Treatment When Your Eczema Gets Worse

Antihistamines

Your doctor may recommend antihistamines to ease inflammation and itching if you have allergies or sensitive skin. Antihistamines are available in the following forms:

• Pills
• Chewable tablets
• Skin creams, lotions, and gels
• Syrups
• Nose sprays
• Eye drops
• Injections
• Anal suppositories

These drugs won’t stop a flare but may ease itching. Over-the-counter options include:

• Diphenhydramine (Benadryl)
• Chlorpheniramine (Chlor-Trimeton)
• Cetirizine (Zyrtec)
• Loratadine (Claritin)

Some antihistamines contain ingredients that make you drowsy, so be sure to read the package before purchasing.

Prescription-strength antihistamines, such as cyproheptadine (Periactin) and hydroxyzine (Atarax), are also an option. Take them at night, as they will make you sleepy.

Side effects of antihistamines

The possible side effects include:

• Drowsiness
• Loss of coordination
• Low blood pressure
• Headaches
• Dizziness
• Blurry or double vision
• Dry mouth
• Dry eyes
• Sore throat
• Belly pain, nausea, or vomiting

Older and newer types of antihistamines cause some different side effects, so ask your doctor what to expect from the one that you take.

Systemic Immunomodulators

These are powerful drugs that you take via injection or in pill form. They suppress your immune system. This helps reduce the inflammation caused by eczema, easing symptoms such as itching, dryness, and other skin irritation.

If your doctor prescribes one of these drugs, it likely will be only for a short time. They’re typically used only until your eczema is well controlled. After that, you’ll slowly come off the drug. Your doctor then may switch you to a topical medication.

Systemic immunomodulators include:

• Azathioprine
• Cyclosporine
• Methotrexate
• Mycophenolate mofetil

Side effects of systemic immunomodulators

• Higher risk of infection
• Nausea and vomiting
• An increased risk for some types of cancer
• High blood pressure (with cyclosporine)
• Possible kidney damage (linked to cyclosporine and methotrexate)
• Possible liver damage (linked to methotrexate)

You may have to undergo tests to find out if these medications will be safe for you to use, and your doctor may want to monitor you while you take these medications.

PDE-4 Inhibitors

These drugs block an enzyme called phosphodiesterase-4, or PDE4. This, in turn, prevents your immune system from producing inflammation-triggering proteins called cytokines. This results in fewer eczema symptoms, such as itching, redness, and thickened skin. Right now, there’s only one PDE-4 inhibitor available: a skin ointment called crisaborole (Eucrisa). Doctors prescribe it for mild to moderate eczema in people aged 3 months or older. You may see improvements in your eczema symptoms in a week.

Calcineurin Inhibitors

These topical drugs block a protein called calcineurin. This helps prevent the activation of immune system cells called T cells. By doing so, these drugs keep inflammation at bay and prevent eczema symptoms such as red, itchy skin.

Two such drugs have been approved: an ointment called pimecrolimus (Elidel) and a cream called tacrolimus (Protopic). They can be prescribed to people with healthy immune systems aged 2 or older.

Side effects of calcineurin inhibitors

• Burning or stinging for 15-20 minutes after applying (usually occurs only during the first week or so of use)
• Increased sun sensitivity

Some people have developed skin cancer or lymphoma (a type of blood cancer) while on these drugs. However, experts don’t know if these drugs can cause cancer. To play it safe, your doctor may prescribe these medications for a short period, only long enough to calm your eczema and allow your skin to begin healing. Your doctor may monitor you while you are on one of these drugs. You should avoid direct sunlight and tanning beds while on these medications to lessen any increased risk of skin cancer.

Biologics

These medications are made from proteins or genes taken from living organisms, which scientists then grow in a lab to create specialized drugs. While very expensive, they can treat some diseases more effectively than other types of drugs. In eczema, they’re used to block a type of immune system protein called interleukin (IL). By doing so, these drugs reduce inflammation and ease your eczema symptoms. They’re prescribed for moderate to severe eczema. You receive them via injection either into your skin or a vein. So far, only two biologics have been approved to treat eczema, but many more are being developed and may eventually prove effective.

Dupilumab (Dupixent)

The first biologic approved for eczema, dupilumab blocks two different interleukin proteins: IL-4 and IL-13. It’s injected under the skin to treat moderate to severe eczema in people aged 6 months or older. You will receive injections every 2 weeks or every month.

