Eczema: A Brief Overview of Treatment Options

Clinical Presentation / Symptoms

“Eczema” or atopic dermatitis, is a general term for many types of skin inflammation. Eczema is most commonly seen in children and infants, but it can occur at any age. Eczema presents dermatologically as a skin rash, which becomes crusty and scaly. The rash is red, itchy, dry, and sore - blisters may or may not develop. Common affected areas include the elbows, behind the knees/ears, face (often on the cheeks), buttocks, hands, and feet. It is important to note that certain products or environmental conditions can trigger eczema, such as allergens (in soaps, perfumes, etc), environmental irritants (pollen), stress, or changes in the weather.

The Key: Moisturize, Moisturize, Moisturize!

Hydration is essential to reduce severity of atopic dermatitis - patients should be advised to use unscented moisturizers such as CeraVe or Eucerin, and to maintain adequate humidity in the home (which can be particularly difficult in the winter months). If necessary, pharmacological treatments can include topical steroids, short courses of oral steroids, antihistamines for itching, and finally immunosuppressant calcineurin inhibitors (if topical steroids with hydration are not adequate). In severe, refractory cases of atopic dermatitis, oral immunosuppressants such as cyclosporine and MTX, or monoclonal antibody drugs can be used. Dupilumab (Dupixent) is an FDA-approved monoclonal antibody for the treatment of moderate to severe eczema. Dupixent is administered as a biweekly subcutaneous injection; however, there are other drugs used for eczema off-label.

The Pharmacist's Favorite OTC Products*

Over the counter options for eczema include petrolatum and/or lanolin-containing moisturizers. These are typically the thicker, more oleaginous products we see on the shelf. I'm a big fan of Aquaphor for any and all skin irritation, dryness, cracking, healing, or otherwise. Aquaphor seals in moisture and allows the skin to heal without exposure to the elements. I use it as chapstick, I use it on sunburns, and I use it on my face after I've nervously picked at and injured my pores. If you prefer a more lotion/cream texture product, go with a rich, unscented formula. Some of my favorite brands include Eucerin or Nivea. You want to avoid any scented products as they are often irritants that may cause a reaction on the skin.

When it comes to topical steroids, your options are limited over the counter. Any hydrocortisone 1% product is the go-to for an over the counter product. You don't need to remain loyal to the brand here, just go for a simple product with as few added ingredients as possible. In the case of eczema, I would lean toward a hydrocortisone ointment, and would avoid a hydrocortisone spray, unless using aquaphor or petroleum jelly to seal the steroid and moisture in.

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For more advice, check out this summarized chart below:

Resources:

1) RxPrep NAPLEX Review 2021. Chapter 39: Common Skin Conditions. Page 571.

2) Lastella, A. "Eczema (Atopic Dermatitis): NAPLEX Review". The Socio Esthetician International. April 2021. Available online at:https://www.the-socioesthetician-international.com/forum/pharm-d-candidate-appe/a-comprehensive-review-of-skin-pharmacotherapy-naplex-review/dl-4c62e5bf-e287-3ab8-9981-acb183914a7d?postId=6075ebad55765f002c0868a6