Table of ContentsView AllTable of ContentsDetermining the Severity of EczemaCommon First-Line TherapiesTreatment For Severe Eczema
Table of ContentsView All
View All
Table of Contents
Determining the Severity of Eczema
Common First-Line Therapies
Treatment For Severe Eczema
For many people with mildeczema, over-the-counter (OTC)lotions and creamsare enough to control eczema symptoms. But if your eczema is severe—or it has stopped responding to OTC strategies—you may need a more aggressive therapy.
Aleksej Sarifulin / Getty Images
When determining the severity of your eczema, your healthcare provider will base it upon characteristics of your skin findings.
With mild eczema, your skin will be dry and may or may not have any redness associated with it. You should also not have any eczema-related disturbances to sleep or other daily activities.
Moderate to moderately-severe casesof eczema may have an impact on your daily activities, including sleep. In cases of moderate eczema, you can expect to havedry, itchyand red areas of eczema. The skin will sometimes also becomeexcoriated.
In severe cases of eczema, you will have widespread areas of dryness and redness. Itchiness increases greatly between moderate and severe cases of eczema. With eczema of this severity, the itchiness that you experience is continuous and can severely impact your ability to sleep and carry on with daily activities. It can affect your mental and social health as well.
There are many options available to help treat eczema that can be found over the counter (OTC). Product lines that can be found in your average grocery & home store include:
7 Home Remedies for Eczema
There are several first-line treatments that you can not buy over-the-counter, but instead can be had with a prescription from your healthcare provider. These products include:
Treatment for Severe or Refractory Eczema
If you are suffering from mild to moderate eczema, OTC or some prescription medications are likely all that you will need to treat single or exacerbated occurrences.
If you are using OTC medications and have either no resolution or even a worsening of symptoms, then you should start with seeing your healthcare provider.
A healthcare provider can help evaluate the following common reasons that treatment may initially be ineffective. Reasons can include:
Prior to starting any prescription medications to enhance your eczema treatment, the items listed above should all be evaluated to help bring resolution as quickly as possible. A resolution will not occur despite more aggressive therapy if instigating factors have not been removed.
Soak and Smear
If you have eczema that is not clearing up with using OTC medications, the soak-and-smear method may be useful for cases that are widespread.
You should avoid rubbing highly concentrated lotions to your groin, armpit (axilla), or face.
Wet Wraps
Children, in particular, may benefit from wet wraps if they have failed both topical corticosteroids and/or topical calcineurin inhibitors. Wet wraps consist of three layers:
Wet wraps can be used for as short a time as 15 minutes to half an hour if done two to three times a day. Typically you will be asked to try and keep these wraps in place for two or more hours, as long as it’s tolerated. If possible, you can leave the wet wraps in place for 24 hours if you are able to sleep comfortably with them on.
Wet wraps that are used for more than two hours should be done once or twice a day. Therapy using wet wraps should be used for two to 14 days until symptoms resolve.
Second-Line Therapies
If your eczema has not resolved after 14 days of using wet wraps, and environmental factors have been removed or deemed not applicable, you should seek an evaluation from either an allergist or a dermatologist. They may recommend one or several second-line therapies.
Phototherapy:This treatment is also referred to as light therapy, as it uses narrow-band ultraviolet B rays to treat eczema.Treatment usually occurs approximately three times a week and is re-evaluated after approximately 20 to 25 treatments.
When you attend aphototherapysession, plan on applying a moisturizing oil to your entire body and then removing your clothes except for underwear and protective glasses while you are in a booth. The treatment only lasts a few seconds to a few minutes. Your response and dose can be adjusted based on tolerance to the treatment.
Phototherapy is not a quick therapy, as it may take a couple of months to help resolve your eczema. Once resolved, you can either stop phototherapy to determine whether you are in remission, or maintain a maintenance schedule.
Systemic Therapy:This is an additional option that may be considered when other treatments have failed. Systemic treatment involves medications that are consideredimmunosuppressive, meaning that the medications decrease your body’s ability to mount an immune response.
