Topical Treatments for Eczema

Introduction to Topical Corticosteroids

For adults with eczema, the American Academy of Dermatology recommends topical corticosteroids as the primary prescription treatment, with potency selection based on disease severity and body location 1, 2, 3
The National Institute for Health and Care Excellence suggests that mild eczema should be treated with hydrocortisone 1-2.5% (mild potency) 1, 2, 3
For moderate eczema, clobetasone butyrate 0.05% (Eumovate) or betamethasone valerate 0.025% (moderate potency) are recommended 1, 2
The American Academy of Dermatology recommends betamethasone valerate 0.1%, mometasone 0.1% (potent) for moderate-to-severe eczema 1, 2
For severe eczema, clobetasol propionate 0.05% (very potent) is suggested 1, 2, 3

The American Academy of Dermatology recommends applying topical corticosteroids for 2-3 weeks short-term for acute flares, then reassessing 1, 2, 3
Treatment should continue until signs and symptoms resolve, as recommended by the National Institute for Health and Care Excellence 1
For maintenance therapy, the American Academy of Dermatology suggests applying medium-potency topical corticosteroids twice weekly to previously affected areas to prevent relapses 4

Ointments are recommended for dry skin, while creams are suggested for weeping/moist skin, according to the National Institute for Health and Care Excellence 1, 2, 3

For the face and neck, mild-to-moderate potency topical corticosteroids (hydrocortisone 1-2.5% or clobetasone butyrate 0.05%) are recommended by the American Academy of Dermatology 1, 2, 5
For the body, trunk, and extremities, potent corticosteroids (betamethasone valerate 0.1%, mometasone 0.1%) can be used, as suggested by the National Institute for Health and Care Excellence 1, 2, 5

The American Academy of Dermatology strongly recommends tacrolimus 0.1% ointment for adults with moderate-to-severe eczema (high-certainty evidence) 4
Pimecrolimus 1% cream is strongly recommended for adults with mild-to-moderate eczema (high-certainty evidence), according to the American Academy of Dermatology 4
The FDA has a black box warning regarding potential cancer risk with calcineurin inhibitors, although long-term safety studies have not confirmed increased risk, as noted by the National Institute for Health and Care Excellence 4

The American Academy of Dermatology recommends reserving corticosteroid-antimicrobial combinations for clinically infected eczema, such as hydrocortisone 1% + fusidic acid 2% (Fucidin H) 1, 2, 3
Topical antimicrobials for routine eczema management are conditionally recommended against (low-certainty evidence) by the American Academy of Dermatology 4

Ruxolitinib cream (JAK inhibitor) is strongly recommended for mild-to-moderate eczema in adults (moderate-certainty evidence), according to the American Academy of Dermatology 4
Crisaborole ointment (PDE-4 inhibitor) is strongly recommended for mild-to-moderate eczema in adults (high-certainty evidence) by the American Academy of Dermatology 4

Inadequate quantities of topical treatments can lead to under-application, and the National Institute for Health and Care Excellence suggests that adults require approximately 15-30g per 2 weeks for face/neck, 30-60g for both arms, 100g for both legs, and 100g for trunk 1, 2, 3