Topical treatments for atopic dermatitis, aka AD or eczema, are those you put directly on your skin. They range from gentle skin care and potent moisturizers to creams and ointments with and without steroids.
Over time, treatment for AD has tended to be the same for everyone. Studies show science has had some catching up to do, though: People of color are not only more likely to have AD, but treatment for it can cause more severe side effects, such as skin color changes, than for lighter-skinned people. These effects can be upsetting and affect your quality of life.
The good news is that some non-steroid treatments that block certain proteins and enzymes have proven to work as well or be better at treating AD, without discoloration and other unwanted effects. Some even improve dark spots from melanin changes after flare-ups, or they even out pale patches some meds cause.
Knowing how various topical treatments, including protective products like sunscreen, affect darker skin can help you make the best choices for management, treatment, and follow-up.
Corticosteroids
For moderate to severe AD, the first line of treatment – meaning the first thing most providers prescribe – is usually a corticosteroid cream or ointment. These products mimic natural hormones and offer quick relief: They can ease heat, swelling, pain, and itchiness from AD. They also can help your skin stay moist and fend off flare-ups. These medications are often used for a limited time.
The downside for people of color is that using strong topical corticosteroids too much can cause areas of your skin to lighten, a condition called hypopigmentation. When your AD flare calms and swelling goes down, it can leave a dry patch of skin that’s paler than your skin tone. Hypopigmentation isn’t the same as skin damage, and it’s temporary. Still, some experts suggest people of color simply avoid this route and try a non-steroid treatment instead.
Calcineurin Inhibitors
These topical medications block a protein called calcineurin, which fuels inflammation in AD. They can both treat and help prevent AD flares. Your provider might prescribe them along with corticosteroids or instead of them. There are two types:
- Elidel cream (pimecrolimus) may be prescribed if your AD is mild to moderate.
- Protopic ointment (tacrolimus) comes in different strengths to treat moderate to severe AD.
PDE4 Inhibitors
Crisaborole is a newer topical drug for mild to moderate AD. It zeroes in on PDE4 (phosphodiesterase 4) enzymes deep in your skin to ease inflammation. Studies show it’s not only a good long-term treatment choice, but it works better than some others. Some people have reported mild temporary pain or a sting when it’s applied.
One study found crisaborole at 2% strength caused fewer side effects in people with AD, including not discoloring skin. It’s also been shown to improve AD symptoms such as lichenification. This happens when scratching or rubbing your skin too much makes scaly, dry silvery-gray patches form on your skin, often in the crease of your arm, the back of your neck, or your wrists.
Wet Wrap Therapy
Wet wrap therapy, aka soak and seal, is a topical treatment option if you have moderate to severe AD. It deeply hydrates your skin, calms itching and swelling, and can reduce the need to take meds. You’ll follow a series of steps:
- Take a bath or shower with lukewarm water for about five to 10 minutes, using a pure, mild cleanser.
- Lightly pat your skin dry to retain dampness, then apply prescribed ointments and moisturizers to areas with AD.
- Within a few minutes, seal in the moisture with an oil-based moisturizer. Let it soak in.
- Wrap the AD-affected skin with wet cloths or dressings.
- Put on loose-fitting, comfy clothes, like pajamas or sweats, and tube socks.
See more on moisturizers and how to choose them below.
Topical Treatments for Skin Changes
Dark spots. It’s common for people of color to have dark spots after an AD flare-up. Called hyperpigmentation, it happens because your skin cells, which are sensitive to swelling, amp up the production of melanin. Melanocytes give your skin its color. The pigment flows into your epidermis, the outer layer of your skin.
Even after your AD clears up, the darker areas, which can look a bit like acne scars, can linger for weeks or months.
You can help fade them with a skin lightening cream. Be sure to talk with your doctor first to make sure of the cause of the dark areas. If they’re triggered by another condition, your treatment may be different.
Skin lighteners. You can buy some products over the counter to help even out your skin tone, without having to have a doctor’s prescription. It’s best to have your provider’s guidance, though. If you go it on your own, choose a product with one of these ingredients, which fade dark spots you already have:
- Vitamin C
- A retinoid (adapalene gel, retinol, tazarotene, or tretinoin)
- Glycolic acid
- Azelaic acid
- Kojic acid
Some of these, like the acids, can also slow down melanin production.
A product that fades spots or evens out your skin tone will work better if you’re using a sunscreen and, if possible, you stop using meds that cause dark spots to form.
