Your doctor may recommend a combination of treatments to manage severe eczema. These may include topical therapies, injected or oral medication, and other treatments.
You may need to try more than one treatment to find what works well for you.
Below, you can find the answers to common questions about treatments for severe eczema.
New treatments have recently become available for severe eczema, including biologic therapies and JAK inhibitors.
Researchers are also continuing to develop and test new treatments for severe eczema. Some of these treatments may become available in the future.
Biologic therapies
Biologic therapies are medications developed from natural sources.
Biologics for eczema help to modify the immune system response that causes inflammation under the surface of your skin. This helps treat and prevent eczema flares.
The Food and Drug Administration (FDA) approved the biologic dupilumab (
The FDA approved the biologic tralokinumab-ldrm (Adbry) for managing moderate to severe eczema in adults in 2021. In 2023, it also approved this medication for managing eczema in children ages 12–17 years old.
Your doctor may prescribe one of these biologic therapies if topical medications and other measures, such as phototherapy, are not enough to relieve your eczema symptoms. These biologic therapies are given as injections under your skin.
Biologics can cause potentially
JAK inhibitors
JAK inhibitors are immune-altering medications that block certain proteins that help drive inflammation. They may help reduce itch and other eczema symptoms.
The FDA has approved ruxolitinib (Opzelura) to treat mild to moderate eczema in people ages 12 years and older. This is a topical JAK inhibitor that you apply to your skin.
The FDA has also approved upadacitinib (Rinvoq) and abrocitinib (Cibinqo) to treat moderate to severe eczema. These are oral JAK inhibitors that you swallow in pill form.
Although JAK inhibitors are generally safe, they may cause potentially serious side effects. Your doctor can help you learn more about the potential benefits and risks of these treatments.
Your doctor may recommend several treatments for severe eczema, including one or more of the treatments below.
Topical medications
Topical medications for eczema include medicated creams, ointments, and other products that you apply to your skin or scalp.
Examples include:
- topical corticosteroids
- topical calcineurin inhibitors (TCIs)
- ruxolitinib (Opzelura), which is a topical Janus kinase (JAK) inhibitor
- crisaborole ointment (Eucrisa), which is a topical phosphodiesterase 4 (PDE4) inhibitor
Topical medications alone are often not enough to manage severe eczema. Your doctor may combine topical medications with other treatments.
Light or phototherapy
Light therapy, also called phototherapy, uses a special lamp or machine to direct ultraviolet light on your skin, which can help reduce inflammation. You may visit a clinic to receive phototherapy or purchase a home phototherapy unit.
Your doctor may prescribe phototherapy if topical medications alone are not enough to manage your eczema symptoms. They may prescribe this treatment for eczema that’s widespread over your whole body or localized on your hands, feet, or other areas.
You’ll likely need multiple sessions of phototherapy to notice improvements in your symptoms.
Injected medications
The FDA has approved the following injected medications for moderate to severe eczema:
- dupilumab (Dupixent)
- tralokinumab-ldrm (Adbry)
These medications are biologic therapies that you inject under your skin. They modify the immune system response that causes eczema symptoms. They may help relieve severe eczema but also carry a risk of potentially serious side effects.
Your doctor may prescribe an injected medication if topical treatments and other measures, such as phototherapy, are not enough to manage your eczema symptoms. They can help you understand the potential benefits and risks of this treatment approach.
Oral medication
Your doctor may prescribe one of the following oral medications to treat a severe eczema flare:
- an oral JAK inhibitor, such as:
- upadacitinib (Rinvoq)
- abrocitinib (Cibinqo)
- a conventional immunosuppressant drug, such as:
- azathioprine
- cyclosporine
- methotrexate
- mycophenolate mofetil
- an oral corticosteroid, such as prednisone
These prescription oral medications modify or suppress your immune system. They may help relieve symptoms of severe eczema, but they carry a risk of potentially serious side effects.
Your doctor may prescribe an oral medication for only short periods of time to lower your risk of side effects.
Certain over-the-counter oral medications may also help reduce some eczema symptoms. These include oral pain relievers. If you have allergies that trigger eczema symptoms, oral antihistamines may also provide some relief.
Wet wraps
Wet wraps may help relieve pain and itchiness during a severe eczema flare.
To make a wet wrap, use warm water to dampen a cloth or piece of clothing. Wrap it over the skin that’s affected by eczema symptoms. Then, wrap a dry cloth around the damp cloth and leave it on for several hours or overnight.
Your doctor may advise you to apply moisturizer or topical treatments to your skin before applying a wet wrap.
