist for a limited period.
Possible complications of inappropriate facial corticosteroid use
- Perioral dermatitis — rash around mouth
- Steroid rosacea — redness and visible blood vessels
- Acne-like eruptions
- Skin thinning with visible blood vessels
How Is Seborrheic Dermatitis Different from Other Eczema?
Seborrheic dermatitis (dandruff/seborrheic eczema) affects the scalp and face, particularly around eyebrows and nasal folds. It has different causes than atopic eczema and requires different treatment approaches.
While seborrheic dermatitis falls under the broader eczema category, it involves overgrowth of a yeast (Malassezia) on the skin and overproduction of sebum. Treatment focuses on controlling the yeast and reducing inflammation.
Treatment differences
- Antifungal shampoos and creams are often first-line treatment
- Different corticosteroid formulations (solutions, foams for scalp)
- Ketoconazole or other antifungal agents
Frequently Asked Questions
The best medication depends on eczema severity and location. For mild cases, emollients combined with mild topical corticosteroids are first-line treatment. Moderate to severe eczema may require stronger corticosteroids, calcineurin inhibitors, or systemic treatments like biologics (dupilumab) or JAK inhibitors. Your dermatologist will recommend the most appropriate treatment based on your specific condition.
Continue using corticosteroid cream until the eczema has healed and itching has stopped. Then, continue for approximately one additional week on facial eczema and two weeks on other body areas, as inflammation may persist beneath the skin surface. Gradually taper off as directed by your doctor, and always continue using emollients after stopping corticosteroids.
No, only mild (Group I) corticosteroids should be used on the face, neck, and skin folds. The skin in these areas is thin and more susceptible to side effects like skin thinning, acne, rosacea, and perioral dermatitis. Calcineurin inhibitors (tacrolimus or pimecrolimus) are often preferred for facial eczema as they don't cause skin thinning.
Biologics like dupilumab and tralokinumab are injectable medications that target specific proteins involved in eczema inflammation. They are approved for patients aged 12 years and older with moderate to severe atopic dermatitis who haven't responded adequately to other treatments. Biologics are prescribed by dermatology specialists.
Signs of infected eczema include: worsening despite regular treatment, spreading to new areas, weeping or oozing, yellow crusting, small fluid-filled blisters, and increased redness or warmth. Staphylococcus bacteria commonly cause eczema infections. Contact your healthcare provider promptly if you notice these signs, as antibiotic treatment may be needed.
If applying both at the same time, apply the corticosteroid first, wait a few minutes, then apply the emollient. Applying emollient first can reduce corticosteroid absorption and effectiveness. Even better is to apply them at different times of day—for example, emollient in the morning and corticosteroid in the evening.
References
- American Academy of Dermatology. Guidelines of care for the management of atopic dermatitis. Journal of the American Academy of Dermatology. 2024. doi:10.1016/j.jaad.2023.08.001
- European Academy of Dermatology and Venereology. Guidelines for treatment of atopic eczema (atopic dermatitis). Journal of the European Academy of Dermatology and Venereology. 2023. doi:10.1111/jdv.19365
- Wollenberg A, et al. Consensus-based European guidelines for treatment of atopic eczema in adults and children. Journal of the European Academy of Dermatology and Venereology. 2024;38(3):e193-e211.
- Simpson EL, et al. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis. New England Journal of Medicine. 2016;375(24):2335-2348.
- Blauvelt A, et al. Efficacy and Safety of Upadacitinib vs Dupilumab in Adults With Moderate-to-Severe Atopic Dermatitis. JAMA Dermatology. 2021;157(9):1047-1055.
- Cochrane Database of Systematic Reviews. Emollients and moisturisers for eczema. 2023. doi:10.1002/14651858.CD012119.pub2
- National Institute for Health and Care Excellence (NICE). Atopic eczema in under 12s: diagnosis and management. NICE guideline [NG190]. 2023.
- World Health Organization. WHO Model List of Essential Medicines. 23rd List. 2023.
Editorial Team
Written by: iMedic Medical Editorial Team - Specialists in Dermatology
Medical Review: iMedic Medical Review Board
Last Medical Review: October 22, 2025
All content follows international guidelines (WHO, AAD, EADV) and the GRADE evidence framework. No commercial funding or pharmaceutical industry influence.