The Treatment Ladder

Moisturizers & Barrier Repair

Ceramide-based creams (CeraVe, Vanicream), petrolatum (Vaseline, Aquaphor), and colloidal oatmeal (Aveeno) form the foundation of every eczema treatment plan. Apply within 3 minutes of bathing to lock in moisture. This isn’t optional supplemental care. Moisturizer is medicine for eczema.

The key distinction is between occlusives (like petrolatum, which seals moisture in), humectants (like glycerin and hyaluronic acid, which draw water to the skin), and emollients (like ceramides, which fill gaps in the skin barrier). The most effective moisturizers combine all three.

• CeraVe Moisturizing Cream — contains ceramides 1, 3, and 6-II plus hyaluronic acid. Dermatologist-recommended standard.
• Vanicream Moisturizing Cream — free of dyes, fragrances, formaldehyde, parabens, and lanolin. Ideal for highly sensitive skin.
• Aquaphor Healing Ointment — 41% petrolatum base. Best used as an occlusive layer over lighter moisturizers.
• Aveeno Eczema Therapy — colloidal oatmeal-based. Soothes itch and restores skin pH.

Steroids & Calcineurin Inhibitors

Topical corticosteroids remain the workhorse treatment for eczema flares, ranging from mild (hydrocortisone 1%) to superpotent (clobetasol propionate 0.05%). The key is matching potency to body area: low-potency for the face and skin folds, medium for the body, high-potency for thick-skinned areas like palms and soles.

For areas where long-term steroid use is not ideal (face, eyelids, groin), calcineurin inhibitors offer a non-steroidal alternative. Tacrolimus (Protopic) 0.03% and 0.1% and pimecrolimus (Elidel) 1% work by blocking T-cell activation without the thinning risk of steroids.

• Eucrisa (crisaborole) — PDE4 inhibitor. FDA-approved for mild-to-moderate atopic dermatitis in patients 3 months and older.
• Opzelura (ruxolitinib cream) — topical JAK inhibitor. Approved for mild-to-moderate AD in non-immunocompromised patients 12+.
• Vtama (tapinarof) — aryl hydrocarbon receptor agonist. Non-steroidal, non-immunosuppressant option under investigation for AD.

Steroid phobia is one of the biggest barriers to effective eczema treatment. When used correctly, under medical guidance, with appropriate potency for each body area and with scheduled breaks, topical steroids have an excellent safety profile.

Narrowband UVB Light Treatment

For moderate eczema that doesn’t respond to topicals alone, narrowband UVB (NB-UVB) phototherapy can calm inflammation across large body areas. The treatment works by suppressing the overactive immune cells in the skin and has been a dermatology staple for decades.

Typically administered 2 to 3 times per week in a dermatologist’s office, each session lasts only seconds to minutes. Most patients see improvement within 2 to 3 months. Home phototherapy units are available for patients who cannot make frequent office visits, though they require careful dosing under physician supervision.

• NB-UVB (311nm) — most commonly used. Good efficacy-to-risk ratio.
• PUVA — psoralen plus UVA. More potent but higher side effect profile. Reserved for refractory cases.
• Excimer laser (308nm) — targeted UVB for localized patches. Fewer sessions needed for small areas.

Phototherapy is particularly useful as a bridge treatment before stepping up to systemic therapy, or as maintenance for patients who want to minimize medication use.

Dupixent, JAK Inhibitors & Beyond

For moderate to severe eczema that has not responded adequately to topical treatments and/or phototherapy, systemic therapies target the immune pathways driving the disease from the inside out. This category has been revolutionized in recent years.

• Dupixent (dupilumab) — IL-4/IL-13 blocker. The first biologic approved for moderate-to-severe AD (ages 6 months+). Injected every 2 weeks. Transformative efficacy for many patients. Most common side effect: conjunctivitis.
• Adbry (tralokinumab) — IL-13-specific blocker. Alternative biologic for adults with moderate-to-severe AD. Injected every 2 weeks.
• Rinvoq (upadacitinib) — oral JAK1 inhibitor. Daily pill. Rapid onset of action (many patients report improvement within days). Requires monitoring for infections and lab abnormalities.
• Cibinqo (abrocitinib) — oral JAK1 inhibitor. Similar mechanism to Rinvoq with slightly different side effect profile. Once-daily dosing.

These treatments have dramatically changed outcomes for patients with severe eczema who previously had limited options beyond cyclosporine and methotrexate (which remain available but carry more significant long-term risks). Check RxSaver.ai for savings programs on biologics and JAK inhibitors, as these medications carry high list prices.