Doctor’s Note: Your Essential Guide to Eczema Treatments

As dermatologists, we understand how tough it can be to live with eczema. The constant itching, dryness, unexpected flare-ups, and sleepless nights can be stressful both physically and emotionally. We know finding the right solutions can feel overwhelming, but we're here to help guide you through it.

What is Eczema?

Eczema, also called atopic dermatitis, is a skin problem that makes your skin dry, red, and itchy.

It often starts in babies, appearing as red patches on the cheeks, scalp, or arms and legs. Many kids see their eczema get better or even go away by their teenage years, but for some, it sticks around into adulthood.

People with eczema usually have times when their skin gets worse (flare-ups) and times when it gets better (remission). This means they need to take care of their skin every day to help prevent flare-ups.

It’s important to understand eczema and how it affects you, since it can be a lifelong condition.

Eczema Symptoms

Eczema usually causes dry, itchy skin that can be uncomfortable. Common signs include red or brown patches, which often show up on the hands, feet, ankles, wrists, neck, upper chest, eyelids, and inside the elbows and knees. The skin can get thick, cracked, or scaly from constant scratching. Sometimes, small bumps may form that can leak fluid and crust over if scratched. Eczema can also make the skin feel sensitive and swollen. Managing eczema often involves keeping the skin moisturized, staying away from triggers, and sometimes using medicines to reduce redness and itching.

Red or brownish-gray patches of skin

Not well-defined: hard to see where rash starts/ends

Intense itching, which may be worse at night

Raw, sensitive, swollen skin from scratching

Thickened, cracked, or scaly skin

Eyelids commonly affected

Small, raised bumps that may leak fluid and crust over when scratched

Hands commonly affected

Eczema = Atopic Dermatitis?! Not exactly. "Eczema" is a broad term referring to inflammation in the skin. Atopic Dermatitis is a particular type of eczema that appears in childhood.

What Causes Eczema?

So why does eczema happen? The exact cause is a bit of a mystery, but here's what we know:

Genetics: You can thank your parents for this one! If they have a history of eczema, allergies, or asthma, you’re more likely to get it too.

Environment: Different things around you can trigger or worsen eczema. Some common triggers are harsh soaps, detergents, certain fabrics, pet dander, pollen, and even changes in the weather, like dry air or extreme temperatures.

Skin Barrier: A weak skin barrier is also a major factor. Healthy skin acts like a strong shield, keeping moisture in and germs out. In people with eczema, the skin barrier is weaker, which lets moisture escape and germs get in, causing dry, easily irritated skin.

Personal and Family History: If you or your family members have eczema, allergies, or asthma, you’re at higher risk for eczema.

tl;dr: People with eczema are born with sensitive skin that gets irritated easily. Managing it means avoiding triggers, strengthening the skin barrier, and using proper care to reduce flare-ups.

How is Eczema Diagnosed?

Eczema is diagnosed through a careful process that starts with a medical history. The doctor will ask about your symptoms—when they began, how long they last, and what might trigger them. They’ll also ask if your family has a history of eczema, allergies, or asthma, and if there are environmental or lifestyle factors that could be affecting your skin. You’ll need to describe how severe the itching is, how much discomfort you feel, and if there are patterns, like when flare-ups occur.

The doctor will then do a physical exam to check for signs of eczema, such as redness, itching, scaling, or thick patches. Dermatologists often identify eczema based on the usual locations of rashes, which can change depending on your age. Here is an overview:

Infant Eczema

Child Eczema

Adult Eczema

If the physical exam doesn’t provide a clear answer, your doctor might do allergy tests, like skin prick tests or blood tests, to see if allergies are causing your eczema. They might also do patch testing, where small amounts of possible allergens are placed on your skin under patches to see if there’s a reaction.

In some cases, the doctor may take a small skin sample (biopsy) to look at under a microscope, which helps rule out other conditions that look like eczema.

Finally, the doctor will compare your symptoms with other skin conditions like psoriasis, fungal infections, or seborrheic dermatitis to make sure it’s eczema. This careful process helps ensure you get the right diagnosis and treatment.

Do you have eczema or psoriasis? See which one you have here!

What Makes Eczema Worse?

