The foundation of eczema treatment is a good moisturizer, applied consistently. Beyond that, the right approach depends on how severe your symptoms are, ranging from over-the-counter creams for mild flares to prescription anti-inflammatory treatments for stubborn or widespread patches. Most people use a combination of daily skin barrier repair and targeted treatments during flare-ups.
Moisturizers: The Non-Negotiable First Step
Eczema-prone skin loses water faster than healthy skin because its protective barrier is compromised. Moisturizing isn’t just comfort care. It’s the single most important thing you can do every day to reduce flares and keep symptoms manageable. The goal is to trap water in the skin and fill in the gaps in that damaged barrier.
Three ingredients do the heavy lifting in eczema moisturizers:
- Petrolatum (petroleum jelly) forms a physical seal over the skin to lock in moisture. It also helps the skin produce natural antibacterial compounds that fight infection, which matters because eczema skin is infection-prone. Plain 100% white petroleum jelly is one of the most effective and cheapest options available, though it does feel greasy, so many people reserve it for bedtime.
- Ceramides are fats that naturally exist in your skin barrier. Eczema skin is low in ceramides, so creams that contain them help rebuild what’s missing.
- Glycerin is a humectant, meaning it pulls water from the air into your skin. Creams with glycerin relieve dryness without the stinging or burning that other products can cause.
Ointments are generally more effective than lotions because they contain more oil and less water. Lotions evaporate quickly and sometimes contain fragrances or preservatives that can irritate sensitive skin. Look for products labeled “fragrance-free” (not just “unscented,” which can still contain masking fragrances).
Apply moisturizer within a few minutes of bathing while your skin is still slightly damp. This seals in the water your skin just absorbed. Reapply at least once more during the day, or whenever your skin feels dry or tight.
Topical Steroids for Flare-Ups
When moisturizer alone isn’t enough to calm a flare, topical corticosteroids are the standard first-line treatment. These creams and ointments reduce inflammation and itching, often within a few days. They’re classified into seven potency levels, from Class VII (mildest, like over-the-counter hydrocortisone 1%) up to Class I (strongest, prescription-only options).
For mild eczema on most of the body, over-the-counter hydrocortisone cream (1% or 2.5%) is often enough. Moderate flares typically call for a mid-strength prescription steroid. The face, eyelids, groin, and armpits need lower-potency options because the skin there is thinner and absorbs more of the medication. Thick-skinned areas like palms and soles can tolerate stronger formulations.
How Much to Apply
Dermatologists use a simple measurement called the “fingertip unit” to guide how much cream you need. One fingertip unit is the amount of cream squeezed from the tip of your index finger to the first crease, which works out to about half a gram for an adult man and 0.4 grams for an adult woman. For children around age four, use roughly one-third of the adult amount. For infants six months to a year, about one-quarter.
As a guide for adults: one hand needs about 1 fingertip unit, one arm needs 3, one leg needs 6, and the face and neck together need about 2.5. The entire body requires around 40 fingertip units. These numbers help you use enough product to actually work without wasting it or overdoing it.
Risks of Long-Term Steroid Use
Topical steroids are safe when used correctly, but prolonged or inappropriate use can cause real problems. The main risk is skin thinning (atrophy). Steroids suppress the production of key structural proteins in the skin and reduce the natural fats that make up the barrier, including ceramides, cholesterol, and fatty acids. Over time, the skin becomes thinner, more transparent, and less elastic, with visible tiny blood vessels near the surface.
Topical steroid withdrawal is a more severe pattern that can develop after extended use of moderate-to-potent steroids. The hallmark is intense redness (reported in over 92% of affected patients) that spreads beyond where the steroid was originally applied. Burning or stinging affects nearly 95% of people experiencing withdrawal. Other signs include thickened, wrinkled skin with reduced elasticity (sometimes called “elephant wrinkles”), skin peeling, and new sensitivity to water, fabrics, temperature changes, or even moisturizers. These symptoms can take weeks to months to resolve. The best prevention is using the lowest potency steroid that controls your symptoms and stepping down as soon as a flare improves.
