Treatments for severe eczema aim to help prevent symptom flare-ups, manage itching, and promote skin healing. Treatments include at-home remedies, systemic therapies, and phototherapy, among others.
Eczema, or atopic dermatitis, is a common skin condition that causes patches of dry, itchy skin to form.
A doctor may classify this skin condition as mild, moderate, or severe, depending on the intensity of your symptoms. Severe eczema:
- doesn’t respond to standard treatment
- covers a large area of your body
- flares up for longer periods of time
With severe eczema, skin patches may sometimes split and leak fluids and be more prone to infection.
There are many types of eczema, so symptoms and effective therapies vary. Keep reading to learn more about the treatment options for severe eczema and their side effects.
Several prescription medications are available to help treat severe eczema.
Corticosteroids
High potency and ultra-high potency corticosteroids can be used to treat severe eczema. These are topical medications that help reduce inflammation and relieve itching.
Some steroids, like prednisolone or prednisone, can also be taken as a pill. When taken by mouth, steroids work throughout the whole body. But this means that oral steroids can have more side effects.
Some common and more severe side effects include:
| More common | More severe |
|---|---|
| • headaches • mood changes • dizziness • insomnia • acne • thin, fragile skin • fatigue • muscle weakness • irregular menstruation • heartburn • increased sweating | • vision problems • fever • cough • seizures • depression • confusion • uncontrollable hand twitches • numbness, burning, or tingling • hives • weight gain • peptic ulcers • shortness of breath • high blood pressure • swelling in different body parts • muscle twitching or tightening |
Get immediate medical attention if any of the more common symptoms worsen or you experience severe side effects.
Oral steroids are usually prescribed to help with severe flare-ups. They should not be taken over a long period of time.
Topical calcineurin inhibitors (TCIs)
Topical calcineurin inhibitors (TCIs) modify your immune system to help reduce the inflammation associated with eczema.
According to the National Eczema Society (NES), there are two types of TCIs:
- tacrolimus (Protopic), which is used for moderate to severe eczema
- pimecrolimus (Elidel), which is used for mild to moderate eczema
Some side effects of applying TCIs to your skin include:
- skin irritation, burning, or itching that will usually go away after 1 week
- viral skin infections, such as cold sores
- folliculitis
Another topical medication approved to treat mild to moderate eczema is crisaborole (Eucrisa). This phosphodiesterase 4 inhibitor (PDE4) drug helps reduce inflammation. It may cause similar symptoms as TCIs, such as initial skin burning or stinging.
Immunomodulators
Oral immunomodulators may be prescribed to help treat eczema that isn’t in one specific area. These work by slowing the immune system response, which can help reduce the severity of eczema symptoms.
Some immunomodulators for severe eczema symptoms
- azathioprine (Imuran)
- cyclosporine
- methotrexate
- mycophenolate
Some side effects of taking oral immunomodulators include:
- increased risk of infection
- nausea
- high blood pressure
- kidney or liver damage
As a result, these medications are typically used for a short time to reduce severe symptoms.
Biologics
Biologics are a relatively new type of drug that can help lower inflammation in moderate to severe eczema. These protein-based drugs work by targeting T cells and immune proteins in your body.
Two biologics have been approved by the
- Dupilumab (Dupixent): This medication can help people with eczema that isn’t well managed, as well as people who can’t use topical products.
- Tralokinumab (Adbry): A doctor may prescribe this medication to be injected once every 2–4 weeks.
Some side effects associated with injectable biologics include:
- conjunctivitis
- cold sores
- eyelid inflammation
- respiratory tract infections
- injection site reactions
Researchers are currently studying other injectable biologics that may help lower inflammation and reduce itching. For example, nemolizumab, which was approved in Japan in 2022 to treat eczema, is currently in phase 3 trials.
JAK inhibitors
Janus kinase (JAK) sends signals that trigger inflammation. JAK inhibitors block these chemical signals.
Abrocitinib (Cibinqo) and upadacitinib (Rinvoq) are two FDA-approved JAK inhibitors to treat severe eczema, according to the American Academy of Dermatology Association (AADA).
Some side effects of JAK inhibitors include:
- common cold
- bronchitis
- ear infection
- urinary tract infection
- headache
- nausea
In rare cases, people may develop tuberculosis or pneumonia.
Baricitinib is another JAK inhibitor that has been approved in Europe for severe eczema treatment. The authors of a
Alitretinoin
The authors of a
Alitretinoin is available in the United States as a prescription topical gel. An oral version is available in Europe and Canada but is not yet available in the United States.