Side effects of dupilumab

• Reactions at the injection site
• Inflammation of the eyes or eyelids, causing redness, swelling, or itching, as well as possible blurred vision
• Dry eyes
• Cold sores on your lips or in your mouth
• Higher than normal white blood cell counts

Janus Kinase (JAK) Inhibitors

One culprit responsible for eczema inflammation is a type of immune system protein called cytokines. They send signals via what’s known as the JAK-STAT, a chemical pathway in your cells. By blocking parts of this pathway, JAK inhibitors prevent the inflammation caused by cytokines. Two JAK inhibitors treat eczema: abrocitinib (Cibinqo) and upadacitinib (Rinvoq). They are prescribed for moderate to severe eczema when other drugs, including biologics, have failed to effectively control your symptoms or if you’re unable to take other drugs.

Side effects of JAK inhibitors

• The common cold
• Bronchitis
• Urinary tract infections (UTIs)
• Ear infections
• Nausea
• Headache

More serious side effects of JAK inhibitors include pneumonia and tuberculosis.

Phototherapy

Also called "light therapy," phototherapy treats widespread eczema that occurs all over your body. Your doctor also may recommend it for more isolated patches of eczema, such as on your hands and feet, if they have not responded to other topical treatments.

Phototherapy typically uses what’s called narrowband ultraviolet-B (NB-UVB) light, though your doctor may opt to use other types of UV light as well. Before treatment, a moisturizing oil will be applied to your skin. You’ll then enter a light cabinet wearing just your underwear and protective goggles and undergo short doses of light, lasting a few seconds or minutes. You likely will require repeated treatments over 1-2 months before you see significant improvements in your symptoms, such as inflammation and itching.

Side effects of phototherapy

• Sunburn
• Skin tenderness
• Skin rash
• Nonmelanoma skin cancer
• Cataracts (a risk if your doctor uses ultraviolet A light)

Antibiotics

These drugs don’t treat your eczema symptoms, such as itching or inflammation. However, certain normally harmless bacteria that live on your skin can trigger infections in the skin of people with eczema. So, your doctor may recommend treatments such as topical and oral antibiotics as well as antiseptic soaps and "bleach baths," which contain sterilizing chemicals. However, recent research suggests such treatments are ineffective. Your doctor can determine if you will benefit from antibiotic treatments.

Wet Wraps

Your doctor may recommend this treatment to manage severe itch and pain caused by intense eczema flares. Wet wraps not only hydrate your skin and ease symptoms but can also help your topical treatments work more effectively. You should do wet wrap therapy after you have bathed and applied moisturizer or any topical treatments you use.

The process is simple. You take clean cotton clothing (white is ideal), cotton wrap dressing, or cotton gauze. Lightly moisten the material with warm water. You don’t want it to drip. Wrap the material on your affected areas. Then get into dry clothes such as pajamas. Use cotton gloves for your hands and cotton socks for your feet, covered with vinyl gloves or plastic wrap. Leave the wraps on for several hours or overnight. If you have eczema on your face, a nurse trained to prepare and place wraps will need to help you.

Talk to your doctor before using wet wraps. It’s important to apply them correctly and keep them moist. Otherwise, they can dry your skin. They also can cause your skin to absorb more of the topical medications that you use. That can increase the risk for steroid side effects.

Therapy

Eczema can take a drastic toll on your mental health. Many adults and children with eczema develop mental health conditions such as depression and anxiety. Nearly half of people with eczema have thoughts of suicide, and they are significantly more likely to attempt suicide. And it’s a two-way street: poor mental health can make your eczema worse.

Fortunately, effective mental health treatment can help. For example, a type of talk therapy called cognitive behavioral therapy (CBT) can lead you to develop a more positive outlook and feel better. It can ease your symptoms of anxiety and depression and teach you ways to better manage your life with eczema. CBT takes time — weeks or months — but it can result in long-term benefits. Your doctor can refer you to a mental health professional.

Stress Management

Stress impacts your immune system and can trigger skin inflammation. By reducing the amount of stress you experience daily, you may ease some of your eczema symptoms. There are several ways you can relax, both with help from a therapist and with practices you do on your own.