Non-Steroid Prescription Options
If you need ongoing anti-inflammatory treatment but want to avoid steroids, especially on the face or other sensitive areas, two main categories of non-steroidal topicals are available.
Calcineurin inhibitors (tacrolimus and pimecrolimus) work by blocking a specific step in the immune activation process that drives eczema inflammation. They suppress the overactive immune cells in the skin without thinning it. These are considered second-line treatments, meaning they’re typically tried after steroids, but they have a real advantage for long-term maintenance and for delicate areas like the eyelids and around the mouth where steroids carry higher risk.
PDE4 inhibitors are a newer class. Crisaborole (Eucrisa) is a 2% ointment approved for mild-to-moderate eczema in patients aged 2 and older. It works by blocking an enzyme that drives inflammation, reducing the release of inflammatory signals in the skin. It’s applied twice daily and is a good option for people who want a steroid-free anti-inflammatory.
A topical JAK inhibitor, ruxolitinib (Opzelura), is also FDA-approved for mild-to-moderate eczema as a cream applied twice daily. It targets a different part of the inflammatory pathway and can provide relief when other topicals haven’t worked well enough.
Systemic Treatments for Severe Eczema
When eczema is moderate to severe and doesn’t respond adequately to topical treatments, oral or injectable medications can help control it from the inside. Dupilumab (Dupixent) is a biologic injection that blocks two key inflammatory signals driving eczema. It’s given every two weeks and has changed the treatment landscape for people with widespread, hard-to-control disease.
Oral JAK inhibitors are another option. Abrocitinib (Cibinqo) and upadacitinib (Rinvoq) are both once-daily tablets approved for moderate-to-severe eczema. Upadacitinib is approved for adults and children 12 and older who weigh at least about 88 pounds. These medications work quickly, often improving symptoms within the first few weeks, but they require monitoring because they affect the immune system more broadly than topicals do.
Bleach Baths to Reduce Bacteria
Eczema skin frequently harbors excess staph bacteria, which can trigger flares and infections. Dilute bleach baths help reduce that bacterial load. The Mayo Clinic recommends adding one-quarter cup of regular household bleach to a 20-gallon (half-full) tub of warm water, or one-half cup for a full standard tub. U.S. bleach products contain 6% to 8.25% sodium hypochlorite; if yours is on the stronger end, use a little less.
Soak from the neck down (or just the affected areas) for 5 to 10 minutes. The concentration is similar to a swimming pool, so it shouldn’t sting or irritate healthy skin. Pat dry gently and apply moisturizer immediately afterward. Two to three baths per week is a common schedule.
Wet Wrap Therapy for Severe Flares
Wet wrap therapy is a technique that dramatically boosts the effectiveness of topical treatments during bad flares. The process starts with a 15-minute soak in a lukewarm bath (bleach can be added for severe cases with infection risk). After the bath, pat the skin mostly dry, leaving it slightly damp. Apply the prescribed topical medication to affected areas, using a milder formulation on the face, then layer on a generous amount of unscented moisturizer.
Next, cover the treated skin with a layer of damp fabric. For full-body coverage, soaking a set of cotton pajamas in warm water works well. Individual areas can be wrapped with wet gauze. A dry layer of clothing goes on top to hold everything in place and keep you warm. The wrap stays on for about two hours, or overnight if needed. This approach is especially useful for children with widespread flares, and the NIAID recommends soaking and wrapping up to three times a day during acute episodes.
What to Avoid on Eczema Skin
Knowing what not to use matters almost as much as knowing what to use. Fragranced soaps, detergents, and lotions are among the most common triggers. Alcohol-based products dry out the skin and damage the barrier further. Harsh exfoliants and scrubs can cause microtears in already compromised skin. Fabric softeners and dryer sheets leave chemical residues on clothing that sit against your skin all day.
Hot water strips natural oils from the skin, so keep baths and showers lukewarm and limit them to 10 to 15 minutes. Rough fabrics like wool can provoke itching even in people without eczema. Soft cotton or bamboo fabrics tend to be the most comfortable choices for clothing and bedding.