Corticosteroids (or steroids for short) are one of the most common treatments for eczema. They work by reducing inflammation and itching from eczema, which gives the skin a chance to heal. This treatment is typically recommended for short-term use only. When used longer than directed and then stopped abruptly, high potency steroid creams can cause a condition called topical steroid withdrawal syndrome. Symptoms include:
  • burning, stinging, and bright red skin
  • swelling
  • skin sensitivity
  • pimple-like bumps (papules)
  • nodules (deeper bumps)
  • pustules
As a result, many people seek alternatives to steroid creams for the treatment of their eczema. But there are a variety of options to consider. Keep reading to learn about steroid-free ways to treat eczema, along with potential risks to discuss with a doctor.

Topical calcineurin inhibitors

Topical calcineurin inhibitors (TCIs) are prescription medications used to treat eczema in both adults and children (ages 2 and up) who haven’t seen results from topical steroids and other conventional therapies, or who can’t take those treatments. This steroid-free eczema treatment is applied directly to the skin. TCIs for eczema come in two forms:
  • tacrolimus ointment (Protopic), used for moderate to severe eczema
  • pimecrolimus cream (Elidel), used for mild to moderate eczema
TCIs work by stopping the activity of certain cells in the immune system. That helps reduce inflammation and relieve certain eczema symptoms, including itchy, discolored skin. According to the National Eczema Society, TCIs for eczema can be used for brief periods to treat flares. They can also be used long term to prevent flares. TCIs are safe and well-tolerated over the short term. The most common side effect is a mild burning or stinging after applying the medication to the skin. This happens in about half of people who use TCIs, according to the National Eczema Society. This type of medication is relatively new, so the long-term risks are still unknown. However, the Food and Drug Administration (FDA) has implemented black box warnings on TCIs due to a possible risk of lymphoma (a type of blood cancer). Talk with your dermatologist or a healthcare professional about whether the benefits of this medication outweigh the risks for you.

Crisaborole

Crisaborole (Eucrisa) is another alternative to steroids for eczema. It works by blocking the production of an enzyme that helps regulate inflammation in the skin, which can provide relief from mild to moderate eczema symptoms. This eczema treatment comes as an ointment that you apply to the skin, typically twice per day. It can be used by both adults and children as young as 3 months old. The most common side effect of crisaborole is burning or stinging at the application site. This sensation typically goes away after you use the medication for a while. The medication can be used continuously over the long term, or intermittently when you experience an eczema flare. Your doctor can recommend how long you should use this medication.

JAK inhibitors

Janus kinase (JAK) inhibitors are relatively new in the treatment of eczema, and they don’t contain steroids. They work by preventing a type of protein called cytokines from attaching to certain receptors in the body that cause overactivity in the immune system. That helps reduce inflammation and reduce the severity of eczema symptoms. JAK inhibitors can be taken orally or applied as a cream directly to the skin, depending on which type your doctor prescribes. JAK inhibitors approved to treat eczema include:
  • abrocitinib (Cibinqo)
  • updacitinib (Rinvoq)
  • ruxolitinib (Opzelura)
These medications are typically recommended for people with moderate to severe eczema who haven’t experienced positive results from other medications. While abrocitinib is only available to adults, updacitinib and ruxolitinib can be used in adolescents 12 years of age or older. JAK inhibitors can be very effective at reducing eczema symptoms, according to a 2021 research review. However, there are some potential side effects, including:
  • nausea
  • swelling of the nasal passages
  • swelling in the back of the throat
  • headache
  • upper respiratory tract infection
Side effects with JAK inhibitors tend to be mild and get less intense over time, but you should still let a healthcare professional know if you experience any side effects. JAK inhibitors also present additional risks when used long term. This is especially true with the oral versions of the medication. Rare but serious complications may include:
  • heart attack and stroke
  • blood clots
  • certain types of cancer
Because these medications suppress the immune system, you may be more likely to develop infections when using them. Talk with a doctor about whether JAK inhibitors are the right alternative to steroids for your eczema, and discuss ways to reduce your risk of infections and other side effects.

Injectable medications

Eczema can now be treated with two injectable medications:
  • dupilumab (Dupixent), available for adults and children ages 6 and up
  • tralokinumab (Adbry), available for adults only
Injectable treatments for eczema do not contain steroids. They’re part of a class of medications called biologics which are made from living cells or organisms. They work by blocking overactivity in the immune system, which helps reduce inflammation. Injectables for eczema are typically recommend for people with more severe symptoms that haven’t gone away with other treatments. These medications come in pre-filled syringes that can be injected by your doctor or on your own at home. Redness and soreness at the injection site are common side effects, but these symptoms are usually mild. Mild infections, including pink eye and upper respiratory tract infections, can also happen. In rare cases, certain types of eye conditions can develop while using these medications, so it’s important to let your doctor know about any vision changes you experience.

Phototherapy

In addition to oral and topical medications, light therapy (phototherapy) can be used to treat eczema flares without steroids. This treatment is typically recommended for adults and kids with moderate to severe eczema who haven’t experienced improvements with other treatments. Phototherapy exposes all or parts of the body to ultraviolet (UV) light in a controlled setting, usually at a dermatologist’s office or another healthcare facility. Sessions can be a few seconds to a few minutes long. Most people with eczema will need to receive two or three phototherapy treatments every week for a few weeks or months until symptoms improve, according to the American Academy of Dermatology (AAD). Phototherapy helps eczema symptoms by reducing inflammation in the skin. While experts aren’t exactly sure how phototherapy works, a 2021 research review found that the treatment can reduce itchiness and the visible symptoms of eczema. It may also reduce the need to use other medications, such as steroids for eczema. The most common side effects of phototherapy are:
  • sunburn
  • skin tenderness
  • premature skin aging
As with any UV exposure, phototherapy may increase the likelihood of developing skin cancer with repeated exposure. If sunlight triggers your eczema symptoms, you should avoid phototherapy.

Frequently asked questions about alternatives to steroids for eczema

What can I use instead of topical steroids for eczema?

If you want an alternative to topical steroids for eczema, there are many options to choose from, including:
  • nonsteroidal ointments and creams
  • oral and topical JAK inhibitors
  • injectable biologics
  • phototherapy
While topical steroids for eczema can cause side effects, other medications come with their own risks, as well. Talk with your doctor about what to expect when switching eczema treatments and the pros and cons of various medications.

Can eczema be treated without steroids?

Yes! Nonsteroidal medications are available for people with eczema who don’t respond well to steroids or want to switch treatments. You may also be able to manage mild eczema symptoms without medications. Techniques include:
  • regularly moisturizing your skin
  • avoiding known eczema triggers
  • bathing in water that’s lukewarm, not hot
  • wet wrap therapy
  • finding fragrance-free alternatives to harsh skin and body products
If at-home remedies don’t help your eczema symptoms, you may consider trying a medication recommended by a healthcare professional.

What can be used instead of cortisone cream?

Nonsteroidal skin creams and ointments can be used in place of cortisone cream to treat symptoms of eczema. Crisaborole or TCIs can be used by both adults and children to help reduce inflammation and relieve itch.

The takeaway

Topical steroids are one of the first-line treatment options for eczema, but they can cause side effects and should only be used as directed by a healthcare professional. Fortunately, there are a variety of alternatives to steroids that can be used to treat eczema, including:
  • TCIs
  • crisaborole
  • JAK inhibitors
  • biologics
  • phototherapy
A doctor can make a specific treatment recommendation for you based on your age, treatment history, and the severity of your symptoms. Keep in mind that every eczema treatment comes with potential risks and benefits. Talk with a healthcare professional about which eczema treatment might be right for you.