Atopic eczema is commonly treated using topical steroid skin creams or other skin creams with immunomodulatory effects. These are placed directly onto the skin where it is itchy and inflamed and can be effective in relieving itchiness, inflammation and other eczema symptoms. Initially, patients may be prescribed a mild cortisone (steroid) cream for eczema.
Stronger steroid creams may be used if this does not relieve the condition sufficiently and different creams may be advised and prescribed for different areas of skin. Oral steroids or injected corticosteroids may be given in extreme cases of eczema but these carry significant risks in terms of lowering the immune system and making a patient vulnerable to infection.
Continuous use of steroid creams can also make the skin thinner and more prone to dysfunction such as eczema which may lead a patient to remain stuck using such creams even if they could have treated their eczema using natural skin care or eczema treatments other than steroids initially.
Topical Immunomodulators (TIMs) may be given for patients with eczema who are over two years of age and these medications are classified as calcineurin inhibitors. Elidel is a common brand of topical immunomodulator (its generic name pimecrolimus) as is tacrolimus (Protopic).
These medications can also have significant side-effects and the FDA issued a black box warning in 2006 stating that the long-term safety of calcineurin inhibitors was unknown. Such drugs have been connected to rare cases of cancer however and patients should ensure that they are aware of the risks with each topical medication and any precautions that should be taken to minimise their risks when using eczema treatments such as these.
TIMs are not recommended as a first-line therapy for eczema and are only usually used for a brief period to bring an acute flare-up under control where it is unresponsive to other eczema treatments.
Barrier creams containing ceramides can be used to lock in moisture and reduce the risks of infection and skin cracking and these may also aid skin repair for some patients. Other creams and unguents may be advised, such as those containing coal tar or anthralin for areas of lichenified (thickened) skin.
Antibiotic creams may be necessary if the skin has become infected, as might oral antibiotics depending on the severity of the infection. Emollient creams with a petrolatum-base are often recommended for application after bathing, and all creams used in managing eczema symptoms should have a low water content and high oil content in order to lock in moisture to the skin.