Eczema (atopic) 

Treatment options for atopic eczema 

Treatment
Pros
Cons

Useful links

 

 

Self-care techniques

Do not scratch and avoid triggers, such as soaps, detergents, woollen or rough clothing, temperature extremes and dusty environments

  • Not scratching will reduce the risk of infection and cause less skin inflammation
  • Avoiding triggers can prevent a flare-up of symptoms
  • May need to keep a diary to work out what your triggers are
  • Not possible to avoid all triggers, for example dust mites cannot be effectively removed from your home
  • Self-care techniques alone may not be effective in controlling eczema
Emollients (moisturisers)

Creams, lotions and oils that reduce the loss of water from the skin

  • An important background treatment for all types of eczema
  • Provide a protective barrier to keep moisture in your skin and irritants out
  • Large number of products to choose from
  • Soap substitutes available
  • Some emollients can be added to the bath
  • Need to be used every day
  • Some ointments and oils can be greasy, which makes them less acceptable
  • Some, such as aqueous cream, can irritate your skin
  • Some products are highly flammable and should not be used near a naked flame
  • Emollients added to the bath can make it very slippery
  • Emollients alone do not control eczema - inflamed, itchy skin needs an anti-inflammatory treatment such as a topical corticosteroid
Steroid creams and ointments

Creams and ointments containing steroid medication, which reduce inflammation

  • The most effective treatment for eczema flare-ups
  • Safe if appropriate strengths are used in the right place for the right amount of time
  • Can be used on weekends between flare-ups to control eczema in the most severe cases
  • Different formulations, such as creams or ointments, are available at different strengths for different parts of the body
  • Can cause mild burning or stinging as you apply them
  • May cause thinning of the skin, visible blood vessels, acne and increased hair growth if the wrong preparation is used in the wrong place for too long (for example, a very strong preparation used on the face for several months)
Antihistamines

Medicine that stops the effects of histamine in the blood, which causes itching

  • Can be used to relieve itching during flare-ups
  • Sedating antihistamines, which make you drowsy, can be used to relieve itching at night
  • Non-sedating antihistamines are sometimes used to relieve long-term itching
  • Will not treat eczema flare-ups
  • Drowsiness caused by sedating antihistamines may affect ability to drive and will be worse after alcohol, and may affect school work in children
  • Non-sedating antihistamines can still cause drowsiness in around 1 in 100 people
  • Evidence to support the benefit of antihistamines is not as strong as for other treatments
Calcineurin inhibitor cream or ointment

Cream or ointment that reduces inflammation

  • May be effective for moderate to severe eczema or eczema that does not respond to other treatments
  • Does not thin your skin
  • Useful for people with eczema who cannot use topical steroids
  • Useful for facial eczema, for example around the eyelids, where topical steroids cannot be used for long periods
  • Only available from a dermatologist
  • Long-term safety is still being evaluated
  • Can cause side effects, such as burning, and makes skin more sensitive to sunlight
  • If you drink alcohol this may cause facial flushing and skin irritation
Bandaging

Medicated dressings or wet wraps applied to the skin

  • May be useful for severe eczema or eczema on the legs or arms that does not respond to other treatments
  • Only available from a dermatologist or from your GP if they have expertise in this area
Steroid tablets

Tablets containing steroids, which reduce inflammation

  • Effective for severe flare-ups
  • Your GP is unlikely to prescribe these more than once a year without referring you to a dermatologist
  • Your GP is unlikely to prescribe these for more than a few weeks at a time
  • If taken for a long time or taken often, they can affect the growth rate of children or cause high blood pressure or brittle bones
Phototherapy

Exposing the eczema to artificial ultraviolet light

  • May be effective for severe eczema or eczema that does not respond to other treatments
  • Only available from a dermatologist at a regulated phototherapy unit
Immunosuppressant medication

A medicine that suppresses your immune system, such as ciclosporin, methotrexate or azathioprine

  • May be effective for severe eczema or eczema that does not respond to other treatments
  • Only available from a dermatologist
  • Not all immunosuppressants are licensed for atopic eczema, which means the medicine may not have undergone clinical trials to see if it is effective and safe in the treatment of this condition
  • Can cause nausea and muscle pain
Alitretinoin capsules

Capsules to reduce irritation and itchiness

  • May be effective for severe long-term eczema on the hands that has not responded to other treatments
  • Only available from a dermatologist
  • Only available for people over 18
  • Can cause birth defects so women must avoid pregnancy, ideally by using two methods of contraception, and must have pregnancy tests throughout treatment
  • Can cause side effects, such as headaches, a dry mouth and dry eyes
  • More serious potential side effects include sight problems and suicidal thoughts
Antibiotic cream or ointment

Applied to kill bacteria on skin

  • Effective in treating small areas of infected eczema
  • Over-using antibiotics to treat minor conditions can make them less effective in treating more serious or life-threatening conditions
  • Can only be used for two weeks or your skin can become sensitive to the product and irritated
  • Antibiotics will not treat the eczema itself
Antibiotic tablets

Tablets to treat eczema that has become infected with bacteria

  • Effective in treating large areas of infected eczema
  • Over-using antibiotics to treat minor conditions can make them less effective in the treatment of more serious or life-threatening conditions
  • Antibiotics will not treat eczema

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Page last reviewed: 21/11/2012

Next review due: 21/11/2014