Your Essential Guide to Eczema Treatments
Doctor’s Note
As dermatologists, we understand the challenges of coping with eczema. The itchiness, dryness, unpredictable flares, and sleepless nights can both cause physical discomfort and emotional distress. We know that finding the right solutions can be overwhelming, but we hope to provide guidance.
What is Eczema?
Eczema, known as atopic dermatitis, is a common skin condition that makes your skin dry, red, and itchy.
It often starts when you are a baby, showing up as red patches on your cheeks, scalp, or limbs. For many kids, eczema gets better or even goes away by the time they become teenagers. But for some people, eczema doesn’t go away and continues into adulthood.
People with eczema often have times when their skin gets worse (flare-ups) and times when it gets better (remission). This means they need to take care of their skin daily to prevent flares.
Understanding eczema and how it affects you is important for managing it, as it can turn into a lifelong condition.
Eczema Symptoms
Eczema typically causes dry, itchy skin that can be very uncomfortable. Common symptoms include red or brownish patches that often appear on the hands, feet, ankles, wrists, neck, upper chest, eyelids, and inside the bend of the elbows and knees. The affected skin can become thickened, cracked, or scaly due to constant scratching and irritation. Sometimes, you may notice small, raised bumps that can leak fluid and crust over if scratched. Eczema can also cause the skin to become sensitive and swollen from scratching. Managing eczema often requires a combination of moisturizing, avoiding triggers, and sometimes using prescribed medications to reduce inflammation and itchiness.
Red or brownish-gray patches of skin
Not well-defined: hard to see where rash starts/ends (as opposed to psoriasis below)
Intense itching, which may be worse at night
Raw, sensitive, swollen skin from scratching
Thickened, cracked, or scaly skin
Eyelids commonly affected
Small, raised bumps that may leak fluid and crust over when scratched
Hands commonly affected
Eczema = Atopic Dermatitis?! Not exactly. "Eczema" is a broad term referring to inflammation in the skin. Atopic Dermatitis is a particular type of eczema that appears in childhood.
What Causes Eczema?
So why does eczema happen? The exact cause is a bit of a mystery, but here's what we know:
Genetics: You can blame Mom and Dad for this one. If your parents have a history of eczema, allergies, or asthma, you're more likely to develop it too. This means your genetic makeup plays a big role in how your skin reacts and protects itself.
Environment: Various environmental triggers can set off or worsen eczema. Common culprits include harsh soaps, detergents, certain fabrics, pet dander, pollen, and even changes in weather, such as dry air or extreme temperatures. These factors can irritate the skin and cause flare-ups.
Skin Barrier: A weakened skin barrier is another key factor. In healthy skin, the barrier works like a strong shield, keeping moisture in and harmful germs out. In people with eczema, this barrier is often weaker, allowing moisture to escape and germs to enter, leading to dry, easily irritated skin.
Personal and/or Family History: A history of eczema, allergies, or asthma in yourself or your family members increases your risk. This connection shows that eczema is often linked with other allergic conditions.
Basically, people with eczema are born with extremely sensitive skin that gets inflamed easily. Managing eczema involves understanding these triggers and taking steps to strengthen the skin barrier and avoid irritants. With proper care and treatment, it's possible to keep eczema under control and reduce flare-ups.
How is Eczema Diagnosed?
Eczema is diagnosed through a detailed process that starts with taking a thorough medical history. The doctor will ask about your symptoms, such as when they started, how long they lasted, and what might trigger them. They will also ask about your family’s history of eczema, allergies, or asthma and consider environmental and lifestyle factors that could affect your skin. You will need to describe how bad the itching and discomfort are and if there are any patterns, like when flare-ups happen.
The next step involves a physical examination by the doctor to look for signs of eczema such as redness, itching, scaling, and thickened patches. Dermatologists often recognize eczema by the consistent locations of the rashes, which can vary depending on your age:
Infant Eczema
Child Eczema
Adult Eczema
If the physical exam doesn't provide a clear diagnosis, your doctor may conduct allergy tests, such as skin prick tests or blood tests, to determine if allergies are causing your eczema. Patch testing may also be performed, where small amounts of potential allergens are applied to your skin under adhesive patches to observe any reactions.
In some cases, a small skin sample (biopsy) may be taken to examine under a microscope, which helps rule out other conditions that resemble eczema.
