Understanding the Different Medicated Treatments for Eczema

When it comes to more targeted treatments for eczema, the use of over the counter (OTC) medications, prescription topical medications, and biologics are often identified as the go-to eczema remedies for moderate to severe cases. When used in conjunction with a proper skincare routine, as well as wet-wrap therapy, these medicated treatments have been shown to be effective in reducing symptoms.


Over the Counter Medications


There are various OTC medications that can help with relieving eczema symptoms including topical OTC hydrocortisone, OTC antihistamines, medicated OTC shampoos, and other OTC moisturizers.


Hydrocortisone

Topical OTC hydrocortisone is a milder form of steroid that helps reduce redness, itching, and inflammation of the skin. It comes in different forms including ointments, creams, lotions, gels, and tape, and is often used as a temporary fix for itching and rashes associated with eczema. The general recommendation for OTC hydrocortisone use is application one to four times a day for up to seven days. OTC hydrocortisone should not be used for longer durations of time or in higher doses, and prior to use, it is recommended that you speak with your healthcare provider to ensure that there are no foreseen complications with use.


OTC Antihistamines

Over-the-counter antihistamines help with relieving itch and can be useful during the night to help promote a more restful sleep. Commonly known antihistamines include loratadine (Claritin), fexofenadine (Allegra), cetirizine (Allegra), and diphenhydramine (Benadryl). Antihistamines work by blocking the activity of histamine, which is a chemical in the body involved in producing inflammatory responses to allergy, infection, or injury.


Medicated OTC Shampoos

For individuals with seborrheic dermatitis on the scalp (aka dandruff), medicated OTC shampoos can be used to help relieve symptoms. These shampoos often contain ingredients such as ketoconazole, selenium sulfide, coal tar, and zinc pyrithione that work to help lift the eczema scales from the scalp. They can also provide antifungal treatment by limiting the growth of malassezia on the scalp. Overgrowth of malassezia, which is a type of yeast, has been linked to the development of seborrheic dermatitis. OTC shampoos work to combat these two main conditions associated with seborrheic dermatitis of the scalp.


OTC Moisturizers

Referring back to our skincare blog, there are many different types of OTC moisturizers that can be used to help replenish the skin barrier. They come in different forms - ointments, creams, and lotions, and mainly work by helping the skin stay hydrated. Commonly used creams and ointments include Vanicream, Eucerin, Cetaphil, Cerave, and Aquaphor.


Prescription Topical Treatments


Topicals are medicated treatments that are directly applied to the skin. The most common forms of topical treatments for eczema include prescription steroids, calcineurin inhibitors, and PDE4 inhibitors.


Topical Steroids

Topical corticosteroids are among the most commonly prescribed medications for eczema treatment. Corticosteroids (commonly known as just steroids) resemble the hormone cortisol, which helps to regulate growth and immune function within the body. When applied to the skin, steroids help to relieve redness and reduce inflammation and itching, allowing the skin to heal. Topical steroids come in different forms (ointment, cream, lotion, or spray) and also have varying strengths. They are classified from a range of the “super potent” (Class 1) to the “least potent” (Class 7). As there is a risk of thinning of the skin from prolonged use, it is recommended that topical steroids be applied only to the eczema-affected areas and only for the recommended quantity and period of time prescribed by your doctor. It is also important to moisturize following steroid application to ensure that the skin receives adequate hydration.


Topical Immunomodulators/Calcineurin Inhibitors

Topical immunomodulators/calcineurin inhibitors (TIM/TCIs) are a steroid-free medication option for eczema treatment. TCIs work by blocking the activity of T-cells within the body that initiate immune responses, thus reducing inflammation. TCIs can be applied to all affected areas of the skin and in contrast to steroids, can be used for extended periods of time to control symptoms. While there are less adverse side effects associated with TCI use, some common side effects do include mild burning/stinging sensation with initial use. As with other medications, it is important to consult with your provider before use to ensure correct application of TCIs.


Topical PDE4 Inhibitor

Topical PDE4 inhibitor is a type of drug that blocks the activity of the enzyme phosphodiesterase 4 (PDE4). PDE4 is produced by our immune system and helps to control cytokine protein activity, which is involved in inflammation initiation. There is currently only one USDA approved PDE4 inhibitor, Eucrisa, which has been found to reduce inflammation and symptoms with use.


Biologics


Biologics are types of drugs that use human DNA to treat diseases at the immune system level. They are genetically engineered medications that are either taken subcutaneously (through the skin) or intravenously (in the vein). Biologics work by blocking interleukin proteins (ILs), which are involved in our immune system response to internal/external triggers. By blocking IL activity, the immune system becomes less reactive, resulting in less inflammation and fewer eczema symptoms. Dupixent, the USDA approved biologic currently used for eczema treatment thus works by limiting the immune system reaction and has been shown to reduce symptoms by 75%. Dupixent is taken subcutaneously through injection every other week and is only available by prescription.


Important Precautions


As with any medication, the above treatment options each have their own side effects. It is important to consult with your provider before using any OTC/prescription medications to determine the benefits and risks of use. Directions should be strictly followed on dosage and duration of use, and if any side effects/complications are observed, immediately stop use.


Weihong Zheng, M.D.