Many factors can trigger eczema. "Triggers" are things that cause eczema to start or get worse. It can be tricky to identify them because flare-ups might happen some time after exposure. Everyone’s eczema is different, but some common triggers include:

Irritants: Soaps, detergents, shampoos, bubble baths, disinfectants, and cleaning products can trigger eczema.

Allergens: Pollen, pet dander, dust mites, mold, and certain foods like eggs, milk, peanuts, soy, wheat, fish, and shellfish can worsen eczema.

Fabric: Wearing wool, synthetic materials, or tight clothing can irritate the skin and cause flare-ups.

Weather: Dry or cold weather is a common trigger. Less common triggers include extreme temperatures, sudden seasonal changes, and high humidity.

Infections: Bacteria (like Staphylococcus aureus), viruses (such as herpes simplex), and yeast (like dandruff-causing yeast) can trigger eczema.

Stress: Emotional stress from school, work, or personal matters can worsen eczema flare-ups.

Scratching: Scratching damages the skin barrier as it tries to heal, making eczema worse.

Hormones: Hormonal changes during puberty, pregnancy, or menstruation can lead to flare-ups.

Many people with eczema struggle to identify their triggers. Keeping a daily journal of foods, stressors, and events can help. Download a FREE printable journal below!

Download Daily Eczema Journal

What Makes Eczema Better?

Eczema management requires a comprehensive approach. It's essential to have a great daily routine that protects your skin. Here are some tips to prevent eczema flares:

Moisturizer: Apply a thick, fragrance-free moisturizer right after bathing to lock in moisture and keep your skin hydrated.

Gentle Products: Use mild, fragrance-free soaps, shampoos, and detergents to avoid irritating your skin.

Short Showers: Keep showers or baths to 10-15 minutes, using lukewarm water to prevent drying out your skin.

Soft Clothing: Wear cotton or other soft, natural fabrics that let your skin breathe and reduce irritation.

Humidifier: Use a humidifier during dry months to keep the air moist and prevent your skin from drying out.

Avoid Allergens: Identify and avoid triggers like certain foods, pollen, dust mites, or pet dander to manage eczema.

Manage Stress: Try stress-reducing techniques like yoga, meditation, deep breathing, or regular exercise to prevent stress-induced flare-ups.

Stay Cool: Dress in layers, stay in cool places, and take breaks during physical activities to avoid overheating and sweating.

Does fragrance-free = unscented? No! "Fragrance-free" products have no added scents at all, while "unscented" products might have scent-masking chemicals. Look for fragrance-free products instead!

Eczema Flares: Step-by-Step Instructions

Managing an eczema flare can be tough, but the right steps can help your skin feel better and stay healthy. Treating flares quickly reduces discomfort and prevents further damage. When a flare starts, look for early signs and adjust your skincare to calm inflammation. This guide will help you find triggers, use gentle skincare, take the right medications, and make lifestyle changes to control eczema and reduce flare-ups.

Step 1: Identify Triggers

Watch for changes in your environment, diet, skincare products, or stress levels. Common eczema triggers include allergens, irritants, stress, and weather changes. If you think you've found a trigger, try to avoid it!

Step 2: Simplify Routine

Stop using unnecessary products like perfume, hair products, nail polish, shaving cream, scented lotions, and anything else you don’t need. During an eczema flare, your skin is more sensitive and exposed. Treat it gently by sticking to the basics: a mild cleanser, a plain moisturizer, and any prescribed medications.

Step 4: Medication

If you have prescribed medication, use it exactly as directed. Apply topical steroids like hydrocortisone to damp skin after a shower, then seal it with moisturizer. For severe flares, try wet wrap therapy: after applying medication and moisturizer, cover the area with wet bandages to help your skin absorb the treatment better.

Step 7: Clothing

Wear soft, breathable clothing made from natural fabrics like 100% cotton. Sleep on soft sheets and skip the fabric softener, as it can irritate the skin.

Step 3: Gentle Skincare

Use a gentle, fragrance-free cleanser and avoid hot water—stick to lukewarm showers or baths. Right after bathing, while your skin is still damp, apply a thick, fragrance-free moisturizer. Reapply it throughout the day, especially on affected areas. If a moisturizer stings or burns, try plain petroleum jelly instead.

