When you have atopic dermatitis, also called eczema, you’ll have itchy, red, and irritated skin that doesn’t go away on its own. If you scratch, your atopic dermatitis will only get worse. Your atopic dermatitis might be relatively mild. But for some people, it can be more severe. Your skin may be unbearably itchy. It can feel like it’s burning or as if you’re being stuck with needles.
The good news is that you’ll have many ways to control your atopic dermatitis today. Your treatment options and plan will depend on whether your skin symptoms are mild or more severe. Even the latest treatments can’t make your atopic dermatitis go away. You’ll likely need to keep using them to keep your flares at bay. But they can help you to control your symptoms and make flares happen less often.
Topical Treatments for Atopic Dermatitis
Your atopic dermatitis treatment will include topicals you’ll rub on your affected skin. That’s true whether your skin condition is mild, moderate, or severe. Some topical treatment options include tried and true methods to keep your skin hydrated. Others include recently approved targeted medicines that work when you apply them to your skin. Topical treatments for atopic dermatitis include:
Moisturizers. Your treatment plan for atopic dermatitis will include basic skin care, including keeping your skin moisturized. Your doctor might prescribe a moisturizer for you. But many times, it works just as well to choose a fragrance-free moisturizer you can buy at the store without a prescription. You’ll likely apply moisturizer at least twice a day and after taking a bath or shower.
Corticosteroids. Topical steroids are considered a mainstay for treating atopic dermatitis when moisturizer alone isn’t enough. Talk to your doctor about the strength they recommend for you. Studies of topical steroids in use for a few weeks show that they’re safe. But topical steroids in sensitive spots or when used for a long time may come with side effects, including:
- Infection
- Atrophy
- Other changes to your skin
It’s usually best to limit your use to a few weeks at time. Ask your doctor about precautions you should take when treating atopic dermatitis on sensitive spots such as your:
- Face
- Folds of skin
- Groin
If you’re a person of color, you may want to be even more careful about using topical steroids for your atopic dermatitis. That’s because they can make your skin get lighter or darker over time.
Calcineurin inhibitors. Topical calcineurin inhibitors (TCIs) work by targeting an inflammatory protein in your skin called calcineurin. You’ll have two options: pimecrolimus cream (Elidel) or tacrolimus ointment (Protopic). You’re most likely to use a TCI if topical steroids don’t work, they stop working, or if they aren’t a good idea for you to use for another reason. TCIs are generally safe to use once or twice a day as needed or continuously. They can be used in body areas where you can’t use topical steroids. Recent studies suggest that TCIs don’t come with an increased risk of skin cancer. But you may have minor side effects, such as irritation or burning. They are similar to low-potency steroids but require a prescription.
PDE inhibitors. A PDE inhibitor called crisaborole (Eucrisa) is another topical option for people with atopic dermatitis of all ages. It’s more likely to work when atopic dermatitis is mild or moderate. A second topical PDE inhibitor roflumilast (Zoryve) is approved for adults and kids as young as 6. These can be first-line treatments for mild or moderate AD.
AhR agonists. This topical medicine works by activating a receptor to lower inflammation. So far, there is only one topical medicine in this class called tapinarof (Vtama). Clinical trials have shown it can help with moderate to severe atopic dermatitis in people with all skin types and in kids as young as 2.
JAK inhibitors. A new type of topical called a JAK inhibitor works by targeting a different protein called Janus kinases, or JAKs. The topical JAK inhibitor ruxolitinib (Opzelura) is approved for people ages 12 and up with mild to moderate atopic dermatitis. You can use it for up to eight weeks, or longer if you don’t use it all the time. Studies have shown it can start to help after the first 12 hours.
Topical antimicrobials. Ask your doctor before using a topical antibiotic or antimicrobial on your skin. You usually won’t need to use this type of medicine for atopic dermatitis unless you have a skin infection.
