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Treatments for eczema and similar skin conditions

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Finding the best treatments for eczema and similar skin conditions can be a challenge for doctors and their patients. Eczema is a broad term applied to different skin conditions with similar effects but may have very different causes. Learn more about the specifics of eczema on our Q&A page here.

A diagnosis from your doctor of eczema can mean one of several conditions. They share some characteristics, which are:

  • they are all some form of immune response
  • they are highly inheritable
  • they affect the outer layer of the skin, causing inflammation, irritation, rashes, itching, bumps and swelling
  • they are not contagious and cannot be transmitted to other people
  • they are chronic, and there are no permanent cures. 

Step 1 – Diagnosis before treatments for eczema

To diagnose the specific condition and before beginning treatments for eczema and similar skin conditions, your doctor will listen to your symptoms and examine the affected areas of your skin. A dermatological examination may be ordered, in which a specialist will study the affected area with a magnifying scope or under polarizing light. The doctor needs to first eliminate other possible skin conditions. Fungal tests may be needed to identify skin disorders and rule out STDs. A skin biopsy may be required to rule out psoriasis or a form of lymphoma known as mycosis fungoides. 

The dermatologist will usually review your general medical history and then get more information, like a history of when the itching or rashes started, the frequencies of attacks, and any noticeable triggers like foods, clothing, time of day, your emotional state and anything else relevant. 

The most common procedure to identify any allergies and rule out other skin diseases is to perform a patch test on your skin. In this test, a wide variety of different possible trigger substances are applied to the skin and then covered. After a few days, the uncovered skin is examined for signs of reactions. Patch testing is beneficial to identify specific allergens that may be causing the dermatitis.

Step 2 – Treatment for eczema and similar skin conditions with topical corticosteroids

Once a definitive diagnosis has been reached, your doctor or the investigating dermatologist can prescribe the most suitable form of treatment for that specific form of eczema. There is a wide variety of treatments for eczema and similar skin diseases that allow the doctor’s many options. Sometimes, multiple treatments may be necessary to best treat the condition in active “flare up” phases and prevent further outbreaks.

The first line of treatment has for many years been prescribing topical corticosteroids for eczema. This medicine usually will reduce inflammation, redness, swelling, itching and heat. It is particularly effective against S. aureus bacteria in people with seborrheic dermatitis.

If the benefits of the treatment start to recede, which happens as the body becomes desensitized to its actions or some of the more severe side effects are noticed, doctors usually switch treatments. One of the side effects that need to be avoided is thinning of the outer skin layer (the epidermis), which shows up as wrinkled or weakened skin or visible blood vessels. 

When the condition needs to be treated with higher-potency topical corticosteroids, especially around the face or neck, these side effects must be avoided sooner rather than being allowed to cause irreparable damage.

Step 3. Treatment for eczema and similar skin conditions with cytokine inhibitors

Elidel (generic term: pimecrolimus) is a type of medicine known as a Topical Calcineurin Inhibitor (TCI). Calcineurin is an enzyme that activates a type of white blood cell that plays a key role in cell-mediated immunity. Calcineurin inhibitors suppress the immune system, so they are known as immunosuppressants.

In most cases, eczema is triggered by an allergic reaction in which the body’s white cells produce a flood of molecules called cytokines. Cytokines are crucial in controlling the level of activity of other immune system cells in the blood. When released, they signal the immune system to ramp up its activity. One way to lessen the activity of the immune system is to interfere with the production of cytokines, and this is what TCIs do.

TCIs like Elidel don’t have many of the unwanted side effects of topical corticosteroids, especially thinning skin. It also can be safely used along with topical corticosteroids. This is often necessary because topical corticosteroids should not be applied in sensitive areas like around the eyelids, nostrils or mouth. 

Elidel has a good safety record; the only reported side effects are mild burning or stinging, which usually disappears as the skin heals.

Step 3 – Advanced treatments

When there are more severe cases of eczema, or other forms of treatments for eczema and similar skin conditions like topical corticosteroids and TCIs are not working satisfactorily, doctors now have a new line of possible treatments known as Jason kinetic inhibitors (JAKis). You can learn more about this exciting new development in our articles about using JAK inhibitors both for dermatitis and hair loss.


