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Treatments and drugs
By Mayo Clinic staffTreatments for atopic dermatitis (eczema) aim to reduce inflammation, relieve itching and prevent future flare-ups. Over-the-counter (nonprescription) anti-itch creams, along with other self-care measures, may help control mild atopic dermatitis.
Although atopic dermatitis is related to allergies, eliminating allergens is rarely helpful in clearing the condition. Occasionally, items that trap dust — such as feather pillows, down comforters, mattresses, carpeting and drapes — can worsen the condition. Allergy shots usually aren't successful in treating atopic dermatitis and might even make the condition worse.
Medications
- Corticosteroid creams or ointments. Your doctor may recommend prescription corticosteroid creams or ointments to ease scaling and relieve itching. Some low-potency corticosteroid creams are available without a prescription, but you should always talk to your doctor before using any topical corticosteroid. Side effects of long-term or repeated use can include skin irritation or discoloration, thinning of the skin, infections, and stretch marks on the skin.
- Antibiotics. You may need antibiotics if you have a bacterial skin infection or an open sore or fissure caused by scratching. Your doctor may recommend taking antibiotics for a short time to treat an infection or for longer periods of time to reduce bacteria on your skin and to prevent recurrent infections.
- Oral antihistamines. If itching is severe, oral antihistamines may help. Diphenhydramine (Benadryl, others) can make you very sleepy and may be helpful at bedtime. If your skin cracks open, your doctor may prescribe mildly astringent wet dressings to prevent infection.
- Oral corticosteroids. For more severe cases, your doctor may prescribe a short-course of oral corticosteroids, such as prednisone, to reduce inflammation and to control symptoms. These medications are effective but can't be used long term because of potential serious side effects, which include cataracts, loss of bone mineral (osteoporosis), muscle weakness, decreased resistance to infection, high blood pressure and thinning of the skin.
- Immunomodulators. A class of medications called immunomodulators, such as tacrolimus (Protopic) and pimecrolimus (Elidel), affects the immune system and may help maintain normal skin texture and reduce flares of atopic dermatitis. This prescription-only medication is approved for children over the age of 2 and for adults. Due to possible concerns about the effect of these medications on the immune system when used for prolonged periods of time, the Food and Drug Administration recommends that Elidel and Protopic be used only when other treatments have failed, or if someone can't tolerate other treatments.
Light therapy (phototherapy)
As the name suggests, this treatment uses natural or artificial light. The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light either alone or in combination with medications.
Though effective, long-term light therapy has many harmful effects, including premature skin aging and an increased risk of skin cancer. For these reasons, it's important to consult your doctor before using light exposure as treatment for atopic dermatitis. Your doctor can advise you on possible advantages and disadvantages of light exposure in your specific situation.
Infantile eczema
Treatment for infantile eczema includes identifying and avoiding skin irritations, avoiding extreme temperatures, and using bath oils, lotions, creams or ointments to lubricate your baby's skin.
See your baby's doctor if these measures don't improve the rash or if the rash looks infected. Your baby may need a prescription medication to control the symptoms or to treat the infection. Your doctor may recommend an oral antihistamine to help lessen the itch and to cause drowsiness, which may be helpful for nighttime itching and discomfort.
- Weston WL, et al. Epidemiology, clinical manifestations, and diagnosis of atopic dermatitis (eczema). http://www.uptodate.com/home/index.html. Accessed May 20, 2009.
- Weston WL, et al. Treatment of atopic dermatitis (eczema). http://www.uptodate.com/home/index.html. Accessed May 20, 2009.
- Bieber T. Mechanisms of disease: Atopic dermatitis. New England Journal of Medicine. 2008;358:1483.
- Eczema/atopic dermatitis. American Academy of Dermatology. http://www.aad.org/public/Publications/pamphlets/EczemaAtopicDermatitis.htm. Accessed May 20, 2009.
- What is atopic dermatitis? National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/hi/topics/dermatitis/ffdermatitis.htm. Accessed May 20, 2009.
- FDA public health advisory Elidel (pimecrolimus) cream and Protopic (tacrolimus) ointment. U.S. Food and Drug Administration. http://www.fda.gov/cder/drug/advisory/elidel_protopic.htm. Accessed May 20, 2009.
- Habif TP. Atopic dermatitis. In: Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 4th ed. Philadelphia, Pa.: Mosby; 2004. http://www.mdconsult.com/das/book/body/138783445-3/843851716/1195/22.html. Accessed May 21, 2009.
- Huang JT, et al. Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics. 2009;123:e808.
- Atopic dermatitis: Possible complications. American Academy of Dermatology. http://www.skincarephysicians.com/eczemanet/complications.html. Accessed June 3, 2009
- German chamomile. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed June 3, 2009.
- Evening primrose oil. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed June 3, 2009.
- Witch hazel. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed June 3, 2009.
- Borage. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed June 3, 2009.
