If you’ve had eczema for years, you probably know the drill. The itch starts, the dry or inflamed patches follow and you reach for whatever cream has gotten you through the last dozen flares. But eczema treatment has evolved in just the last few years. Steroid creams are no longer the only topical option, newer medications can target specific inflammatory pathways and doctors can now personalize treatment based on where your eczema appears, how much it bothers you and even how you prefer to treat it.
So, what should you know if your current routine isn’t cutting it? We asked three dermatologists to answer six questions patients frequently ask.
Featured Experts
- Aegean Chan, MD is a double board-certified dermatologist in Santa Barbara, CA
- Jessie Cheung, MD is a board-certified dermatologist in Willowbrook, IL
- Mansha Sethi Thacker, MD is a board-certified dermatologist in Center Valley, PA
Do I have to just live with my eczema symptoms?
Santa Barbara, CA dermatologist Aegean Chan, MD: “It is incredible how many new treatments we now have available for people with moderate-to-severe eczema. When I was in residency a little over 10 years ago, we didn’t have many options for patients who fell somewhere in the middle, where their eczema may not have been widespread but still severely impacted their quality of life. Patients often felt like they simply had to live with some degree of itching, dryness, scaling and cosmetically noticeable skin changes. Today, we have so many new treatments with favorable side effect profiles that patients no longer necessarily have to choose between taking a higher-risk medication and having their disease completely controlled. That has been a major shift in how we’re able to manage eczema.”
My doctor prescribed a steroid cream. Is there anything else?
Willowbrook, IL dermatologist Jessie Cheung, MD: “Eczema treatment has changed dramatically. We’ve moved from relying on topical steroids, phototherapy and broad immunosuppressants to therapies that target the specific inflammatory pathways driving the disease. Topically, we’ve also moved beyond steroids with options including Opzelura, Vtama, Eucrisa and Zoryve, which can be especially useful for sensitive areas like the face and eyelids, without the risk of skin thinning that comes with steroids.”
What if my eczema is only in one small spot, but it’s driving me crazy?
Dr. Cheung: “I don’t treat an eczema score; I treat the patient. I look at severity, location, itch, sleep disruption, frequency of flares, age, other medical conditions and how much the disease is interfering with daily life. A small amount of eczema on the eyelids, hands or genitals can have an enormous impact on someone's quality of life.”
I’ve been resistant to treatments in the past. What’s different about the new ones?
Dr. Chan: “The major difference is how targeted these newer medications are. Biologics can specifically target the immune pathways that are overactive in eczema, such as IL-4 and IL-13 signaling, rather than relying on medications with broader effects and potentially more complicated side effect profiles. In my experience, Dupixent can provide extremely effective control of atopic dermatitis for many patients while maintaining a very favorable side effect profile. Oral JAK inhibitors provide another targeted option and can be especially effective at controlling itch. Overall, patients today have the potential to achieve a level of disease control that was much harder to offer with the treatment options we had a decade ago.”
How do I know if I need a pill or a shot?
Center Valley, PA dermatologist Mansha Sethi Thacker, MD: “This is a discussion I have with my patients. I always present options and we pick a treatment together based on several factors: disease severity, the part of the body affected, age, patient preference, co-morbidities and insurance. Some people hate injections and others don’t want to take a pill every day. They would rather do an injection every two to four weeks, depending on the medication. Some patients want fast results, others want to minimize the side effect profile.”
With all these new treatments, how clear can my skin actually get?
Dr. Thacker: “The newer biologics are much more precise. They only target specific immune pathways that are linked to eczema. Many patients can achieve clear or almost-clear skin, major itch reduction, better sleep, fewer flares and a much better quality of life.”
