When eczema flares, the priority is reducing inflammation, protecting the skin barrier, and avoiding anything that will make it worse. Most flares respond well to a combination of proper moisturizing, the right anti-inflammatory treatment, and trigger avoidance. Here’s what to do, step by step.
Cool the Inflammation First
Topical corticosteroids are the first-line treatment for active flares. The key is matching the strength of the steroid to the body area. Medium- to high-potency steroids work well on the trunk, arms, and legs, while low-potency steroids are the safe choice for thin-skinned areas like the face, eyelids, groin, and skin folds. Super-high-potency steroids are reserved for severe flares on thick skin like the palms and soles, and should only be used for short periods.
Apply your prescribed steroid to damp skin right after bathing, then layer moisturizer on top. This “soak and seal” approach helps the medication absorb while locking in hydration. Most flares improve within a few days of consistent use, but continue for as long as your prescriber recommends to prevent a rebound.
If steroids haven’t worked on sensitive areas like your face, or if you’re concerned about prolonged steroid use, non-steroidal alternatives exist. Calcineurin inhibitors (tacrolimus and pimecrolimus) are particularly useful on the face and eyelids where potent steroids aren’t ideal. Newer options include crisaborole cream for mild to moderate eczema, though it’s modestly effective: about 30% of patients were clear or nearly clear after 28 days in clinical trials, compared to 18 to 25% with a plain moisturizer base.
Restore Your Skin Barrier
Eczema-prone skin contains less ceramide, a fat that locks moisture in and keeps irritants out. During a flare, this barrier is even more compromised, which is why moisturizing aggressively matters just as much as the anti-inflammatory treatment itself.
Use thick ointments or creams rather than lotions. Products containing ceramides or vitamin B3 (niacinamide) can help replenish what your skin is missing. Plain petrolatum (petroleum jelly) is also highly effective as a barrier sealant and is well tolerated by most people. Apply moisturizer at least twice a day, and always within a few minutes of bathing while skin is still slightly damp. Switch to non-soap, low-pH, hypoallergenic cleansers, since regular soap strips the skin barrier further.
Try Wet Wrap Therapy for Severe Flares
If your flare is widespread or not responding to standard treatment, wet wrap therapy can dramatically speed up healing. The technique works by keeping medication and moisturizer in prolonged contact with the skin while cooling inflammation.
Start by soaking in a lukewarm bath for about 15 minutes. Pat skin mostly dry, leaving it slightly damp. Apply your topical medication to the affected areas, then follow with a generous layer of unscented moisturizer. Next, put on a layer of damp clothing or wrap affected areas in wet gauze, then cover with a dry layer to stay warm. Wear the wraps for about two hours, or overnight for more severe cases. For intense flares, this can be done up to three times a day.
Consider Bleach Baths
Eczema-prone skin is frequently colonized by bacteria that worsen flares. Dilute bleach baths help reduce this bacterial load without antibiotics. Add one-quarter cup of regular household bleach to a 20-gallon (half-full) bathtub of warm water, or one-half cup for a full tub. U.S. bleach products typically contain 6% to 8.25% sodium hypochlorite; if yours is at the higher end of that range, use a bit less. The resulting concentration is similar to a swimming pool.
Soak for about 10 minutes, once or twice a week. Rinse off afterward, pat dry, and immediately apply your moisturizer and any prescribed treatments.
Remove the Triggers Fueling the Flare
While you’re treating the flare itself, eliminate whatever is keeping the cycle going. Some common triggers are obvious, but others catch people off guard.
- Temperature swings: Moving between air-conditioned rooms and summer heat, or transitioning into cold winter weather, can provoke flares. Low humidity in winter is especially problematic because it dries out already compromised skin. A humidifier in the bedroom helps.
- Stress and poor sleep: Even a single night of bad sleep increases inflammatory signaling in the body, which can trigger or worsen a skin flare. High-stress periods like exams, deadlines, or major life changes are common flare catalysts.
- Viral illness: A common cold or other viral infection ramps up whole-body inflammation, and eczema flares along with it. If your flare started around the same time as a cold, this is likely the connection.
- Air pollution: Living in or visiting areas with poor air quality, particularly warm, dry metro areas with stagnant air, can trigger flares through irritating particles contacting the skin.
- Hair dye: A chemical called PPD found in many hair dyes causes allergic reactions in the general population, but for people with eczema it can trigger excessive itching and flaking.
Beyond these, the usual suspects still apply: fragranced products, wool and synthetic fabrics, hot showers, dust mites, and pet dander. During an active flare, be stricter than usual about avoiding anything that contacts your skin unnecessarily.
Watch for Signs of Infection
Broken, inflamed skin is vulnerable to bacterial and viral infections, and an infected flare won’t heal with standard treatment alone. Watch for oozing that looks pus-colored or yellowish, crusting over the eczema patches, or skin that’s becoming increasingly painful rather than just itchy. Systemic signs like fever, chills, fatigue, achiness, or swollen lymph nodes in the neck, armpit, or groin suggest the infection has progressed and needs prompt medical attention. If your eczema starts weeping fluid, especially in a baby or young child, contact your healthcare provider quickly.
When Standard Treatment Isn’t Enough
For moderate to severe eczema that doesn’t respond to topical treatments, several systemic options now exist. Dupilumab is an injectable medication given every two weeks that blocks specific inflammatory signals driving eczema. It’s an immunomodulator rather than an immunosuppressant, which means it targets eczema pathways without broadly suppressing your immune system. It must be prescribed by a dermatologist or immunologist and is used alongside topical treatments.
Oral JAK inhibitors like upadacitinib represent another option, with a notably fast onset: 70 to 80% of patients in trials achieved a 75% reduction in eczema severity by 16 weeks. Newer topical options are also expanding. The latest AAD guidelines now recommend tapinarof cream for moderate to severe eczema in adults and roflumilast cream for mild to moderate cases, both with strong confidence based on available evidence. These give you and your dermatologist more tools when steroids alone aren’t cutting it.