Advances in eczema treatments: what you need to know

Eczema, or atopic dermatitis, is a chronic inflammatory skin condition that affects individuals of all ages. From infants to adults, eczema can have a significant impact on daily life, causing itchy, red, scaly, or oozing skin, disrupted sleep, and emotional or social stress. While many people are familiar with moisturisers and over-the-counter creams, recent advances in medical therapies, including topical medications, systemic treatments, and biologics, have dramatically improved outcomes for patients with moderate-to-severe eczema. Understanding the full range of options and the latest innovations is essential for effective management.

Topical treatments: the foundation of eczema care

Topical therapy remains the cornerstone of eczema management, particularly for mild-to-moderate cases. Moisturisers, including creams, ointments, and lotions, are essential for restoring and maintaining the skin barrier, reducing dryness, and preventing flare-ups. Applying moisturisers multiple times per day keeps the skin hydrated, improves barrier function, and can reduce the need for stronger medications. It’s important to select formulations that are free from fragrances, dyes, and other irritants, particularly for sensitive or inflamed skin.

Topical corticosteroids are prescribed to control inflammation during flare-ups and vary in potency:

• Mild: suitable for delicate areas such as the face, neck, and skin folds; safe for infants and young children

• Moderate: appropriate for the trunk and limbs; ideal for older children and adults

• Potent: reserved for thickened, resistant plaques; typically used on limbs or scalp under careful supervision

Correct application—how much, how often, and for how long—is crucial to maximise effectiveness while minimising side effects. Many patients have concerns about “steroid phobia,” but when used appropriately under medical guidance, topical corticosteroids are both safe and highly effective.

Topical calcineurin inhibitors, including tacrolimus and pimecrolimus, are an alternative to corticosteroids for sensitive areas or long-term use. They reduce inflammation without thinning the skin and are especially useful for facial or intertriginous eczema. These medications are often combined with moisturisers to optimise results.

Wet wrapping is another topical strategy used during severe flares. This involves applying moisturisers or topical medications to the affected area and covering it with damp bandages or clothing, followed by a dry layer on top. Wet wrapping enhances hydration, improves medication absorption, reduces itch, and can accelerate the resolution of acute flares. Typically, wet wrapping is applied for a few hours or overnight under supervision and can be repeated as needed for a limited period.

Bleach baths can also play a role in eczema management, particularly when the skin is prone to bacterial colonisation. A diluted, lukewarm bleach bath—carefully prepared according to medical guidance, can help reduce the presence of bacteria such as Staphylococcus aureus on the skin, which may trigger inflammation and worsen eczema. Bleach baths are typically performed once or twice weekly and are always followed by moisturisation to protect the skin barrier.

Systemic treatments: for moderate-to-severe eczema

When topical therapies are insufficient, systemic treatments are considered for patients with widespread or treatment-resistant eczema. These medications work by modulating the immune system to reduce inflammation and prevent flare-ups. Common systemic treatments include:

• Methotrexate: An immune-modulating medication often used for long-term control. Patients require regular blood tests to monitor liver function, kidney function, and blood counts. Methotrexate is particularly useful for patients with chronic, persistent eczema that has not responded to topical therapies.

• Ciclosporin: A potent immunosuppressant that can provide rapid improvement in severe eczema. Ciclosporin is generally used short-term due to potential side effects, including kidney toxicity and increased blood pressure. Close monitoring is required to ensure safe use.

• Acitretin: Primarily used in adults with chronic, thickened eczema. Acitretin normalises skin cell turnover and reduces scaling, but requires monitoring of liver function and lipid levels. It is generally avoided in women of childbearing age unless strict contraception is observed.

Systemic therapies are typically reserved for individuals with moderate-to-severe eczema that has failed to respond to topical medications, those with significant sleep disruption, or recurrent infections. Regular follow-up and monitoring are essential to minimise risks and ensure optimal outcomes.

Biologics: a transformative advancement

Biologic therapies, such as dupilumab, target specific immune pathways that drive eczema inflammation. By selectively modulating the immune response, biologics reduce itching, redness, and lesion severity while generally avoiding systemic side effects associated with traditional immunosuppressants. Biologics are approved for adults and children over six years of age in Australia, and ongoing trials are expanding their use to younger children. Biologics are especially effective for patients who have not responded adequately to topical or conventional systemic therapies.

Emerging treatments and combination strategies

Research continues to advance our understanding of eczema and its treatment. JAK inhibitors, both oral and topical, are showing promise in targeting key inflammatory pathways and providing rapid symptom relief. Novel barrier repair creams and combination strategies, using moisturisers alongside topical anti-inflammatories or biologics, further improve outcomes. The goal of these approaches is to personalise therapy to each patient’s disease severity, age, and underlying immune profile.

Supportive care remains essential

Even with advanced therapies, daily skincare routines are critical. Gentle, lukewarm showers, fragrance-free cleansers, and consistent moisturisation protect the skin barrier. Clothing choices and soft, breathable fabrics such as cotton or bamboo, reduce friction and irritation. Identifying and minimising environmental triggers, such as allergens or harsh detergents, can prevent flare-ups.

Questions to ask your dermatologist

Patients and caregivers are encouraged to discuss these questions during appointments:

• Which topical steroid potency is most appropriate for me or my child?

• How often should treatments be applied during a flare versus maintenance?

• Are calcineurin inhibitors suitable for sensitive areas?

• When should systemic therapy be considered?

• What are the risks and benefits of biologic therapy?

• How should biologics be combined with topical therapies, if at all?

• What lifestyle or environmental adjustments can support eczema management?

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Modern eczema management combines topical therapies, systemic treatments, biologics, and supportive care to provide meaningful relief for patients of all ages. Education about treatment options, correct application, and early intervention is crucial for optimising outcomes. With ongoing research and emerging therapies, individuals living with eczema now have more options than ever to reduce flare-ups, improve quality of life, and achieve long-term skin health.