Eczema treatment options
Pro Research Analysisby 
Searched over 200M research papers
Eczema Treatment Options: Topical Therapies and Patient Education
The first step in managing eczema, including atopic dermatitis and hand eczema, is basic skin care. This involves regular use of hydrating and barrier-stabilizing topical treatments (emollients) and avoiding known triggers or irritants 347. Patient education on prevention, allergen avoidance (for allergic contact dermatitis), and therapeutic patient education programs ("eczema school") are also recommended to improve outcomes 1347.
Topical corticosteroids remain the mainstay and first-line treatment for both acute and chronic eczema flares, but they should not be used daily for more than 8 weeks to avoid side effects 134. Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, are preferred for sensitive areas and can be used for proactive, long-term intermittent therapy in frequently relapsing cases 13410. Other topical agents, including delgocitinib and combinations like calcipotriol/betamethasone, are being explored for hand eczema .
Systemic Treatments for Severe or Refractory Eczema
For severe or long-lasting eczema that does not respond to topical treatments, systemic therapies may be considered. Alitretinoin is the only licensed systemic therapy for severe chronic hand eczema, while other options like cyclosporine, methotrexate, azathioprine, and mycophenolic acid are used off-label for severe atopic dermatitis 134710. Systemic corticosteroids are generally avoided due to their unfavorable risk-benefit profile .
Biologics and Emerging Targeted Therapies
Recent advances have led to the development of biologic drugs that target specific immune pathways involved in eczema. Dupilumab, an IL-4/IL-13 receptor antagonist, and tralokinumab, which targets IL-13, are approved for atopic dermatitis and have shown good safety and efficacy 2367. These biologics are especially useful for moderate-to-severe cases and are being studied for hand eczema as well 610.
Janus kinase (JAK) inhibitors, such as baricitinib, upadacitinib, abrocitinib, and delgocitinib, are new oral or topical drugs that block inflammatory signaling and have demonstrated promising results in clinical trials for both atopic dermatitis and hand eczema 26710. Other novel agents, like fevipiprant (a DP2 receptor antagonist), are under investigation for their potential to provide effective treatment with fewer side effects .
Phototherapy and Adjuvant Treatments
Phototherapy, including narrowband UVB and UVA1, is effective for some patients but can be time-consuming and inconvenient 134. Coal tar preparations may be helpful for hand and foot eczema . In cases of secondary infection or microbial colonization, antimicrobial treatments may be necessary 347.
Additional and Supportive Therapies
Dietary interventions should be individualized and only recommended when a food allergy is confirmed 347. Allergen-specific immunotherapy may be considered in select cases with aeroallergen sensitivity 347. Psychosomatic counseling is advised for patients with stress-induced flares, and antihistamines have limited benefit for itch 347.
Conclusion
Eczema treatment is multifaceted and should be tailored to the type, severity, and individual patient needs. First-line therapies include emollients and topical corticosteroids, with calcineurin inhibitors and phototherapy as alternatives. Systemic immunosuppressants, biologics, and JAK inhibitors are reserved for more severe or refractory cases. Ongoing research continues to expand the range of effective and safer treatment options for eczema 123467810.
Sources and full results
Most relevant research papers on this topic