Sunscreen. Sunscreen can not only protect against dark spots, it can help clear them, too. Apply sunscreen every two hours, and after you swim or sweat heavily, to all areas of your skin that aren’t covered when you go outside. Wear protective clothing, like a wide-brimmed hat and long sleeves. Try to stay inside between 10 a.m. and 2 p.m., when the sun is at its hottest.
Look for sunscreen that:
- Has at least 30 SPF
- Contains titanium dioxide, zinc oxide, or both
- Is a color that blends with your skin tone, if you want to avoid a whitish cast
- Offers broad-spectrum protection
- Is water-resistant
- Is a non-comedogenic formula – meaning it won’t clog your pores – if your skin is oily
Keep a lookout for allergens. Even if a product contains an ingredient you want, make sure it’s not also made with anything that’s harmful. Be extra careful before buying products made in other countries, which might not list all the ingredients in them. For example, mercury and steroids have been found in some products, unlabeled. It’s a safe bet to stick with products from the U.S., which must state all ingredients, or use what your provider recommends.
Moisturizers Are Key
Darker skin – and Black skin in particular – tends to be drier, making moisturizer even more important. It also goes far to ease itching that comes with AD, helping lessen chances of lichenification. Increasing and retaining moisturizer in your skin should be a top priority.
Moisturizers guard your skin barrier, trapping in hydration and making sure your skin is keeping what it needs. Look for products that have ceramides, cholesterol, or fatty acids. For example, petroleum jelly and some natural oils, such as coconut and safflower oils, have these ingredients. Shea butter also is a solid natural alternative to commercial moisturizers.
Take care with oils, though: Some, like olive oil, can make your condition worse. Fragrance-free emollients should be used at least once per day, ideally right after bathing (using warm, not hot, water). Thicker moisturizers, such as creams and ointments – rather than more liquid lotions – tend to work better for adults with AD.
Other things to bear in mind as you scope out a moisturizer for AD:
- Avoid products that contain allergens such as heavy fragrance, formaldehyde and formaldehyde releasers, and balsam of Peru or Peru balsam (a popular, pleasant-smelling resin with some medicinal properties).
- A full list of allergens can be found on the National Eczema Association’s Ecz-clusion List, as well as a list of recommended products: https://nationaleczema.org/eczema-products/about-nea-seal-of-acceptance/
- Avoid moisturizers that perform “double duty,” such as anti-aging or exfoliating. They’re made for different purposes.
- The National Eczema Association also keeps a list of moisturizers approved for AD treatment.
Practice Gentle Skin Care
Choose mild, soap-free skin care cleansers formulated for AD to go with your heavier-duty moisturizer and other topical treatments. Search “cleansers” on the National Eczema Association’s Seal of Acceptance list for the best picks.
Avoid Untested or ‘Traditional’ Treatments
You might be tempted to try herbal, “natural,” or traditional AD remedies. They tend to be untested and can make your AD worse. Stick with the above guidelines and your dermatologist’s advice.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
American Journal of Clinical Dermatology: “Efficacy and Safety of Crisaborole Ointment, 2%, for the Treatment of Mild-to-Moderate Atopic Dermatitis Across Racial and Ethnic Groups.”
American College of Allergy, Asthma & Immunology: “New Website Spotlights Unique Differences of Eczema In People of Color,” “Eczema in Skin of Color: Diagnosis and Treatment.”
National Eczema Association: “Eczema in Skin of Color: What You Need to Know,” “Ask the Ecz-perts: What Can Be Done About Dark Spots Left by Eczema?” “Bathing, Moisturizing and Wet Wraps,” “Why Is Moisturizing So Important for Managing Atopic Dermatitis?”
National Eczema Society (U.K.): "Topical Steroids," “Topical Calcineurin Inhibitors (TCIs),” “Skin Pigmentation and Eczema.”
Frontiers in Pharmacology: “Phosphodiesterase-4 Inhibitors for the Treatment of Inflammatory Diseases
Cureus: Advancing Treatment in Atopic Dermatitis: A Comprehensive Review of Clinical Efficacy, Safety, and Comparative Insights Into Corticosteroids, Calcineurin Inhibitors, and Phosphodiesterase-4 Inhibitors as Topical Therapies.”
American Academy of Dermatology: How to Fade Dark Spots in Darker Skin Tones.”
Contact Dermatitis: “Myroxylon pereirae (balsam of Peru): Still worth testing?”