Common medication choices may include:
How Eczema Is Treated
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hanifin JM, Baghoomian W, Grinich E, Leshem YA, Jacobson M, Simpson EL.The eczema area and severity index-a practical guide.Dermatitis. 2022;33(3):187-192. doi:10.1097/DER.0000000000000895Schonmann Y, Mansfield KE, Hayes JF, et al.Atopic eczema in adulthood and risk of depression and anxiety: a population-based cohort study.J Allergy Clin Immunol Pract. 2020;8(1):248-257.e16. doi:10.1016/j.jaip.2019.08.030Elsner P, Agner T.Hand eczema: treatment.J Eur Acad Dermatol Venereol. 2020;34 Suppl 1:13-21. doi:10.1111/jdv.16062Brown SJ.Atopic eczema.Clin Med (Lond). 2016;16(1):66-69. doi:10.7861/clinmedicine.16-1-66Weber TM, Herndon JH Jr, Ewer M, et al.Efficacy and tolerability of steroid-free, over-the-counter treatment formulations in infants and children with atopic dermatitis.J Dermatol Nurses Assoc. 2015;7(1):17-24. doi:10.1097/JDN.0000000000000101Lax SJ, Harvey J, Axon E, et al.Strategies for using topical corticosteroids in children and adults with eczema.Cochrane Database Syst Rev. 2022;3(3):CD013356. doi:10.1002/14651858.CD013356.pub2National Eczema Society.Treatments for eczema.American Academy of Pediatrics.Treatment of atopic dermatitis.González-López G, Ceballos-Rodríguez RM, González-López JJ, Feito Rodríguez M, Herranz-Pinto P.Efficacy and safety of wet wrap therapy for patients with atopic dermatitis: a systematic review and meta-analysis.Br J Dermatol. 2017;177(3):688-695. doi:10.1111/bjd.15165Musters AH, Mashayekhi S, Harvey J, et al.Phototherapy for atopic eczema.Cochrane Database Syst Rev. 2021;10(10):CD013870. doi:10.1002/14651858.CD013870.pub2Sawangjit R, Dilokthornsakul P, Lloyd-Lavery A, Lai NM, Dellavalle R, Chaiyakunapruk N.Systemic treatments for eczema: a network meta-analysis.Cochrane Database Syst Rev. 2020;9(9):CD013206. doi:10.1002/14651858.CD013206.pub2Wollenberg A, Blauvelt A, Guttman-Yassky E, et al.Tralokinumab for moderate-to-severe atopic dermatitis: results from two 52-week, randomized, double-blind, multicentre, placebo-controlled phase III trials (ECZTRA 1 and ECZTRA 2).Br J Dermatol. 2021;184(3):437-449. doi:10.1111/bjd.19574Additional ReadingNational Eczema Association.Eczema treatment.UpToDate.Management of severe, refractory atopic dermatitis (eczema) in children.
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hanifin JM, Baghoomian W, Grinich E, Leshem YA, Jacobson M, Simpson EL.The eczema area and severity index-a practical guide.Dermatitis. 2022;33(3):187-192. doi:10.1097/DER.0000000000000895Schonmann Y, Mansfield KE, Hayes JF, et al.Atopic eczema in adulthood and risk of depression and anxiety: a population-based cohort study.J Allergy Clin Immunol Pract. 2020;8(1):248-257.e16. doi:10.1016/j.jaip.2019.08.030Elsner P, Agner T.Hand eczema: treatment.J Eur Acad Dermatol Venereol. 2020;34 Suppl 1:13-21. doi:10.1111/jdv.16062Brown SJ.Atopic eczema.Clin Med (Lond). 2016;16(1):66-69. doi:10.7861/clinmedicine.16-1-66Weber TM, Herndon JH Jr, Ewer M, et al.Efficacy and tolerability of steroid-free, over-the-counter treatment formulations in infants and children with atopic dermatitis.J Dermatol Nurses Assoc. 2015;7(1):17-24. doi:10.1097/JDN.0000000000000101Lax SJ, Harvey J, Axon E, et al.Strategies for using topical corticosteroids in children and adults with eczema.Cochrane Database Syst Rev. 2022;3(3):CD013356. doi:10.1002/14651858.CD013356.pub2National Eczema Society.Treatments for eczema.American Academy of Pediatrics.Treatment of atopic dermatitis.González-López G, Ceballos-Rodríguez RM, González-López JJ, Feito Rodríguez M, Herranz-Pinto P.Efficacy and safety of wet wrap therapy for patients with atopic dermatitis: a systematic review and meta-analysis.Br J Dermatol. 2017;177(3):688-695. doi:10.1111/bjd.15165Musters AH, Mashayekhi S, Harvey J, et al.Phototherapy for atopic eczema.Cochrane Database Syst Rev. 2021;10(10):CD013870. doi:10.1002/14651858.CD013870.pub2Sawangjit R, Dilokthornsakul P, Lloyd-Lavery A, Lai NM, Dellavalle R, Chaiyakunapruk N.Systemic treatments for eczema: a network meta-analysis.Cochrane Database Syst Rev. 2020;9(9):CD013206. doi:10.1002/14651858.CD013206.pub2Wollenberg A, Blauvelt A, Guttman-Yassky E, et al.Tralokinumab for moderate-to-severe atopic dermatitis: results from two 52-week, randomized, double-blind, multicentre, placebo-controlled phase III trials (ECZTRA 1 and ECZTRA 2).Br J Dermatol. 2021;184(3):437-449. doi:10.1111/bjd.19574Additional ReadingNational Eczema Association.Eczema treatment.UpToDate.Management of severe, refractory atopic dermatitis (eczema) in children.