Management

There is no known cure for eczema, with treatment aiming to control symptoms by reducing inflammation and relieving itching.

Lifestyle

Bathing once or more a day is recommended. It is a misconception that bathing dries the skin in people with eczema. It is not clear whether dust mite reduction helps with eczema.

There has not been adequate evaluation of changing the diet to reduce eczema. There is some evidence that infants with an established egg allergy may have a reduction in symptoms if eggs are eliminated from their diets. Benefits have not been shown for other elimination diets, though the studies are small and poorly executed. Establishing that there is a food allergy before dietary change could avoid unnecessary lifestyle changes.

People can also wear clothing designed to manage the itching, scratching and peeling. Soaps and detergents should not be used on affected skin because they can strip natural skin oils and lead to excessive dryness.

Moisturizers

Moisturizing agents (also known as emollients) are recommended at least once or twice a day. Oilier formulations appear to be better and water based formulations are not recommended. It is unclear if moisturizers that contain ceramides are more or less effective than others. Products that contain dyes, perfumes, or peanuts should not be used. Occlusive dressings at night may be useful.

Medications

There is little evidence for antihistamine and they are thus not generally recommended. Sedative antihistamines, such as diphenhydramine, may be tried in those who are unable to sleep due to eczema.

Corticosteroids

If symptoms are well controlled with moisturizers, steroids may only be required when flares occur. Corticosteroids are effective in controlling and suppressing symptoms in most cases. Once daily use is generally enough. For mild-moderate eczema a weak steroid may be used (e.g. hydrocortisone), while in more severe cases a higher-potency steroid (e.g. clobetasol propionate) may be used. In severe cases, oral or injectable corticosteroids may be used. While these usually bring about rapid improvements, they have greater side effects.

Long term use of topical steroids may result in skin atrophy, stria or telangiectasia. Their use on delicate skin (face or groin) is therefore typically with caution. They are, however, generally well tolerated.

Immunosuppressants

Topical immunosuppressants like pimecrolimus and tacrolimus may be better in the short term and appear equal to steroids after a year of use. Their use is reasonable in those who do not respond to or are not tolerant of steroids. Treatments are typically recommended for short or fixed periods of time rather than indefinitely. Tacrolimus .1% has generally proved more effective than picrolimus, and equal in effect to mid-potency topical steroids.

The United States Food and Drug Administration has issued a health advisory a possible risk of lymph node or skin cancer from these products, however subsequent research has not supported these concerns. A major debate, in the UK, has been about the cost of these medications and, given only finite NHS resources, when they are most appropriate to use.

When eczema is severe and does not respond to other forms of treatment, systemic immunosuppressants are sometimes used. Immunosuppressants can cause significant side effects and some require regular blood tests. The most commonly used are ciclosporin, azathioprine and methotrexate.

Light therapy

Light therapy using ultraviolet light has tentative support but the quality of the evidence is not very good. A number of different types of light may be used including UVA and UVB. Overexposure to ultraviolet light carries its own risks, particularly that of skin cancer.

Alternative medicine

There is currently no scientific evidence for the claim that sulfur treatment relieves eczema. It is unclear whether Chinese herbs help or harm. Dietary supplements are commonly used by people with eczema. Neither evening primrose oil nor borage seed oil taken orally have been shown to be effective. Both are associated with gastrointestinal upset. Probiotics do not appear to be effective. There is insufficient evidence to support the use of zinc, selenium, vitamin D, vitamin E, pyridoxine (vitamin B6), sea buckthorn oil, hempseed oil, sunflower oil, or fish oil as dietary supplements.

Other remedies lacking evidential support include chiropractic spinal manipulation and acupuncture. There is little evidence supporting the use of psychological treatments. While dilute bleach baths have been used for infected dermatitis there is little evidence for this practice.