Systemic Treatments for Moderate to Severe Atopic Dermatitis
When topical treatment options aren’t enough to keep your moderate to severe atopic dermatitis under control and your flares at bay, you’ll have many systemic treatment options to consider. Systemic options aren’t usually recommended for atopic dermatitis that’s mild. The latest treatments work by targeting some of the signals in your body that drive the inflammation in your skin. Systemic treatments approved for atopic dermatitis include:
Interleukin (IL) inhibitors or biologics. Interleukins are chemicals that signal your immune system to drive inflammation. IL inhibitors work by blocking some of these signals. You’ll have four IL inhibitor biologics to choose from. Because these medicines are monoclonal antibodies, you’ll have to take them through a shot on a regular schedule. They come in easy-to-use prefilled pens or autoinjectors. IL inhibitors for atopic dermatitis include:
- Dupilumab (Dupixent)
- Lebrikizumab (Ebglyss)
- Nemolizumab (Nemluvio)
- Tralokinumab (Adbry)
Clinical trials have shown biologics are safe, tolerable, and effective for many people with moderate to severe atopic dermatitis that doesn’t respond to topical medicines. They also improve quality of life. But they don’t work for everyone.
Oral Janus kinase (JAK) inhibitors. This class of systemic medicines targets JAK proteins instead of interleukins to treat atopic dermatitis in another way. You’ll take them by mouth. You’re most likely to try a JAK inhibitor if other treatments, including biologics, haven’t worked. JAK inhibitors come with a black box warning for possible adverse events, including serious infections, heart events, and cancer. Oral JAK inhibitors approved for atopic dermatitis include:
- Abrocitinib (Cibinqo)
- Upadacitinib (Rinvoq)
Immunosuppressants. Doctors traditionally used other general immune suppressants for moderate to severe atopic dermatitis. They aren’t approved specifically for eczema, and they also come with serious side effects since they don’t work in a targeted way. Sometimes they may still be used for a short time, but experts generally don’t recommend them. These medicines include:
- Azathioprine
- Cyclosporine
- Methotrexate
- Mycophenolate
Oral corticosteroids. Oral steroids are another way to suppress the immune system. They’re not good to take for long periods because of their side effects. In general, doctors don’t recommend taking these medicines for atopic dermatitis today. In rare cases, you might take one for a short time if you’re having an intense flare or lack other options.
Other Therapies for Atopic Dermatitis
Along with topical and systemic medicines, dermatologists sometimes use other treatment methods for atopic dermatitis. Some of them may still be recommended and may be part of your treatment plan.
Wet wrap therapy. In this method, you’ll wrap your skin with wet bandages or damp, tight clothing. Then put on dry pajamas over them after putting moisturizer or topical medicines on your skin. This treatment can help to keep your skin hydrated while keeping you from scratching. Talk to your dermatologist before trying wet wrap therapy. Experts suggest it may be best to try this in a small area first to see if it works for you.
Light therapy. Light therapy uses special light bulbs or lasers on your skin. You may need to go to your doctor’s office for regular treatments or use a device at home. You shouldn’t try to use tanning beds, UV lamps, or sun tanning on your own to treat your atopic dermatitis.
Diluted bleach baths. You’ll put small amounts of bleach in your bath water. It may help by killing bacteria on your skin. Your doctor may recommend this if your atopic dermatitis is moderate to severe. Be sure to check with your doctor and follow their advice if you’re using bleach baths to help with your flares.
Sublingual or subcutaneous immunotherapy (SCIT or SLIT). Atopic dermatitis is sometimes driven or triggered by allergens or other irritants. Your doctor may suggest allergy testing to see if you have allergies. Some studies have shown that allergy immunotherapy, especially to house dust mites, may help with atopic dermatitis or make it less severe. Treatments may involve injections or tablets under the tongue to increase your tolerance for certain substances. While this method may help, it can take a long time with regular treatments.
Elimination diets. You’re more likely to have food allergies when you have atopic dermatitis. You may be tempted to try changing your diet or avoiding certain foods to see if it helps. Talk to your allergist or dermatologist if you have food allergies or suspect you might. You may need testing to look for food allergies. In general, elimination diets aren’t recommended as a way to manage or control your atopic dermatitis.
