Management of Eczema: Treatment Options and Dosages

First-Line Treatment: Topical Corticosteroids

For mild eczema, start with mild-potency topical corticosteroids, according to the American Academy of Dermatology 1
Apply a thin layer to affected areas only, as recommended by the American Academy of Dermatology 1
Do not apply more frequently than recommended as this doesn't improve efficacy but increases risk of side effects, as stated by the American Academy of Dermatology 1

Sedating antihistamines provide the most effective symptomatic relief for pruritus, according to the American Academy of Allergy, Asthma, and Immunology 2
Non-sedating antihistamines have little to no value in controlling itch in atopic eczema, as reported by the American Academy of Allergy, Asthma, and Immunology 2, 1
Use sedating antihistamines primarily at night to avoid daytime sedation, as recommended by the American Academy of Allergy, Asthma, and Immunology 2

Use emollients regularly as they provide a surface lipid film which retards evaporative water loss, according to the American Academy of Dermatology 1
Apply emollients after topical corticosteroids, as recommended by the American Academy of Dermatology 1
Avoid soap and detergents as they remove natural lipids from the skin surface, as stated by the American Academy of Dermatology 1

Systemic corticosteroids have a limited but definite role in tiding occasional patients with severe atopic eczema, according to the British Medical Association 3
Should not be considered for maintenance treatment until all other avenues have been explored, as recommended by the British Medical Association 3
Try to avoid oral corticosteroids during crises, as stated by the British Medical Association 3

Keep nails short to minimize damage from scratching, as recommended by the American Academy of Pediatrics 1
Hydroxyzine is contraindicated during early pregnancy, according to the American College of Obstetricians and Gynecologists 2

The British Medical Journal suggests that traditional guidelines emphasize topical corticosteroids as the mainstay of eczema treatment, but roflumilast offers a non-steroidal option 4

For acute flares requiring rapid control, potent topical corticosteroids remain the most effective first-line option based on network meta-analysis evidence, while roflumilast is better positioned for maintenance therapy or as a corticosteroid alternative, as suggested by guidelines from the British Medical Journal 4
If eczema shows signs of secondary bacterial infection, add appropriate antibiotic therapy before or alongside roflumilast, according to the British Medical Journal 4