Gentle skin care routine
Your doctor may recommend changes to your skin care routine to help manage severe eczema.
You may find it helpful to practice these skin care habits:
- Moisturize your skin regularly.
- Use lukewarm rather than hot water to clean your skin.
- Use mild, fragrance-free cleansers and other gentle skin care products.
- Avoid taking long baths and showers.
It may also help to limit contact between your skin and products that contain fragrances, dyes, or other irritating ingredients.
Creams and other topical treatments are often not enough to treat severe eczema, but combining topical treatments with other therapies may provide relief.
Your doctor may recommend creams, ointments, or other topical products to help manage eczema symptoms. They may recommend one or more of the products below.
Moisturizers
Regularly applying moisturizer to your skin may help limit symptoms of eczema by preventing dryness and protecting your skin barrier, which is the layer of skin that keeps harmful chemicals and irritants out.
The National Eczema Association (NEA) recommends using moisturizing ointments or creams, which contain high concentrations of oil. The oil in these products helps keep moisture in and irritants out. Moisturizing lotions may be less effective than ointments or creams because they contain less oil. Lotions also have a higher water content than creams, which causes them to evaporate quicker, so that they may not be as hydrating to the skin.
It’s generally best to avoid moisturizers that contain fragrances, dyes, or other common irritants. Consider looking for products marked with the NEA’s Seal of Acceptance or search for products in the NEA’s Eczema Product Directory. These products are free of common allergens and irritants.
Topical corticosteroids
Applying topical corticosteroids can help reduce inflammation, itch, and other symptoms of eczema.
Topical corticosteroids are available as creams, ointments, and other formulas.
Some topical corticosteroids are available over the counter. These contain 1% hydrocortisone.
Stronger topical corticosteroids are available with a prescription. Your doctor may prescribe prescription-strength topical corticosteroids if over-the-counter products are not effective for managing your symptoms.
Topical calcineurin inhibitors (TCIs)
TCIs are immune-altering medications that you apply to your skin. They block a certain protein that’s involved in the immune system response that causes eczema. This helps reduce eczema symptoms.
The FDA has approved two types of TCIs for eczema:
- pimecrolimus (Elidel)
- tacrolimus (Protopic)
TCIs are typically used to manage mild to moderate eczema, or eczema that is located in delicate areas, such as your face or genitals. A doctor may also prescribe TCIs instead of topical corticosteroids for children.
Topical JAK inhibitors
JAK inhibitors are immune-altering medications that block certain proteins that help drive inflammation.
Ruxolitinib (Opzelura) is a topical JAK inhibitor that the FDA has approved for mild to moderate eczema. It may not be effective on its own for treating severe eczema, but your doctor might prescribe it as part of a larger treatment plan.
Topical PDE4 inhibitors
PDE4 inhibitors block certain proteins that help trigger inflammation.
Crisaborole (Eucrisa) is a topical PDE4 inhibitor that’s generally used to treat mild to moderate eczema. It may help reduce inflammation, itch, and other symptoms.
This treatment alone may not be enough to treat severe eczema.
Eczema is different for everyone. Your treatment plan may differ from another person’s treatment plan.
Some people experience relief from topical treatments and gentle skin care alone. Other people may need phototherapy or systemic treatments, such as injected or oral medication. Severe eczema often requires phototherapy and/or systemic treatments to manage.
Let your doctor or dermatologist know if your eczema symptoms continue to get worse with your current treatment plan. They may recommend changes to your treatment.
Severe eczema doesn’t have a cure. But with treatment, you can reduce the frequency and severity of flares.
According to the American Academy of Dermatology, eczema sometimes gets less severe over time. People who develop eczema in childhood often find their symptoms improve or resolve entirely as they get older.
Untreated eczema flares may last for a while or not resolve unless the trigger is removed. Treatment helps control eczema flares, and in some cases, prevents flares from occurring.
Leaving eczema untreated raises your risk of complications.
Eczema makes you more susceptible to skin infections. The National Institute of Allergy and Infectious Diseases reports that about
Talk with your doctor right away if you notice signs of infection on your skin. It’s important to get early treatment.
Over-the-counter products may be enough to treat mild to moderate eczema, but severe eczema often requires phototherapy or prescription-strength medication to manage.
Topical, injected, and oral medications are available to manage moderate to severe eczema. Your doctor will tailor your treatment plan to your specific needs and preferences.
Many prescription-strength medications for eczema may cause side effects. Your doctor can help you learn how to recognize and manage potential side effects. Let them know if you think you may be experiencing side effects.
Let your doctor know if your eczema symptoms continue or get worse. They may adjust your treatment plan.