Finally, the doctor will differentiate eczema from other skin conditions such as psoriasis, fungal infections, or seborrheic dermatitis, using specific criteria for diagnosing eczema. This thorough process ensures that you receive an accurate diagnosis and appropriate treatment.
...Eczema or Psoriasis?
Psoriasis and eczema are both chronic skin conditions, but they have distinct characteristics. While both conditions can cause discomfort and skin inflammation, their typical distributions, visual appearance, and underlying causes differ, making accurate diagnosis essential for effective treatment.
Eczema
Location: Front of Neck, Inner Arm Creases, Back of Knees, Hands, Hands, Feet
Symptoms: VERY itchy
Appearance: Less well-defined (it's hard to see exactly where the rash starts/stops)
Age: More common in children
Note: Often improves with age
Psoriasis
Location: Scalp, Back of Neck, Elbows, Belly Button, Lower Back/Upper Butt, Front of Knees
Symptoms: Somewhat itchy
Appearance: Well-defined (you can clearly see where the rash starts/stops). Thick, white scale.
Age: More common in adults
Note: May involve nails and joints
What Makes Eczema Worse?
Many factors can trigger eczema. "Triggers" are elements that cause or worsen eczema. Recognizing them can be tough since flare-ups might occur sometime after exposure. Every patient's eczema is different, but some common triggers include:
Irritants - Soaps, detergents, shampoos, bubble baths, disinfectants, and surface cleaners.
Allergens - Pollen, pet dander, dust mites, mold, and certain foods like eggs, milk, peanuts, soy, wheat, fish, and shellfish.
Fabric - Wearing wool, synthetic fabrics, or tight clothing that can irritate the skin.
Weather: Dry and cold are typical triggers. Extreme temperatures, seasonal changes, and high humidity are less common triggers.
Infections - Bacteria (like Staphylococcus aureus), viruses (such as herpes simplex), and yeast (like what causes dandruff).
Stress - Emotional stress from school, work, or personal issues can trigger or worsen eczema flare-ups.
Scratching - Scratching can damage your skin barrier (“stratum corneum”) as it’s trying to heal.
Hormones - Hormonal changes during puberty, pregnancy, or menstruation can cause eczema to flare up.
Oftentimes, patients with eczema find it difficult to pinpoint their exact trigger. If you don't know what is flaring you, it is important to keep a daily journal to record the day's foods/stressors/events to look back and find your triggers. Download a daily printable journal below!
What Makes Eczema Better?
Eczema management requires a comprehensive approach. It's essential to have a great daily routine that protects your skin. Here are some tips to prevent eczema flares:
Moisturizer - Apply a thick, fragrance-free moisturizer immediately after bathing to lock in moisture and keep skin hydrated.
Gentle Products - Choose mild, fragrance-free soaps, shampoos, and detergents to avoid irritating your skin.
Short Showers - Limit showers or baths to 10-15 minutes and use lukewarm water instead of hot to prevent drying out your skin.
Soft Clothing - Choose clothing made of cotton or other soft, natural fibers that allow your skin to breathe and reduce irritation.
Humidifier - Use a humidifier during dry months to maintain moisture in the air and prevent your skin from becoming too dry.
Avoid Allergens - Identify and avoid allergens that trigger your eczema, such as certain foods, pollen, dust mites, or pet dander.
Manage Stress - Practice stress-reducing techniques such as yoga, meditation, deep breathing exercises, or regular physical activity to help prevent stress-induced flare-ups.
Stay Cool - Dress in layers, stay in cool environments, and take breaks to cool down during physical activities to avoid overheating and excessive sweating.
Does fragrance-free = unscented? No! "Fragrance-free" products have no added scents at all, while "unscented" products might have scent-masking chemicals. Look for fragrance-free products instead!
Eczema Flares: Step-by-Step Instructions
Managing an eczema flare can be tough, but with the proper steps, you can make your skin feel better and stay healthier. Addressing eczema flares promptly and effectively is essential to ease discomfort and prevent further skin damage. When a flare occurs, it's important to recognize the signs early and adapt your skincare routine to counteract the inflammation. This guide will walk you through easy steps to find out what triggers your eczema, use gentle skincare routines, take the right medications, and make lifestyle changes to keep your eczema under control and make flare-ups less frequent.
Step 1: Identify Triggers
Take note of any environmental changes, diet, skincare products, or stress levels. Common triggers include allergens, irritants, stress, and weather changes. If you suspect a specific trigger, avoid it!