Step 5: Prevent Infections

To prevent infection, use products that reduce bacteria on the skin, such as hypochlorous acid sprays, antiseptic washes, or bleach baths.

Step 8: Optimize Sleep

You can take antihistamines like Benadryl to help with sleep, but they might not reduce itching. If the air is dry, use a humidifier to keep indoor humidity between 30-50% to help maintain skin moisture. Wear gloves at night to prevent scratching while you sleep.

Step 6: Avoid Scratching

During an eczema flare-up, your skin’s top layer becomes thin and less protective. Avoid scratching to let it heal, which may take up to two weeks. Keep nails short, wear gloves at night, and use cold compresses for itching relief. If you feel like scratching, try pinching the area gently instead to avoid more damage. Or, try an ice pack!

Step 9: Phototherapy

Consider using a UVB light treatment unit at home to reduce inflammation, itching, and scaling. This small light shines on affected areas a few times a week, helping to reduce skin inflammation. You can buy it online without a prescription and use it for both flare-ups and ongoing maintenance.

One of the most important aspects of managing eczema is managing stress. Easier said than done, I know. But stress worsens all inflammatory conditions (eczema, acne, psoriasis, etc.). Try to practice relaxation techniques such as deep breathing, meditation, or yoga. Or finally get that divorce! Just kidding.

Best Cleansers for Eczema

When choosing a cleanser for eczema, it’s best to look for gentle, fragrance-free options that won’t irritate sensitive skin. Avoid cleansers with active ingredients like niacinamide or hyaluronic acid, as they can sometimes cause irritation during flare-ups. Instead, opt for mild, non-foaming cleansers that help preserve your skin's natural moisture. Great options include Vanicream Gentle Facial Cleanser and CeraVe Hydrating Cleanser, both designed to cleanse without stripping or aggravating eczema-prone skin.

EltaMD Foaming Facial Cleanser

Texture: Clear gel that foams upon activation
Bromelain: Gently exfoliates
Amino Acids: Help maintain moisture
Glycerin: Hydrates
Best For: Normal to oily skin, sensitive skin

Aveeno Calm + Restore Nourishing Oat Face Cleanser

Texture: Gel that lathers lightly
Oat Extract: Soothes and calms skin
Glycerin: Hydrates
Panthenol: Moisturizes and softens skin
Best For: Sensitive, dry skin

Vanicream Gentle Facial Cleanser

Texture: Gel that lathers lightly
Oat Extract: Soothes and calms skin
Glycerin: Hydrates
Panthenol: Moisturizes and softens skin
Best For: Sensitive, dry skin

Neutrogena Ultra Gentle Hydrating Facial Cleanser

Texture: Rich, creamy
Glycerin: Hydrates
Pro-Vitamin B5: Soothes and moisturizes
Polyglycerin: Enhances moisture retention
Best For: Dry, sensitive skin

Best Moisturizers for Eczema

Moisturizers for sensitive skin are designed to soothe and protect without causing irritation. They often contain skin-repairing ingredients like ceramides or squalane, which help strengthen the skin’s natural barrier. It’s best to avoid moisturizers with fragrances, alcohol, hyaluronic acid, and niacinamide, as these can sometimes worsen sensitivity.

Vanicream Moisturizing Lotion

Texture: Light, non-greasy lotion
Glycerin: Hydrates and retains moisture
Petrolatum: Seals in moisture
Free of: Dyes, fragrance, and parabens
Best For: Dry, sensitive skin

Aveeno Calm + Restore™ Oat Gel Moisturizer

Texture: Lightweight, creamy lotion
Oat Extract: Soothes and calms skin
Ceramides: Restore the skin barrier
Glycerin: Hydrates
Best For: Dry, sensitive skin

La Roche-Posay Toleriane Double Repair Face Moisturizer

Texture: Lightweight, creamy
Ceramides: Restore the skin barrier
Niacinamide: Calms and soothes
Glycerin: Hydrates
Best For: Normal to dry, sensitive skin

Vanicream Moisturizing Cream

Texture: Thick, creamy
Petrolatum: Locks in moisture
Glycerin: Attracts and retains moisture
Free of: Fragrances, dyes, parabens
Best For: Very dry, sensitive skin

Best Sunscreens for Eczema

The best sunscreens for sensitive skin are mineral-based, containing zinc oxide or titanium dioxide, which offer broad-spectrum protection against both UVA and UVB rays. These ingredients sit on the skin's surface to physically block UV radiation, minimizing the risk of irritation. With an SPF of at least 30, these sunscreens provide effective coverage and are ideal for those prone to skin reactions.

