The most effective ointment for eczema depends on how severe your flare is. For mild, dry patches, a thick moisturizing ointment with ceramides can be enough on its own. For active, inflamed eczema, a prescription steroid ointment or a non-steroidal alternative is typically needed to get the flare under control. The American Academy of Dermatology recommends moisturizers, topical corticosteroids, calcineurin inhibitors, and newer non-steroidal ointments as core treatments for both adults and children.
Why Ointments Work Better Than Creams
Ointments have a higher oil content than creams or lotions, which makes them better at sealing moisture into the skin. This matters for eczema because the condition stems partly from a damaged skin barrier that lets water escape and irritants get in. A thick ointment creates a physical layer that slows water loss, keeps medications in contact with the skin longer, and generally causes less stinging on broken or cracked patches. The trade-off is a greasier feel, which is why many people prefer to use ointments at night and lighter products during the day.
Moisturizing Ointments for Barrier Repair
Plain moisturizing ointments are the foundation of eczema care, regardless of severity. You should be applying one daily even when your skin is clear, not just during flares. The most basic option is plain petroleum jelly, which is inexpensive, fragrance-free, and surprisingly effective at preventing water loss.
For more targeted repair, look for ointments containing ceramides, cholesterol, and fatty acids. These are the three main lipids that make up your skin’s natural barrier, and eczema-prone skin tends to be deficient in all three. Research from the mid-1990s showed that applying these lipids in a specific 3:1:1 ratio (ceramides to cholesterol to free fatty acids) significantly accelerates barrier repair. Studies have since confirmed that this ratio can improve signs and symptoms of moderate eczema in adults over 28 days compared to a placebo. Notably, incorrect proportions can actually slow the repair process, so products formulated at this ratio tend to outperform generic “ceramide” moisturizers. Several pharmacy-brand eczema ointments now use this formulation.
Topical Steroid Ointments
When moisturizers alone aren’t controlling redness, itching, or inflammation, topical corticosteroids are the most commonly prescribed treatment. They work by calming the immune response in the skin. Steroids are ranked on a potency scale from Class VII (mildest) to Class I (strongest), and the right strength depends on where the eczema is and how inflamed it is.
For mild eczema or sensitive areas like the face, eyelids, and skin folds, low-potency steroids are standard. Hydrocortisone 1% or 2.5% ointment sits at Class VII, the gentlest level, and is available over the counter. Moving up, desonide 0.05% ointment (Class V to VI) is a common prescription for mild-to-moderate patches.
For moderate eczema on the body, mid-potency options like triamcinolone acetonide 0.1% ointment (Class III to IV) or mometasone furoate 0.1% ointment (Class II) are widely prescribed. These are effective for stubborn patches on the arms, legs, and trunk.
For severe, thick plaques that haven’t responded to milder treatment, high-potency steroids like clobetasol propionate 0.05% ointment (Class I) may be used for short courses, typically no more than two weeks at a time. These are not appropriate for the face, groin, or armpits, where skin is thinner and more vulnerable to side effects like thinning.
Steroid Safety and Long-Term Use
The biggest concern with topical steroids is what happens with prolonged, continuous use. Skin thinning, stretch marks, and visible blood vessels can develop over time, especially with higher potencies. A less common but increasingly recognized issue is topical steroid withdrawal: some people who use steroids for extended periods and then stop experience rebound redness, burning, skin heat, intense itching, and peeling. These symptoms can appear even on areas where the steroid was never applied. This is why most prescribers recommend using steroids in short bursts to control flares, then stepping down to moisturizers or non-steroidal options for maintenance.
Non-Steroidal Prescription Ointments
If you want to avoid steroids, or if your eczema is in a sensitive area like the face where long-term steroid use is risky, several non-steroidal prescription ointments are available.
Calcineurin Inhibitors
Tacrolimus ointment works by blocking the immune system from producing the substances that trigger eczema inflammation. It’s typically applied twice daily in a thin layer to affected areas. It’s approved for people whose eczema hasn’t responded to other treatments or who need to avoid potent steroids. The most common side effect is a temporary burning or stinging sensation when first applied, which usually fades after a few days of regular use. Pimecrolimus cream is a similar option with slightly less potency. Both are FDA-approved for ages 2 and older, though doctors sometimes use them off-label in infants as young as 3 months when eczema is difficult to control.
PDE4 Inhibitors
Crisaborole is a 2% ointment that reduces inflammation by blocking a specific enzyme involved in the immune response. It’s applied twice daily and is approved for children as young as 3 months, making it one of the earliest non-steroidal options available for infants. In clinical studies, crisaborole reduced eczema signs by about 52% based on dermatologist assessment, compared to roughly 10% with a placebo. Roflumilast is a newer option in the same drug class, approved for ages 6 and older at one strength and ages 2 to 5 at a lower concentration.
Newer Topical Options
Ruxolitinib cream targets a different part of the immune pathway and is approved for ages 2 and older. Tapinarof cream, approved for eczema in children 2 and older as of 2024, works through yet another mechanism. These newer options give prescribers more flexibility, especially for children or for eczema on the face and neck where steroid use needs to be limited.
How to Apply Ointment for Best Results
The way you apply ointment matters almost as much as which one you use. The most effective approach is to apply your ointment right after bathing, while your skin is still slightly damp. Soaking in a lukewarm bath for about 15 minutes hydrates the outer layer of skin, and patting dry (not rubbing) leaves enough surface moisture for the ointment to lock in. Apply any prescription medication first to the affected areas, then follow with your moisturizing ointment over the rest of your body.
For severe flares, wet wrap therapy can dramatically boost effectiveness. After applying medication and moisturizer, you cover the treated skin with a layer of damp fabric (wet pajamas, gauze, or cotton wraps), then a dry layer on top. The wrap keeps the ointment pressed against the skin and prevents it from rubbing off. Wraps are typically worn for about two hours or overnight, depending on severity. This technique is especially useful for children with widespread, hard-to-control eczema.
Choosing the Right Ointment by Severity
- Dry skin with no active redness: A ceramide-based moisturizing ointment or petroleum jelly, applied at least once or twice daily, is usually sufficient to prevent flares.
- Mild redness and itching: Over-the-counter hydrocortisone 1% ointment for short-term use (a week or two), combined with a daily moisturizing ointment.
- Moderate, persistent patches: A mid-potency prescription steroid ointment for flares, with a calcineurin inhibitor or PDE4 inhibitor ointment for maintenance between flares.
- Severe or widespread eczema: A higher-potency steroid for short bursts to gain control, then a step-down to non-steroidal options. Wet wrap therapy may be recommended during the worst periods.
- Face, eyelids, or skin folds: Low-potency steroids for brief use, or a non-steroidal ointment like tacrolimus or crisaborole for longer-term management.
No single ointment works perfectly for everyone, and most people with eczema end up using a combination: a moisturizing ointment daily and a prescription ointment as needed for flares. The goal is to find the least potent option that keeps your skin comfortable and clear, and to always maintain the moisturizing base even when your skin looks fine.