Barrier repair moisturizers
Barrier repair moisturizers help your skin keep in water and repair damage. These are available over-the-counter (OTC) or by prescription.
Unlike regular moisturizers, they contain active ingredients that help repair skin with eczema. The authors of a
Speak with a healthcare professional about the best barrier repair moisturizer for you. For best results, the National Eczema Association (NEA) recommends moisturizing after a bath or shower.
Wet wrapping is an effective method to help reduce your eczema symptoms. It works by keeping your skin hydrated and improving the effectiveness of topical treatments.
To do this, a healthcare professional may first spread a topical medication on the affected area. Then, they will cover it with a wet bandage and cover this with dry bandages.
They can also show you how to apply wet wraps so you can put them on at home. The NEA has a step-by-step guide for wet wrapping.
It’s important to note that the warm, damp environment under the wrap is ideal for bacteria or fungi to spread.
According to a 2015 research review, the most common infections reported as side effects of wet wraps include:
Speak with a doctor if you experience signs of an infection, such as inflammation, blisters, or pain.
Phototherapy, or light therapy, may help treat severe eczema that doesn’t respond to creams or covers a wide area. It involves a machine that exposes your skin to ultraviolet (UV) light. The UV light hinders your skin’s inflammatory response.
UVB light is most common. However, some forms of eczema therapy use UVA.
Psoralen plus ultraviolet A (PUVA) therapy is when you take the drug psoralen before exposing your skin to UVA light. This helps make your skin more sensitive to UV light.
Phototherapy treatment typically lasts 12–16 weeks with 2–3 sessions per week, according to the NES.
Side effects of phototherapy are minimal but may include:
- skin dryness
- skin discoloration
- cold sores
- accelerated skin aging
Bleach baths involve adding a small amount of bleach to your bathwater. The bath helps to moisturize your skin, while the bleach can kill infections like staph.
A 2017 research review found that people with eczema reported bleach baths to be helpful in relieving their symptoms. However, there wasn’t much evidence to support that bleach baths provided better relief than regular baths.
The NEA suggests adding the following to regular baths to help manage symptoms:
- unscented bath oil to help moisturize your skin
- baking soda or oatmeal to relieve itching
- salt to ease the sting you might feel from water during a flare
- vinegar to kill bacteria
Speak with a healthcare professional before using bleach baths as therapy for your severe eczema. They can advise you about how often to take one and how much bleach to use.
Some alternative remedies may help you manage severe eczema.
According to the NEA, applying sunflower oil to the affected skin may help promote hydration and reduce inflammation. Coconut oil may help lower your risk of bacterial infection.
Taking certain vitamins and supplements may also help. These include:
- vitamin D
- fish oil
- zinc
- selenium
- prebiotics
- probiotics
- turmeric
- melatonin
- primrose oil
Research to support the effects of these vitamins and supplements is limited. Speak with a doctor about any potential drug interactions, as these may pose serious risks.
Managing severe eczema might help you avoid flare-ups. While you can’t always avoid flare-ups, there are things you can do to reduce your chances of them happening.
Here are some tips to help prevent flare-ups:
- know and avoid your triggers
- keep your skin moisturized
- avoid scratching to prevent infection
- use a humidifier to help keep your skin from drying
- keep track of what you eat
- wear loose, breathable clothes
- use a towel to wipe off sweat regularly when you exercise
- find ways to manage stress
- quit smoking, if you smoke
What helps severe eczema flare-ups?
What works to treat severe eczema will be different for each person. A combination of the following therapies may be used to help relieve symptom flare-ups:
- topical ointments, such as corticosteroids
- systemic therapies, such as biologics
- natural remedies, such as wet wraps
- phototherapy
What is severe eczema that won’t go away?
Eczema is a chronic skin condition, which means it can be long lasting. Symptoms of severe eczema that won’t go away may be a sign that your current treatment isn’t right for you.
Speak with a healthcare professional about treatment alternatives.
Why is my eczema so severe?
Several factors may influence the severity of your eczema, such as:
- the environment you live in
- your lifestyle and dietary habits
- underlying medical conditions
Speak with a healthcare professional if your symptoms of eczema aren’t improving with your current treatment plan or if they’re getting worse.
Severe eczema can affect your quality of life.
If the itching, burning, and discomfort have made your eczema unbearable, speak with a healthcare professional. You can book an appointment with a dermatologist in your area using our Healthline FindCare tool.
Many medications and therapies are available that can reduce or stop severe symptoms.