Step 4: Medication
If prescribed medication, follow directions closely. Apply topical steroids like hydrocortisone to damp skin post-shower and seal with moisturizer. For severe flares, try wet wrap therapy by wrapping the area with wet bandages after medication and moisturizer application.
Step 7: Clothing
Wear soft, breathable, natural clothing, such as 100% cotton. Sleep on soft sheets and avoid using fabric softener, which can irritate the skin.
Step 2: Simplify Routine
Stop using ALL unnecessary products, such as perfume, hair products, nail products, shaving cream, scented lotions, and anything else that you don’t need. When you have an eczema flare, your skin is impaired and open to the environment. We treat intact skin and compromised skin very differently! Stick to the basics: a gentle cleanser, plain moisturizer, and prescribed medications.
Step 5: Prevent Infections
To prevent infection, use products that reduce bacteria on the skin. Popular choices include hypochlorous acid sprays, antiseptic washes, or bleach baths.
Step 8: Optimize Sleep
You can use antihistamines, like Benadryl, to help you sleep (although they may not reduce itching). If dry, use a humidifier to keep indoor humidity between 30-50%, which helps maintain skin moisture. Wear gloves at night to prevent scratching in your sleep.
Step 3: Gentle Skincare
Use a gentle, fragrance-free cleanser. Avoid hot water; opt for lukewarm showers or baths. Apply a thick, fragrance-free moisturizer immediately after bathing while the skin is still damp. Reapply moisturizer throughout the day, especially to affected areas. If your skin stings or burns when applying moisturizer, use plain petroleum jelly.
Step 6: Avoid Scratching
During an eczema flare-up, the top layer of your skin becomes too thin and cannot protect you adequately. It's crucial to keep this area safe and avoid scratching until it heals, which can take up to two weeks. Keep your nails short, consider wearing gloves at night, and use cold compresses to soothe itching. If you feel the need to scratch, try the pinch technique instead of scratching to avoid additional damage to the skin.
Step 9: Phototherapy
Consider using a UVB light treatment unit at home to reduce inflammation, itch, and scale. It is a small light that you shine on the affected areas a few times weekly. The light decreases the inflammation in the skin. You can buy it online (no doctor required) and use it for both flares and ongoing maintenance.
One of the most important aspects of managing eczema is managing stress. Easier said than done, I know. But stress worsens all inflammatory conditions (eczema, acne, psoriasis, etc.). Try to practice relaxation techniques such as deep breathing, meditation, or yoga. Or finally get that divorce! Just kidding.
Best Cleansers for Eczema
EltaMD Foaming Facial Cleanser
Best For - Sensitive
Form - Cream to Foam
Bromelain - Pineapples enzymes reduce inflammation
Note: Contains fragrance.
Aveeno Calm + Restore Nourishing Oat Face Cleanser
Best For - Sensitive
Form - Gel to Foam
Glycerin - Moisturizer
Oat - Moisturizer
Feverfew - Moisturizer, antioxidant
Vanicream Gentle Facial Cleanser
Best For - Dry, Sensitive
Form - Cream
Glycerin - Moisturizer
Note: Vanicream is known for being safe for the most sensitive skin. This is Vanicream’s mildest cleanser for daily use.
Neutrogena Ultra Gentle Hydrating Facial Cleanser
Best For - Dry, Sensitive
Form - Cream
Note: Minimal ingredients, safe for eczema and rosacea. Fragrance-free.
Vanicream Moisturizing Lotion
We love the Vanicream brand for the most sensitive of skin.
This is a lighter version of Vanicream™ Moisturizing Cream.
Aveeno Calm + Restore™ Oat Gel Moisturizer
Lightweight Gel
Hydrates (Glycerin)
Soothes (Oat, Feverfew, Panthenol)
La Roche-Posay Toleriane Double Repair Face Moisturizer
Lightweight Cream
Hydrates (Glycerin, Squalane, Ceramides)
Soothes (Niacinamide, Thermal Water)
Note: Provides “48 Hour” hydration. LRP’s Toleriane line is for sensitive skin. Niacinamide may cause irritation for those with most sensitive skin.
Vanicream Moisturizing Cream
We love the Vanicream brand for the most sensitive of skin.
This is a heavier version of Vanicream™ Moisturizing Lotion.
Best Moisturizers for Eczema
Moisturizers for sensitive skin are formulated to soothe and protect without causing irritation. They also often feature skin-repairing components such as ceramides or squalane to reinforce the skin's natural barrier.
