Eczema in Adults: Moisturizers, Steroids, and Newer Treatments

Your skin itches so much it wakes you at night. Patches on your hands, elbows, or neck turn red, dry, and cracked, then calm down, then come back. Many people think eczema is a childhood condition, but many adults live with it too. Treatment options have grown a lot in recent years. This guide explains what works, from daily skin care to newer medications.

What eczema is

Eczema is a group of conditions that cause itchy, inflamed skin [3]. The most common type is atopic dermatitis, which is what most people mean when they say eczema. It is a long-term condition with flares and calmer periods.

In atopic dermatitis, the skin barrier does not work as well as it should. Water escapes, and irritants and allergens get in more easily. The immune system in the skin also overreacts. Together, these cause:

• Itching, often severe
• Dry, rough skin
• Red or darker patches, depending on skin tone
• Thickened skin from scratching
• Oozing or crusting during flares

In adults, common areas include the hands, eyelids, neck, inner elbows, and backs of the knees. Many people with atopic dermatitis also have asthma, hay fever, or food allergies.

Common triggers

• Soaps, detergents, and fragrances
• Hot showers and dry winter air
• Sweat and heat
• Wool and rough fabrics
• Stress
• Skin infections

What your doctor looks at

Diagnosis

Atopic dermatitis is diagnosed from your history and a skin exam. There is no single test. Clinicians look at where the rash is, how it looks, how long it has lasted, and your personal and family history of allergies. They may check for look-alike conditions, such as contact dermatitis (a reaction to something touching the skin), psoriasis, or a fungal infection. Patch testing can help if contact allergy is suspected.

Measuring severity

Clinicians judge severity by how much skin is affected, how intense the rash is, how much it itches, and how it affects sleep and daily life. This helps decide whether creams are enough or whether a systemic treatment (one that works through the whole body) is needed.

Topical treatment guideline

The American Academy of Dermatology (AAD) 2023 guideline on topical treatment strongly recommends [1]:

• Moisturizers
• Topical corticosteroids (steroid creams and ointments)
• Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus
• Topical PDE-4 inhibitors, such as crisaborole
• Topical JAK inhibitors, such as ruxolitinib cream

Systemic treatment guideline

The AAD 2023 guideline on systemic treatment strongly recommends, for moderate to severe atopic dermatitis that does not respond to topical care [2]:

• Biologic injections: dupilumab and tralokinumab
• Oral JAK inhibitors: abrocitinib, baricitinib, and upadacitinib

It conditionally recommends phototherapy (light treatment) and older drugs such as cyclosporine, methotrexate, and mycophenolate [2]. It recommends against steroid pills for routine treatment because of side effects and rebound flares [2].

Since that guideline, more biologics have been approved in the US, including lebrikizumab and nemolizumab. Approval and coverage differ between Health Canada and the FDA, so the available options depend on where you live.

Treatment step by step

Daily skin care

• Moisturize at least once or twice a day, and after every bath or hand wash.
• Use lukewarm water and short showers.
• Choose gentle, fragrance-free cleansers.
• Pat skin dry, then moisturize within a few minutes.

Topical steroids

Steroid creams and ointments come in many strengths. Clinicians match the strength to the body area. Milder ones are used on the face and skin folds, and stronger ones on thick skin like the hands. Many people use them once or twice a day during a flare. Some use them twice a week on problem areas to prevent flares, which the AAD supports [1].

Non-steroid creams

Tacrolimus and pimecrolimus are useful for the face, eyelids, and skin folds, where steroid thinning is a concern [1]. They can sting at first. In the US, they carry a boxed warning about a possible cancer risk based on animal studies, though studies in people have not shown a clear link.

Systemic treatments

• Biologics: injections that block specific immune signals. Eye irritation (conjunctivitis) is a known side effect of dupilumab.
• JAK inhibitor pills: work quickly on itch. In 2021, the FDA required boxed warnings for JAK inhibitors used for chronic inflammatory conditions, covering serious infections, heart events, cancer, blood clots, and death [4]. Clinicians check your risks and do blood tests before and during treatment.

Questions to ask your clinician

• Is this atopic dermatitis, or could it be something else?
• Which steroid strength should I use, where, and for how long?
• Can I use steroids to prevent flares, not just treat them?
• Is a non-steroid cream better for my face or eyelids?
• Am I a candidate for a biologic or JAK inhibitor?
• What tests and follow-up are needed with these treatments?
• Would patch testing help find a trigger?

When to get care quickly

Get same-day care or go to the emergency department if you have:

• Painful, punched-out sores or clusters of blisters on eczema patches, especially with fever. This can be eczema herpeticum, a serious herpes virus infection.
• Spreading redness, warmth, pus, or fever, which can be signs of a bacterial infection
• Eye pain or vision changes
• Red, peeling skin over most of your body

Bottom line

Atopic dermatitis is a common long-term skin condition in adults. Daily moisturizers and gentle skin care are the base of treatment, and topical steroids remain safe and effective when used as directed. Non-steroid creams help on thin skin. For moderate to severe eczema, biologics and JAK inhibitor pills offer strong new options, with different benefits and risks to discuss with your clinician.

Primary AI can show you the guideline and study sources behind this topic in plain language, so you can bring better questions to your appointment.