Vanicream Facial Moisturizer

Protection: SPF 30 (Mineral)
Texture: Lightweight cream
Vitamin E: Antioxidant
Ceramides: Restore skin barrier
Glycerin: Hydrates
Best For: Dry, sensitive skin

Tatcha The Silk Sunscreen

Protection: SPF 50 (Mineral)
Texture: Silky, fluid-like lotion
Vitamin E: Antioxidant
Silk Extract: Soothes and supports skin barrier
Hyaluronic Acid: Hydrates
Best For: Normal to dry, sensitive skin

Dr. Jart Every Sun Day Mineral Sunscreen

Protection: SPF 30 (Mineral)
Texture: Lightweight cream
Vitamin E: Antioxidant
Ceramides: Restore skin barrier
Glycerin: Hydrates
Best For: Dry, sensitive skin.

Peter Thomas Roth Max Mineral Tinted Sunscreen

Protection: SPF 45 (Mineral)
Texture: Lightweight, tinted lotion
Vitamin E: Antioxidant
Willow Bark Extract: Soothes skin
Glycerin: Hydrates
Best For: Normal to oily skin, with uneven skin tone

Best Eczema Prescriptions

Sometimes, over-the-counter creams and lotions aren't enough to handle eczema. When that happens, doctors often prescribe stronger medicines that you can only get with a prescription. These prescription topicals are usually more powerful and can help manage the symptoms better. If over-the-counter options aren't working, it's important to talk to your doctor about getting a prescription. The most common prescriptions we use for eczema include:

Topical Steroids: Topical steroids help reduce redness and itching. They come in different strengths but should only be used short-term because they can thin the skin over time. Common examples include hydrocortisone, triamcinolone, and betamethasone.

Eucrisa : Eucrisa is an ointment that reduces inflammation and itching without being a steroid. It’s considered safe for regular use.

Rinvoq: Rinvoq is a daily pill and a “JAK” inhibitor that reduces inflammation when topical treatments aren’t effective. It requires regular blood tests and carries a risk of heart attack or stroke in people over 50.

Prednisone: Prednisone is an oral steroid used for severe eczema flare-ups. It’s meant for short-term use only, as stopping it suddenly can cause symptoms to return. It’s not recommended for long-term treatment.

Phototherapy: Phototherapy uses UVB light to reduce inflammation and itching. It’s effective for moderate to severe eczema and can be done either in a clinic or at home with a special unit.

Dupixent: Dupixent is an injection given every two weeks that blocks certain inflammatory proteins called IL-4 and IL-13. It’s used when topical treatments aren’t enough to manage eczema. The injections are simple to use, and you won’t see the needle.

Elidel + Protopic: Elidel and Protopic are creams that reduce inflammation and itching, but they are not steroids. These are called “Non-Steroidal Alternatives.” They’re often used on sensitive areas like the face, armpits, and groin.

Cibinqo: Cibinqo is a daily pill that acts as a “JAK” inhibitor to reduce inflammation. It’s used when topical treatments don’t work. Regular blood tests are needed, and it carries a risk of heart attack or stroke for people over 50.

What Is Patch Testing?

If you experience prolonged flares (meaning more than 4-8 weeks) or repeated flares, you might consider patch testing. Patch testing is a test used to identify specific allergens that may be triggering your eczema flare. Small amounts of various substances are applied to the skin using adhesive patches, and the skin's reaction is observed to pinpoint the cause of the inflammation. The typical patch testing schedule is:

Monday - Apply patches to back with tape Wednesday - Return to the office to take patches off Friday - Return to office for final reading; leave with a list of your specific allergens/what to avoid!

If we're being honest, patients hate this test because you cannot shower for the week, or do anything that will make you sweaty. Despite this, it provides valuable information!

The T.R.U.E Test is commonly used for patch testing. It tests for 36 allergens. To see what allergens are tested, click here!

Another commonly used system is called the North American 80 Comprehensive Series (NAC-80). It tests for 80 allergens in total. To see what allergens are tested, click here!

