Eczema is a chronic and life-long condition that can prove very tricky to treat, despite there being a variety of treatment options for eczema—both over-the-counter and prescription—widely available now. That being said, medicine and skincare technology is advancing more and more every year, thus begging the question: Why *is* it still so hard to find eczema treatments that actually work effectively and consistently?
Here, we take a look at a few of the most common treatment options currently available for eczema—plus, why they’re far from perfect.
1. Topical Corticosteroids
One of the most commonly prescribed medications for eczema is topical corticosteroids, or topical steroids for short. Hydrocortisone, triamcinolone, fluocinonide, and clobetasol are the most well-known prescription steroid creams for eczema. For those unfamiliar, topical corticosteroids are synthetic or man-made medications with potent anti-inflammatory properties that are used for treating skin conditions such as eczema, psoriasis, and more. Steroid creams for eczema are effective in helping to control skin flare-ups and relieve symptoms, such as itching and irritation. In most cases, topical steroids are safe and well-tolerated, but it’s important to follow your dermatologist's instructions on proper use to avoid experiencing negative side effects.
According to Dr. Peter Lio, topical corticosteroids can be tempting to use as they generally work quickly and provide great relief, but it’s sadly not sustainable because the results are short-lived and dependent on consistent use, which isn’t safe. “People do great while they're using them, but then can flare right back up,” explains Lio. Additionally, they come with pretty alarming side effects. “The problem is, if you overuse topical corticosteroids, you can risk thinning the skin and permanently damaging it, or even worse, absorbing enough to cause systemic problems which is a major issue.”
2. Topical Calcineurin Inhibitors (TCIs)
Topical calcineurin inhibitors like tacrolimus and pimecrolimus are nonsteroidal, immunosuppressive treatments for eczema that can help to minimize itch, inflammation, and dryness (especially when used in ointment form). TCIs can be applied to all affected areas of the skin, including delicate and sensitive areas where topical steroids may not be preferred. As a result, TCIs are typically prescribed to adults and children over 2 years of age who are not responding well to topical steroids. TCIs can also be used for extended periods of time to control symptoms and reduce flares. While applying TCIs and topical steroid creams on the same area is not recommended, your dermatologist may prescribe a TCI and topical steroid for use on different parts of the body.
That being said, Lio says they come with a far-from-comforting warning label on them, which is off-putting for many people. “It's called the black box warning and talks about the potential cancer risk,” he explains. “While we think that it is an extremely low likelihood to have anything like that occur from these, the fact is it’s still there and can be nerve-wracking to patients and families.” Additionally, they still pose a risk for infection and can be extremely costly (more than $60 for a 30 gram tube), which isn’t ideal for those who don’t have the funds to afford it. It’s important to discuss these risks with your healthcare provider to determine whether or not topical calcineurin inhibitors are right for you.
3. Topical PDE4 Inhibitors
Topical PDE4 Inhibitors are a nonsteroidal option for mild-to-moderate eczema treatment. They act at a cellular level to stop the production of an enzyme called PDE4, which is believed to increase inflammation in your skin. PDE4 inhibitors are a relatively new treatment that can be applied to all affected areas of the skin, including delicate spots like eyelids. Crisaborole (Eucrisa) is one commonly prescribed topical treatment for eczema that can reduce itching and redness.
According to Lio, a percentage of patients experience burning and stinging when they apply the medication, and it can also be very costly. Moreover, some people have adverse reactions, including hives, redness, and swelling. “Ultimately, there is a huge, huge need for new innovative therapies and approaches to eczema,” Lio says.
4. Broad-Spectrum Antibiotics
While oral antibiotics can be helpful at treating eczema that’s flaring due to an infection in the skin, they work by killing off all bacteria, including the good types that we need in order to have a balanced skin microbiome. Lio calls this “collateral damage.” Moreover, we know that people can develop a resistance to many commonly used antibiotics if they’re used too often or in excess. “Any antibiotic that has a mechanism will find a way around that over time,” explains Lio. Antibiotics are also only effective at treating eczema if an infection is present, so if that’s not the case, they won’t be helpful.
5. Phototherapy (Light Therapy)
Phototherapy, also called light therapy, is defined as the “controlled delivery of ultraviolet light for anti-inflammatory purposes.” In other words: It uses UVB rays to stop the immune system from overreacting and can thereby have a healing effect on eczema. UV light therapy is used to treat moderate to severe eczema that is not responding to conventional treatments. If the patient has UV-sensitive dermatitis or a photo allergy disorder, phototherapy should not be used.
Because UV rays can cause serious health problems such as cancer, as well as premature skin aging, treatments are typically administered in super short time periods (as little as 15 seconds) and done over a long period of time. Unlike most of the aforementioned treatment options, phototherapy isn’t a quick fix and is usually done over the course of five months or more. Additionally, because everyone responds to UV light differently, it can be difficult to pinpoint who’s most likely to benefit from phototherapy.