Eczema treatments

What Are the Main Treatments for Eczema ?

As eczema is a chronic condition, the goal isn't to cure it permanently. Instead, the treatment of eczema and atopic dermatitis aims to manage symptoms during acute phases and minimise the risk of new flare-ups.

It's crucial to follow the doctor's prescription precisely by applying the topical corticosteroid on eczema lesions until the inflammation (redness, itching) disappears, ideally after a shower or bath. Apply corticosteroids to slightly damp skin to enhance their absorption, and spread it in a thin layer with a light massage for penetration. One application per day is sufficient. 
For thick and resistant lesions, particularly on the palms of the hands or the soles of the feet, dermatologists may prescribe topical corticosteroids under occlusion (wrapped under wet bandages) to enhance their effect. 
Treatment with topical corticosteroids usually lasts between 1 and 3 weeks. Noting the number of tubes used and taking photos of the lesions between consultations can help the doctor assess eczema evolution.
Although topical corticosteroids have a bad reputation, side effects such as skin thinning are rare and mainly occur after prolonged and excessive treatment. Most treatment failures are due to insufficient topical corticosteroid use (not potent enough corticosteroid, too short or irregular treatment).

Topical Calcineurin Inhibitors¹ ²

This class of immunomodulatory treatments is used in patients over 16 years old with moderate to severe eczema poorly controlled by topical corticosteroids. Tacrolimus and pimecrolimus (depending on availability in countries) do not carry a risk of skin thinning, even with prolonged use, and are therefore preferred for treating atopic eczema on the face and eyelids.
They are photosensitising treatments, so avoid sun exposure during use. Only dermatologists may prescribe them. 

Janus Kinase Inhibitors

Apart from upadacitinib, which is usable from 12 years old, Janus kinase (JAK) inhibitors are reserved for treating adults with moderate to severe atopic dermatitis.
A pre-treatment assessment is necessary to rule out infection or pregnancy, and vaccinations must be current.

Cyclosporine

Cyclosporine is indicated in the treatment of severe eczema in adults. Patients must be closely monitored due to possible adverse effects of the treatment on the kidneys, liver, and blood pressure.

Monoclonal Antibodies

These treatments block pro-inflammatory molecules (cytokines) that steer the immune system towards a Th2-type allergic reaction.
Dupilumab is usable in adults and children from 6 months old, while tralokinumab is reserved for adults and adolescents over 12 years old.
The doctor prescribes a pre-treatment assessment to ensure the absence of infection or pregnancy and can ensure that vaccinations are up to date.

How Do Medications for Atopic Dermatitis Work ?

Topical Corticosteroids² ³ 

Corticosteroids are molecules naturally produced by the adrenal glands. Their action mechanism is anti-inflammatory and immunosuppressive. Via a specific receptor in cells, corticosteroids interact with DNA to promote the production of anti-inflammation molecules and decrease the synthesis of pro-inflammation molecules. 
As the gene for the corticosteroid receptor can take several forms, the effectiveness of the treatment and the adverse effects of topical corticosteroids vary from person to person.

Topical Calcineurin Inhibitors²

Tacrolimus and pimecrolimus inhibit the activity of calcineurin, an essential enzyme in activating T lymphocytes, which play a role in eczema's inflammatory and allergic reactions.

Phototherapy

Phototherapy targets skin cells (eosinophils, lymphocytes) that promote the allergic-type inflammation associated with eczema.

Janus Kinase Inhibitors

Janus kinases (JAK) are enzymes that facilitate the action of pro-inflammatory cytokines. By blocking their activity, JAK inhibitors reduce inflammation and eczema symptoms.

Cyclosporine

Cyclosporine is an immunosuppressive treatment which acts mainly on T lymphocytes, JAKs and cytokines. 

Monoclonal Antibodies

Type 2 helper T-cell (Th2) immune response is one of the underlying causes of atopic dermatitis, notably through the secretion of pro-inflammatory cytokines IL-4 and IL-13, which lead to skin barrier defects. Dupilumab is an antibody that targets the IL-4 receptor, while tralokinumab acts by inhibiting IL-13.

How to Prevent Eczema Flare-ups ?

To minimise eczema flare-ups, consider the following advice.

Look after your skin

• Moisturize daily with an emollient to hydrate your skin and restore the skin barrier. 
• Limit showers or baths to once a day with lukewarm water, and opt for gentle, soap-free cleansers. 
• Pat your skin dry, avoiding rubbing, and choose cotton clothing over synthetic fabrics or wool. 
• Rinse clothes thoroughly to remove detergent residues and steer clear of fragranced fabric softeners.

Eliminate Trigger and Aggravating Factors

• Keep your home cool, steer clear of carpets and rugs, and ventilate regularly. 
•  Trim your nails often and avoid scratching eczema patches to prevent further lesions and infection.

Optimize Your Lifestyle

• If applicable, quit smoking. 
•  Engage in physical activities that don't cause excessive sweating.
•  Following each session, take a lukewarm shower and then apply an emollient. 
•  In cold, dry weather, apply emollients more frequently. 
•  Do not alter your diet without medical advice unless a food allergen has been identified.