Complementary Therapies for Atopic Dermatitis
You may be curious to know if complementary or alternative medicine approaches would help with your atopic dermatitis. These methods won’t cure your skin condition and shouldn’t replace treatment. But it’s possible they could help by easing stress and inflammation. Check with your doctor to be sure they’re safe to try, especially if you’re adding herbs or supplements that may interfere with treatment or come with potentially serious side effects. Supplements aren’t regulated in the way that medicines are.
Some complementary therapies for atopic dermatitis may include:
- Chinese medicine
- Aromatherapy
- Reflexology
- Probiotics or other supplements
- Hypnosis or hypnotherapy
You may benefit from relaxation approaches, such as:
- Deep breathing
- Meditation
- Mindfulness
- Yoga
Lifestyle Tips for Atopic Dermatitis
There’s a lot you can do to help with your atopic dermatitis along with using your medicines as prescribed. Some common lifestyle recommendations for atopic dermatitis include:
- Find a skin care routine that works for you and stick to it.
- Pay attention to any product that touches your skin or clothes.
- Identify and work to avoid your triggers.
- Avoid overheating.
- Keep yourself hydrated.
- Take steps to reduce itching and scratching at night, so you can get rest.
Treatments Under Development for Atopic Dermatitis
Studies are underway to develop and test new ways to treat atopic dermatitis. For example, researchers are exploring biologics that target different signals or multiple signals at once. Studies also are exploring other ways to treat eczema, including treatments targeting the microbiome. The microbiome includes all the microbes that normally live in and on our bodies. If you’re curious about new treatments currently being tested for atopic dermatitis, ask your dermatologist about clinical trials near you or search for them at clinicaltrials.gov.
Atopic Dermatitis Treatment Plan
Your doctor can help you come up with a treatment plan based on how severe your atopic dermatitis is, your preferences, your eczema triggers, how well treatments have worked, and other things. The basic treatment recommendations for atopic dermatitis are the same no matter what type or color of skin you have. No matter which treatments you use, the goals are to:
- Prevent your flares
- Relieve itching, pain, redness, and other symptoms
- Keep your atopic dermatitis from getting worse
- Reduce your risk of permanent changes to your skin, such as thickening
- Moisturize your skin
- Prevent infections
Your doctor can help you understand how severe your atopic dermatitis is and how that affects your treatment options based on:
- How much of your skin is affected
- Visible symptoms, such as redness, oozing, or swelling
- Other symptoms, including itching and trouble sleeping
Questions to ask about your atopic dermatitis treatment options
What should I try first to treat my atopic dermatitis?
What type of moisturizer do you recommend?
Is it safe to use topical steroids?
Should I try a targeted topical medicine?
Should I try a biologic?
Should I try a JAK inhibitor?
What are common side effects of the treatments you recommend?
What other steps can I take to help with my atopic dermatitis?
How long will it take for therapy to work?
Where can I get help if I’m worried about treatment access or costs?
Show Sources
SOURCES:
Allergy & Asthma Network: "What is Moderate to Severe Eczema?"
Annals of Allergy, Asthma & Immunology: "Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations."
Eczema in Skin of Color: "Eczema in Skin of Color: Diagnosis and Treatment."
Journal of the American Academy of Dermatology: "Tapinarof cream 1% once daily: Significant efficacy in the treatment of moderate to severe atopic dermatitis in adults and children down to 2 years of age in the pivotal phase 3 ADORING trials."
American Academy of Dermatology Association: "Eczema Types: Atopic dermatitis diagnosis and treatment."
Journal of Allergy and Clinical Immunology in Practice: "Biologic versus small molecule therapy for treating moderate to severe atopic dermatitis: clinical considerations," "Natural history of food triggered atopic dermatitis and development of immediate reactions in children."
British Journal of Dermatology: "Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement."
American College of Allergy, Asthma and Immunology: "Immunotherapy with allergy tablets."
National Eczema Society: "Complementary therapies and eczema," "20 Lifestyle and Health Hacks for Controlling Eczema."
Management of Atopic Dermatitis: "The Future of Atopic Dermatitis Treatment."
DermNet: "SCORAD."