❌ Avoid fragrances, alcohol, hyaluronic acid, and niacinamide, as these can exacerbate sensitivity. ❌
Vanicream Facial Moisturizer
SPF 30: Mineral
Hydrates (Glycerin, Ceramides, Squalane)
Note: Great for sensitive skin.
Tatcha The Silk Sunscreen
SPF 50: Mineral
Hydrates (Squalane, Hyaluronic Acid)
Calms (Niacinamide, Bismolol, Allantoin, Extracts)
High transparency zinc oxide (KLEAIR™)
Smoothes + Hydrates (Silk Extract)
Note: Great for skin of color and sensitive skin.
Dr. Jart Every Sun Day Mineral Sunscreen
SPF 50: Mineral
Antioxidant (Vit E)
Note: Matte finish. Contains some fragrance.
Peter Thomas Roth Max Mineral Tinted Sunscreen
SPF 45: Mineral
Nourishes (Vit C, Vit E, Safflower Extract)
Hydrates (Squalane)
Gently Exfoliates (Gluconolactone)
Note: Includes universal “vanishing” Diamond Powder for coverage. Great for skin of color and sensitive skin.
Best Sunscreens for Eczema
The best sunscreens for sensitive skin are mineral-based, containing zinc oxide or titanium dioxide, which offer broad-spectrum protection against both UVA and UVB rays. These ingredients sit on the skin's surface to physically block UV radiation, minimizing the risk of irritation. With an SPF of at least 30, these sunscreens provide effective coverage and are ideal for those prone to skin reactions.
Best Eczema Prescriptions
Sometimes, over-the-counter creams and lotions aren't enough to handle eczema. When that happens, doctors often prescribe stronger medicines that you can only get with a prescription. These prescription topicals are usually more powerful and can help manage the symptoms better. If over-the-counter options aren't working, it's important to talk to your doctor about getting a prescription. The most common prescriptions we use for eczema include:
Topical Steroids
- Reduces inflammation and itching
- Available in various strengths
- Prolonged use can thin the skin (we try not to use steroids for too long!)
- Ex: Hydrocortisone, Triamcinolone, Betamethasone
Eucrisa
- Reduces inflammation and itching
- Not a steroid
- Safe for regular use
Rinvoq
- Daily pill
- “JAK” Inhibitor
- Reduces inflammation
- Used when topical treatments fail
- Regular blood tests needed
- Risk of heart attack, stroke if >50
Prednisone
- Oral steroids sometimes used for severe flares
- Short-term use only
- Not our favorite treatment: you can flare after you stop the prednisone!
Phototherapy
- Uses UVB light to reduce inflammation and itching
- Effective for moderate to severe eczema
- Administered in a clinical setting or at home with a unit
Dupixent
- Self-injections every 2 weeks
- Stops inflammatory proteins IL-4 and IL-13
- Used if topicals are not sufficient
- Risks of eye issues
- Note: Injection is very easy, and you DON'T see the needle!
Elidel + Protopic
- Reduces inflammation and itching
- Not a steroid
- Used for sensitive areas like the face
Cibinqo
- Daily pill
- “JAK” Inhibitor
- Reduces inflammation
- Used when topical treatments fail
- Regular blood tests needed
- Risk of heart attack, stroke if >50
What Is Patch Testing?
If you experience prolonged flares (meaning more than 4-8 weeks) or repeated flares, you might consider patch testing. Patch testing is a test used to identify specific allergens that may be triggering your eyelid dermatitis. Small amounts of various substances are applied to the skin using adhesive patches, and the skin's reaction is observed to pinpoint the cause of the inflammation. The typical patch testing schedule is:
If we're being honest, patients hate this test because you cannot shower for the week, or do anything that will make you sweaty. Despite its challenges, there is tremendous insight to be gained from this test!
The T.R.U.E Test is a commonly used system for patch testing. It tests for 36 allergens in total. To see what allergens are tested, click here!
Another commonly used system is called the North American 80 Comprehensive Series (NAC-80). It tests for 80 allergens in total. To see what allergens are tested, click here!
Friday Picture: Mann J, Caruana D, Luo E, Gottesman E, Agrawal N, Lozeau D, Hessel J, Neumann M, Khanijo S, Hasan Z, Rizvi K, Gunther R, Donovan D, Chan D, Lee-Wong M, Szema AM. Attenuation of Human Growth Hormone-Induced Rash With Graded Dose Challenge. Cureus. 2022 Aug 12;14(8):e27920. doi: 10.7759/cureus.27920. PMID: 36110455; PMCID: PMC9464419.
