What we do know is that there is a wealth of eczema treatments, including home remedies like warm baths, adequate sleep, and regular moisturizing, as well as over-the-counter antihistamines and creams.
For many, these strategies are enough to control eczema symptoms, but if you’ve exhausted all your options and eczema is still running your life, it’s probably time to look to prescription medications for help.
“You need a prescription when everything else you’re doing isn’t working,” says Doris Day, MD, a dermatologist with Lenox Hill Hospital in New York City. “You’re moisturizing, you’re using every OTC [treatment] you can find, you adjusted your diet and sleep, you’re drinking more water, and the itch has become intractable.”
If those at-home and over-the-counter strategies haven’t helped, doctors will often start you on prescription cortisone creams, which are stronger than the versions you can buy over the counter. Cortisone is a type of steroid, and steroids have long been the gold standard in eczema treatment, Dr. Day says. “Of the products that have been available, steroid creams and ointments have worked faster and given more immediate relief.”
But they’re not perfect. Steroid creams can cause your skin to thin, so doctors typically prefer non-steroidal treatment for long-term eczema control, she adds. Those options might include topical calcineurin inhibitors (TCIs), which improve eczema by tweaking your immune system, or other non-steroidal creams, like crisaborole, to reduce inflammation.
When steroid creams aren’t cutting it, your doctor may decide to try oral steroids instead. “You get relief and better quality of life,” says Luz Fonacier, MD, a spokesperson for the American College of Allergy, Asthma, and Immunology and professor of medicine at SUNY Stony Brook. But there are downsides to oral steroids too: The meds can only be taken for short periods of time because of the risk of severe side effects like bone fractures, glaucoma, and even diabetes. Oral steroids also have a high rebound rate, with patients markedly improving while they’re on the drugs, then re-developing symptoms as soon as they come off, Dr. Fonacier says.
In general, doctors will want to see how you respond to treatment for two to four weeks before deciding to try another method, says Dr. Fonacier, who is also head of allergy and immunology at New York University Winthrop Hospital.
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