At-home therapies alone may not relieve moderate-to-severe eczema and dermatitis. Our dermatologists understand that persistent, intense itching and rash, especially in visible places such as the face and hands, may significantly affect your life. NYU Langone doctors can recommend medications in a variety of forms to relieve symptoms and manage eczema and dermatitis for the long term.
Many people find that topical medications—creams, gels, or ointments applied directly to the skin—relieve itching and reduce redness and swelling. Topical medications may also prevent a rash from spreading.
Corticosteroids are anti-inflammatory medications that can be very effective in relieving symptoms of eczema and dermatitis. Corticosteroids suppress the activity of some immune cells, which can interrupt the inflammatory process and prevent itching, redness, and swelling.
Topical corticosteroids are available in different strengths, including some low-potency anti-itch creams such as hydrocortisone that are available over the counter at drugstores. But moderate-to-severe eczema and dermatitis may not respond to over-the-counter products. Our dermatologists recommend and prescribe a topical corticosteroid based on your age, the location and surface area of a rash, and the severity of symptoms.
Topical corticosteroids are applied directly to the affected areas of skin once or twice a day, depending on the type of corticosteroid prescribed. Doctors recommend maintaining this schedule until symptoms improve or a specified time has elapsed. Typically, corticosteroids relieve symptoms within a few weeks, or sometimes within a few days. At that time, doctors may recommend reducing the frequency of application to once or twice a week to keep symptoms under control and prevent flare-ups.
Your dermatologist determines the duration of topical corticosteroid treatment, which varies depending on factors such as the severity of flare-ups and the age of the person being treated. For severe eczema or dermatitis, topical corticosteroids may be used intermittently for months or years. Continued use requires regular evaluation by your dermatologist.
Side effects of topical corticosteroids may include thinning of the skin, stretch marks, lightening of the skin, and acne. They may also affect the eyes when used for prolonged periods.
Topical calcineurin inhibitors are a type of anti-inflammatory medication. They are formulated to block an overactive immune system response to the skin, which may reduce itching, redness, and swelling.
Doctors typically prescribe calcineurin inhibitors when topical corticosteroids are ineffective or if eczema or dermatitis affects sensitive areas of skin that can’t be treated with topical corticosteroids for long periods. A dermatologist may recommend this medication for a rash on the eyelids, face, or other sensitive areas where skin touches skin, such as the underarms or groin.
Topical calcineurin inhibitors are available in different formulations and concentrations. Our dermatologists determine which is appropriate based on a number of factors, such as the age of the person being treated and the severity and location of symptoms.
Topical calcineurin inhibitors are applied directly to the affected areas of skin once or twice a day, depending on the formulation prescribed. Doctors recommend maintaining this schedule until symptoms improve. Typically, calcineurin inhibitors relieve symptoms within one to six weeks. After symptoms improve, doctors recommend reducing the frequency of application to once or twice a week to keep symptoms under control and prevent new flare-ups.
These regimens require ongoing follow-up and evaluation. Your dermatologist determines the duration of treatment, depending on such factors as the severity of outbreaks and the age of the person being treated. Topical calcineurin inhibitors generally have fewer long-term side effects than corticosteroids and may be used safely for months or years.
Side effects may include a small risk of infection, and some people may experience a stinging sensation when the medication is first applied, but it generally fades over time.
If symptoms of eczema and dermatitis are not relieved by topical medications, doctors may recommend stronger medications that are taken by mouth or injected into the skin.
In many instances, oral medications are prescribed for a short period to help get symptoms under control, and treatment then, ideally, shifts to management using topical medications and at-home therapies. But for severe eczema or dermatitis that is unresponsive to other treatment and causes persistent symptoms that interfere with your everyday life, some medications may be prescribed for months or years.
Oral immunosuppressant medications prevent the body’s immune system from sending an inflammatory response to the skin, which results in less itching, redness, and rash.
Immunosuppressant medications are available in varying strengths, and doctors determine the dosage based on your age, severity of symptoms, location and extent of the rash, your weight, and whether you have other medical conditions. Typically, these medications are taken once or twice daily, although the dosage can vary.
If eczema or dermatitis is severe, a doctor may recommend immunosuppressant medication that is injected into the skin. Your dermatologist determines the appropriate schedule of injections. He or she may administer the injections in a doctor’s office or show you how to do it so you can inject the medication at home.
Dermatologists may prescribe immunosuppressant medication for weeks or months or until symptoms of eczema or dermatitis are under control. Often, our doctors may reduce or stop a prescription at that time to see whether symptoms can be managed using topical medication, phototherapy, or at-home therapies.
In some instances when symptoms can’t be relieved by other treatments, therapy with immunosuppressant medications may continue for years. Your doctor can discuss side effects of immunosuppressant medications.
Oral corticosteroids are powerful anti-inflammatory medications that often relieve symptoms of dermatitis or eczema, including itching, redness, and rash, within hours or days. But taking corticosteroids by mouth may produce more serious side effects than using topical formulations, including high blood pressure, gastrointestinal problems, decreased bone density, and weight gain.
Our dermatologists usually avoid prescribing oral corticosteroids except in instances of severe outbreak or as a short-term treatment to get symptoms under control before you start another long-term medication such as an immunosuppressant.
If a skin infection develops as a result of broken skin—which may occur if a rash cracks or splits or if scratching breaks the skin—our doctors may recommend an antibiotic to be taken by mouth. Antibiotics target bacteria and prevent infection from spreading. Many types of antibiotics are available, and our dermatologists determine the appropriate type and dosage based on factors such as your age and the severity of infection.
Side effects may include nausea, allergic reactions, and the development of antibiotic-resistant infections. For this reason, dermatologists limit prescriptions to 7 to 14 days and prescribe antibiotics only when an infection is present.