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Hanifin JM, Baghoomian W, Grinich E, Leshem YA, Jacobson M, Simpson EL.The eczema area and severity index-a practical guide.Dermatitis. 2022;33(3):187-192. doi:10.1097/DER.0000000000000895Schonmann Y, Mansfield KE, Hayes JF, et al.Atopic eczema in adulthood and risk of depression and anxiety: a population-based cohort study.J Allergy Clin Immunol Pract. 2020;8(1):248-257.e16. doi:10.1016/j.jaip.2019.08.030Elsner P, Agner T.Hand eczema: treatment.J Eur Acad Dermatol Venereol. 2020;34 Suppl 1:13-21. doi:10.1111/jdv.16062Brown SJ.Atopic eczema.Clin Med (Lond). 2016;16(1):66-69. doi:10.7861/clinmedicine.16-1-66Weber TM, Herndon JH Jr, Ewer M, et al.Efficacy and tolerability of steroid-free, over-the-counter treatment formulations in infants and children with atopic dermatitis.J Dermatol Nurses Assoc. 2015;7(1):17-24. doi:10.1097/JDN.0000000000000101Lax SJ, Harvey J, Axon E, et al.Strategies for using topical corticosteroids in children and adults with eczema.Cochrane Database Syst Rev. 2022;3(3):CD013356. doi:10.1002/14651858.CD013356.pub2National Eczema Society.Treatments for eczema.American Academy of Pediatrics.Treatment of atopic dermatitis.González-López G, Ceballos-Rodríguez RM, González-López JJ, Feito Rodríguez M, Herranz-Pinto P.Efficacy and safety of wet wrap therapy for patients with atopic dermatitis: a systematic review and meta-analysis.Br J Dermatol. 2017;177(3):688-695. doi:10.1111/bjd.15165Musters AH, Mashayekhi S, Harvey J, et al.Phototherapy for atopic eczema.Cochrane Database Syst Rev. 2021;10(10):CD013870. doi:10.1002/14651858.CD013870.pub2Sawangjit R, Dilokthornsakul P, Lloyd-Lavery A, Lai NM, Dellavalle R, Chaiyakunapruk N.Systemic treatments for eczema: a network meta-analysis.Cochrane Database Syst Rev. 2020;9(9):CD013206. doi:10.1002/14651858.CD013206.pub2Wollenberg A, Blauvelt A, Guttman-Yassky E, et al.Tralokinumab for moderate-to-severe atopic dermatitis: results from two 52-week, randomized, double-blind, multicentre, placebo-controlled phase III trials (ECZTRA 1 and ECZTRA 2).Br J Dermatol. 2021;184(3):437-449. doi:10.1111/bjd.19574
Hanifin JM, Baghoomian W, Grinich E, Leshem YA, Jacobson M, Simpson EL.The eczema area and severity index-a practical guide.Dermatitis. 2022;33(3):187-192. doi:10.1097/DER.0000000000000895
Schonmann Y, Mansfield KE, Hayes JF, et al.Atopic eczema in adulthood and risk of depression and anxiety: a population-based cohort study.J Allergy Clin Immunol Pract. 2020;8(1):248-257.e16. doi:10.1016/j.jaip.2019.08.030
Elsner P, Agner T.Hand eczema: treatment.J Eur Acad Dermatol Venereol. 2020;34 Suppl 1:13-21. doi:10.1111/jdv.16062
Brown SJ.Atopic eczema.Clin Med (Lond). 2016;16(1):66-69. doi:10.7861/clinmedicine.16-1-66
Weber TM, Herndon JH Jr, Ewer M, et al.Efficacy and tolerability of steroid-free, over-the-counter treatment formulations in infants and children with atopic dermatitis.J Dermatol Nurses Assoc. 2015;7(1):17-24. doi:10.1097/JDN.0000000000000101
Lax SJ, Harvey J, Axon E, et al.Strategies for using topical corticosteroids in children and adults with eczema.Cochrane Database Syst Rev. 2022;3(3):CD013356. doi:10.1002/14651858.CD013356.pub2
National Eczema Society.Treatments for eczema.
American Academy of Pediatrics.Treatment of atopic dermatitis.
González-López G, Ceballos-Rodríguez RM, González-López JJ, Feito Rodríguez M, Herranz-Pinto P.Efficacy and safety of wet wrap therapy for patients with atopic dermatitis: a systematic review and meta-analysis.Br J Dermatol. 2017;177(3):688-695. doi:10.1111/bjd.15165
Musters AH, Mashayekhi S, Harvey J, et al.Phototherapy for atopic eczema.Cochrane Database Syst Rev. 2021;10(10):CD013870. doi:10.1002/14651858.CD013870.pub2
Sawangjit R, Dilokthornsakul P, Lloyd-Lavery A, Lai NM, Dellavalle R, Chaiyakunapruk N.Systemic treatments for eczema: a network meta-analysis.Cochrane Database Syst Rev. 2020;9(9):CD013206. doi:10.1002/14651858.CD013206.pub2
Wollenberg A, Blauvelt A, Guttman-Yassky E, et al.Tralokinumab for moderate-to-severe atopic dermatitis: results from two 52-week, randomized, double-blind, multicentre, placebo-controlled phase III trials (ECZTRA 1 and ECZTRA 2).Br J Dermatol. 2021;184(3):437-449. doi:10.1111/bjd.19574
National Eczema Association.Eczema treatment.UpToDate.Management of severe, refractory atopic dermatitis (eczema) in children.
National Eczema Association.Eczema treatment.
UpToDate.Management of severe, refractory atopic dermatitis (eczema) in children.
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