Friday Picture: Mann J, Caruana D, Luo E, Gottesman E, Agrawal N, Lozeau D, Hessel J, Neumann M, Khanijo S, Hasan Z, Rizvi K, Gunther R, Donovan D, Chan D, Lee-Wong M, Szema AM. Attenuation of Human Growth Hormone-Induced Rash With Graded Dose Challenge. Cureus. 2022 Aug 12;14(8):e27920. doi: 10.7759/cureus.27920. PMID: 36110455; PMCID: PMC9464419.

Eczema Complications

Eczema can cause serious problems that impact daily life. Infections are a major concern, as irritated skin can break easily. Constant scratching can also make the skin thick and tough, worsening the dermatitis and lowering quality of life. Along with physical discomfort, eczema can lead to emotional stress, causing feelings of embarrassment and anxiety. These complications highlight the importance of managing and treating eczema effectively.

Skin Infections: Scratching can break the skin, making it prone to infections. If an infection is suspected, topical or oral antibiotics may be needed.

Thickened Skin: Chronic scratching can cause the skin to thicken, while ongoing inflammation can change skin color.

Occupational Risk: Certain jobs, like healthcare, cleaning, or hairdressing, put people at higher risk for eczema. Severe symptoms can impact work performance and may even require a career change for some.

Reduced Quality of Life: Eczema can make daily activities and work challenging, affecting overall quality of life. Tasks that require fine motor skills, like typing, may become difficult.

Psychological Impact: The visible symptoms of hand eczema can cause self-consciousness and social withdrawal. This can increase stress and anxiety, potentially worsening the skin condition.

Thickened skin from years of chronic eczema

Eczema FAQs

Is tallow good for eczema?
Tallow can be beneficial for eczema as it is rich in fatty acids and vitamins that nourish and repair the skin barrier. However, it’s important to patch test first to ensure no adverse reactions.

Is Ivory soap good for eczema?
Ivory soap is not ideal for eczema as it can be too drying and potentially irritate sensitive skin. Gentle, fragrance-free cleansers are better options.

Should you exfoliate eczema?
Exfoliation is generally not recommended for eczema, as it can irritate and damage the already compromised skin barrier. Focus on gentle moisturizing and barrier repair instead.

Is castile soap good for eczema?
Castile soap can be too harsh for eczema-prone skin due to its high pH, which may disrupt the skin barrier. Look for cleansers specifically formulated for sensitive or eczema-prone skin.

Can I get a piercing if I have ear eczema?
It’s best to wait until eczema is fully healed before getting a piercing, as broken or inflamed skin increases the risk of infection and complications.

Is castor oil good for eczema?
Castor oil may help with eczema due to its moisturizing and anti-inflammatory properties. However, some people may find it too occlusive or irritating, so a patch test is recommended.

Is shea butter good for eczema?
Shea butter is excellent for eczema-prone skin as it helps moisturize, soothe inflammation, and repair the skin barrier. Choose a pure, fragrance-free shea butter for best results.

Is Aquaphor good for eczema?
Aquaphor is often recommended for eczema as it creates a protective barrier, locks in moisture, and soothes irritated skin.

Is eczema communicable?
No, eczema is not communicable. It is a non-contagious skin condition often caused by genetics, environmental triggers, or an overactive immune system.

Is eczema transmittable?
No, eczema is not transmittable. It cannot spread from one person to another through contact.

Does eczema flare up in the summer?
Yes, eczema can flare up in the summer due to heat, sweating, and increased exposure to allergens like pollen. Staying cool and using gentle skincare can help manage symptoms.

Is eczema herpes?
No, eczema and herpes are different conditions. However, people with eczema are at risk of a complication called eczema herpeticum if infected with the herpes simplex virus.

Is eczema hereditary?
Yes, eczema can be hereditary. It often runs in families, and individuals with a family history of eczema, asthma, or allergies are at a higher risk.

Is Vaseline good for eczema?
Yes, Vaseline is good for eczema as it provides intense hydration, locks in moisture, and helps repair the skin barrier without causing irritation.

Will cold showers help eczema?
Cold showers can help soothe eczema symptoms by reducing inflammation, calming itching, and preventing the skin from drying out.

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