How can I get rid of eczema?

As we have said, there are no cures for eczema, but several treatments can help to lessen the symptoms. Each patient needs a tailored treatment designed to meet the specific conditions that create the problem, giving enough benefit without causing unwanted side effects. Your healthcare professional is the best person to consult with in both diagnosis and treatment.

As well as medical treatment, people with eczema can benefit from a few simple routines, like using gentle skin moisturizing creams that have been carefully chosen because they don’t trigger an allergic reaction. Talk to your pharmacist about which creams will help you. Treat your skin carefully when you are damp after a bath or shower.

After diagnosis, a family doctor or dermatologist may prescribe topical medications like topical steroids or anti-inflammatory medicines to reduce itchiness and swelling. In some cases, oral antihistamines or corticosteroids may be needed simultaneously to control asthma and hay fever.

The diagnosis should be able to identify the specific triggers that cause flare-ups, and you should be careful to avoid these at all times.

How to reduce itching caused by atopic dermatitis?

Inflammation and irritation directly trigger sensations of itching, so apart from reducing the degree of inflammation, there are only a few ways to lessen the sensation. 

There are a few simple ways to temporarily reduce the itching for babies and young children. Keep the skin moisturized with a suitable gel. Cool baths in warm weather can reduce inflammation and lower irritation. In general, dermatologists do not recommend using over-the-counter anti-itch products. They often fail to provide any relief when the itching comes from eczema. Even worse, some contain ingredients that can cause eczema to flare up. Only use an anti-itch product that your dermatologist prescribes.

What is the best therapy for dyshidrotic eczema?

Dyshidrotic eczema is one form of atopic dermatitis that most often appears on the palms of the hand or soles of the feet. Doctors are not quite sure what causes dyshidrotic eczema. Many of the triggers that cause dermatitis in other parts of the body are likely to have the same effect in cases of dyshidrotic eczema.

The same treatments that are recommended for atopic dermatitis will usually be prescribed. At first, doctors commonly use topical steroid ointments. But, if the flare-ups fail to respond to this treatment, the following approach is to try TCIs (cytokine inhibitors ) like Elidel. If the patient has particularly bad outbreaks, especially when the skin is blistering and splitting, and this makes everyday work and walking impossible, a combination of TCIs and JAK inhibitors could be tried in order to reduce the levels of discomfort.

How do I treat vitiligo disease? Does vitiligo come back after treatment?

Vitiligo is a form of skin disease where hair and skin color gradually turns white in patches that grow steadily. Melanin determines the skin’s normal coloration, and vitiligo occurs when the cells that produce melanin stop functioning. Most often, this is caused by an autoimmune or allergic reaction. Like other types of eczema, vitiligo is not contagious or life-threatening. Nevertheless, it can make sufferers feel very sensitive about their appearance and can, therefore, affect social behaviors.

The best hope for people with vitiligo is to catch the condition very early before it affects large areas of visible skin. Then, calcineurin inhibitor ointments, such as Elidel, can slow down the progress of the disease and minimize the visible effects.

Some skin treatments for vitiligo can temporarily restore color to the affected areas. However, the condition cannot be reversed, and there will be continued loss of skin color unless medications are prescribed to slow down its progress.

How to cure seborrheic dermatitis? 

A seborrheic dermatitis is a form of eczema caused by excess oil produced by the sebaceous glands, which are abundant on the scalp, upper face, upper back and chest, under the armpits, breasts and in the groin. The condition responds well to any treatment that controls the levels of this oil, so doctors usually recommend frequent bathing with specially formulated body washes and shampoos. 

Some prescription medications can reduce the irritation once the skin has become inflamed. An antifungal with ketoconazole (Nizoral) or ciclopirox (Penlax) can reduce the severity of a bout but are unsuitable for long-term use due to unwanted side effects on the skin. They will mostly be taken once a week with a moisturizing conditioner.

When inflamed areas of the skin are causing discomfort, a prescription-strength corticosteroid can be applied until symptoms clear up, but not for continued use due to side effects, mainly loss of skin color and thinning skin. If the steroid cream is not producing a good enough response, doctors can use a calcineurin inhibitor such as Elidel. It also has fewer side effects than corticosteroids.

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