Eczema Complications
Eczema can lead to several serious problems that affect daily life. One major issue is infections, which can happen when the irritated skin breaks. The skin can also become thick and tough from constant scratching. This can make their dermatitis worse and lower their quality of life. Besides physical discomfort, eczema can also cause emotional stress, leading to feelings of embarrassment and anxiety. These complications show how important it is to manage and treat this condition effectively.
Skin Infections - Scratching can break the skin, making it susceptible to infections. Topical or oral antibiotics may be prescribed if an infection is suspected.
Thickened Skin—Chronic scratching can cause patches of skin to become thick, and persistent inflammation can lead to changes in skin pigmentation.
Occupational Risk - People in certain professions, such as healthcare, cleaning, and hairdressing, are at high risk. Chronic symptoms can impact job performance and may even necessitate a change in occupation for some.
Reduced Quality of Life - Can interfere with daily activities and work, leading to a decline in the quality of life. Tasks requiring fine motor skills (like typing) may become difficult.
Psychological Impact - The visible symptoms of hand eczema can lead to self-consciousness and social withdrawal. Can contribute to stress and anxiety, potentially creating a vicious cycle that worsens the skin condition.
Thickened skin from years of chronic eczema
Eczema Support
Eczema can often be as challenging emotionally as it is physically. Online eczema support groups can help patients share their experiences. Whether you've lived with eczema for years, are newly diagnosed, or are supporting a loved one, these digital communities offer both practical guidance and emotional reassurance. Some of our favorites include the National Eczema Association and The Global Parents for Eczema Research (for eczema caregivers).
Eczema FAQs
Best Deodorant for Eczema?
You can’t go wrong with Vanicream if you need a product for sensitive skin. They make a deodorant that is also aluminum-free.
Sea Moss for Eczema… Yes or No?
Sea moss, also known as Irish moss, is a type of seaweed that some people use to help with skin conditions like eczema. It contains lots of vitamins and minerals that are good for your skin. When applied to the skin, its gel-like texture can be soothing and help keep the skin hydrated. However, there isn't a lot of scientific research proving it works for eczema, so it's best to talk to a doctor before using sea moss as a treatment.
Can I Use Castor Oil for Eczema?
Castor oil can help with eczema because it is moisturizing, anti-inflammatory, and antimicrobial. This is especially good for eczema, considering any open skin is more prone to infections. However, scientific evidence is limited, so it's best to do a patch test first and consult with a healthcare provider.
Does Eczema Get Better in the Summer?
For some people, eczema can get better in the summer due to increased humidity, which helps keep the skin hydrated. However, heat and sweat can also trigger flare-ups in others, so it really depends on your skin and environment.
Is Aquaphor Good for Eczema?
Yes, Aquaphor is good for eczema. It acts as a barrier that locks in moisture, helping to soothe and protect dry, irritated skin. Many people with eczema find it helpful for managing their symptoms.
Does Aquaphor Help Eczema?
Aquaphor can help with eczema by keeping the skin moisturized and preventing it from drying out. This can reduce itchiness and irritation, making it a popular choice for eczema relief. It does contain lanolin alcohol, though, which can be irritating if you have extremely sensitive skin. If you have VERY sensitive skin, we prefer plain Vaseline.
Is Aloe Vera Good for Eczema?
Aloe vera is good for eczema because it has soothing and moisturizing properties. It can help reduce the itchiness and inflammation associated with eczema, making it a natural option for relief.
Is Shea Butter Good for Eczema?
Shea butter is often used for eczema because it’s rich in fats that can help moisturize and protect the skin. It’s a good option for keeping dry, eczema-prone skin hydrated.
Does Sun Help Eczema?
For some people, sunlight can help improve eczema by reducing inflammation and bacteria on the skin. However, too much sun exposure can also dry out the skin and worsen eczema, so it’s important to find a balance.
What Soap Is Good for Eczema?
Soaps that are gentle, fragrance-free, and formulated for sensitive skin are best for eczema. Look for products labeled as hypoallergenic or specifically designed for eczema to avoid irritation.
Does Epsom Salt Help Eczema?
Epsom salt baths can help soothe the skin and reduce itching associated with eczema. However, they can also dry out the skin, so it’s important to moisturize well after taking a bath.