• Cognitive behavioral therapy (CBT)
• Deep breathing, particularly while listening to soothing music or recordings of nature sounds
• Guided meditation and mindfulness, both of which you can do with the help of an app
• Yoga or tai chi
• Walks in nature
• Creative activities, such as writing, painting, baking, knitting, or even playing video games, to distract you from negative thoughts

Diet Changes

Eczema is not caused by your diet, but food allergies often accompany eczema and can lead to eczema symptoms when you eat those foods. Avoiding those foods — which are different for different people — can help, but it won’t eliminate your eczema entirely. It can be hard to identify the foods that cause an allergic reaction, as they don’t always show up on allergy tests. Adding to the confusion: when in a flare, some people react poorly to lots of different foods, while you may be able to eat triggering foods without consequence if your eczema is in remission.

So, what do you do? First, talk to your doctor about any concerns you have about the role of your diet in your eczema. Your doctor may recommend an anti-inflammatory diet, which avoids foods more likely to contribute to inflammation. Such foods include:

• Red meat
• Processed meat
• Sugary foods and beverages
• Bread and pasta made from white rather than whole-grain flour
• Deep-fried foods
• Commercially baked products such as pies, cookies, and brownies
• Trans fats, found in margarine and shortening, frozen pizza, microwave popcorn, and nondairy creamer

Instead, your doctor may recommend an eating plan such as the Mediterranean diet. This focuses on the following types of anti-inflammatory foods:

• Fruits and vegetables
• Whole grains
• Nuts and seeds
• Fish
• Olive oil
• Beans

Trigger Management

Although experts don’t know what causes eczema, they do know that certain things can trigger the disease to flare, causing symptoms such as itching and inflammation. Knowing and avoiding your triggers can help. Here are the most common triggers:

• Dry skin
• Food allergies
• Environmental allergens, such as pollen, mold, pet dander, and dust mites
• Contact allergies, or reactions to things that touch your skin, such as nickel, rubber, and chemicals found in some cosmetics and skin care products
• Skin irritants, such as certain soaps, detergents, fragrances, and fabrics such as wool and synthetics
• Heat, which can cause dry skin and irritating sweat

Getting Expert Help for Severe Eczema Treatment

If you have severe eczema, you should be treated by a board-certified dermatologist who can create an effective treatment plan for you. This plan will include:

• A skin care routine of bathing and moisturizing
• Identifying and avoiding triggers
• Medications

It’s also critical to diagnose and treat other health conditions you may have because they may make your eczema treatments less effective or your eczema worse. For example, untreated depression can increase inflammation and trigger eczema.

Takeaways

Lots of effective options exist to treat eczema. The right one for you will depend in large part on the severity of your disease. In addition to medications, there’s plenty that you can do to feel better, including avoiding eczema triggers, eating a healthy diet, taking care of your mental health, and managing your stress. Talk to a dermatologist, who can develop a personalized treatment plan.

Severe Eczema Treatment FAQs

What is the best treatment for severe eczema?

Your treatment plan for severe eczema will include skin care, such as baths and moisturizers, avoiding eczema triggers, and medications. Your dermatologist will determine which medications will be most effective for you.

What is the best OTC eczema medication?

There are a few effective types that your doctor likely will recommend:

• Lotions and moisturizers for dry skin
• Antihistamines and pain relievers to curb inflammation and pain
• Topical hydrocortisone, a low-potency steroid cream
• Medicated shampoos that contain ingredients like ketoconazole, selenium sulfide, coal tar, and zinc pyrithione

What is the number one trigger for eczema?

Everyone has different triggers. Some of the most common types of eczema triggers include:

• Environmental triggers, like pollen and other allergens
• Certain foods
• Dry skin
• Heat and dry weather
• Irritants like certain soaps, detergents, and fragrances

How do people live with severe eczema?

If you have severe eczema, a board-certified dermatologist can help you manage it. Your treatment plan will include skin care, avoiding triggers, and medications. You may benefit from mental health therapy as well as self-care routines like stress management.

How do you calm an eczema flare-up?

You should talk to your doctor and have a plan ready for a flare. Often, this will mean using topical steroids for a short period in order to ease inflammation. You also will need to stick with your regular skin care routine, such as moisturizing. Don’t ignore the signs of a flare. It’s best to act fast. Also, be sure to have medications and other essentials on hand in anticipation of a flare.

Which doctor should I see for atopic eczema treatment?

You should see a dermatologist, a doctor who specializes in treating the skin.