Managing Eczema

modified November 2025

The chart below provides information and a comparison of products for the management of eczema. For help estimating the quantity of topical medication needed to cover an application site see footnote “b.”

Management of Eczema

Reduce triggers.2,3

  • Help patients determine their individual triggers with a careful history.
  • Common triggers can include: airborne irritants (e.g., dust mites, pollen, tobacco smoke, air pollution), cold or dry air, dyes and fragrances (e.g., in soaps, detergents), stress, sweat, tight-fitting clothing, or chemicals sometimes found in clothing (e.g., formaldehyde).3,5-7

Maximize non-pharmacologic therapy:

  • Recommend short (five to ten minute) warm baths with mild or non-soap cleansers.8
  • Liberal amounts of moisturizer should be applied:
    • immediately after bathing (within three minutes, while skin is still damp) to the entire skin surface [Evidence Level A-2].9-11
    • at least twice daily, and as needed to prevent and treat dry skin.8
    • AFTER any topical medication (if being used).11
    • Select a moisturizer based on patient preference, ingredients (e.g., lack of irritants, fragrances, preservatives), effectiveness, and cost.9
      • Ointment and oil formulations (e.g., petroleum jelly) may be too greasy or thick for some; but may offer the most relief.3,8,12
  • Patients should keep fingernails short and smooth. Consider cotton gloves during sleep to reduce scratching.8
  • Room temperatures and humidity should be controlled to prevent skin dryness and sweating.8
  • Encourage use of a written eczema action plan (developed with prescriber) to help take appropriate and consistent measures based on their symptoms.3,10,13
  • Bleach baths can be considered to decrease inflammation and reduce skin bacteria; however, they may not be more effective compared to bathing with water [Evidence Level B-2].14,c May be useful in patients with recurrent skin infections.8,10

Use topical steroids as the foundation of anti-inflammatory therapy for eczema [Evidence Level A-1] to prevent and/or treat flares.2,6,9,10

  • Steroids inhibit the release of inflammatory cytokines, reducing the rash and itch of eczema.6,9
    • See our chart, Comparison of Topical Corticosteroids (US) (Canada), for details on products within each potency category.
  • When used chronically for prevention, use the smallest amount of the lowest potency steroid to limit exposure and adverse effects.9
  • Long-term use of high- or very high-potency topical steroids can cause hypothalamic-pituitary-adrenal (HPA) axis suppression, hyperglycemia, and hypertension.6,9

Topical calcineurin inhibitors reduce inflammation by blocking the production of inflammatory cytokines.9

  • Use when steroids can’t be used (e.g., sensitive skin), not tolerated, or to limit topical steroid exposure [Evidence Level A-1].9
    • Indicated for intermittent use, second-line after topical steroids for moderate to severe eczema (tacrolimus), or mild to moderate eczema (pimecrolimus).15-18 In Canada, tacrolimus is also indicated for prevention of frequent flares where there has been an initial response with up to six weeks of twice daily tacrolimus.16
    • Long-term safety has been demonstrated with continuous and intermittent use.20 Labeling carries a boxed warning for elevated cancer risk. Studies indicate an increased relative risk of lymphoma; however, risk does not appear to be clinically meaningful.9
    • Topical steroids and calcineurin inhibitors can be used together if neither agent is effective alone.9
  • Patients may have localized burning and itching (especially during flares). Pre-treatment with a topical steroid may minimize these effects.6

Availability

Costa

Approved age

tacrolimus
(Protopic, generics [US])

0.03% and 0.1% ointment

US: 0.03%: ~$130; 0.1%: ~$200

Canada: 0.03%: $200; 0.1%: $215

tacrolimus 0.03%:15,16  ≥2 years
(may be considered for off-label use for <2 years9)
tacrolimus 0.1%:15,16 adults

pimecrolimus
(Elidel, generics [US])

1% cream

US: ~$600 (Elidel); ~$500 (generic)

Canada: $190 (Elidel)

US:17 ≥2 years (may be considered for off-label use (US) for <2 years.9)
Canada:18 ≥3 months

Topical phosphodiesterase-4 (PDE4) inhibitors reduce inflammation by inhibiting the phosphodiesterase-4 enzyme.23,24

  • Indicated for treatment of mild to moderate eczema.23,24 Usually used when steroids can’t be used (e.g., sensitive skin [e.g., face, genitals]) or aren’t tolerated, or when topical steroids aren’t effective alone [Evidence Level B-1].25
  • Adverse effects may include application site pain, and (for crisaborole) burning, or stinging.23,24,37,38

Availability

Costa

Approved age

crisaborole
(Eucrisa)

2% ointment

US: ~$700

Canada: $155

≥3 months23,24
roflumilast
(Zoryve)
 		 0.15% cream 

US:  $930 

Canada: $315 

 ≥6 years37,38 

Topical aryl hydrocarbon receptor (AhR) agonists regulate gene expression in immune and epithelial cells.

tapinarof
(US only) (Vtama)
 1% cream 

US:  $1,510 

 ≥2 years40

Monoclonal antibodies for eczema target key inflammatory cytokines (interleukin-4 [IL-4], interleukin-13 [IL-13], or interleukin-31 [IL-31]) of eczema.22,26,27,36

  • Indicated to treat moderate to severe eczema if other therapies are inadequate or can’t be used.  Use with or without topical steroids.22,26,27,36,39  Nemolizumab is also indicated for use with or without calcineurin inhibitors.39

Availability

Costa

Approved age

dupilumab
(Dupixent)

200 mg, 300 mg pre-filled syringe or pre-filled injectable pen

US: $3,800/200 mg or 300 mg

Canada:1 ~$980/200 mg or 300 mg

≥6 months26,27

lebrikizumab
(Ebglyss)

250 mg/2 mL pre-filled pen

US: $1,750/250 mg

Canada: $2,025/250 mg

≥12 years and ≥40 kg
nemolizumab (US only)
(Nemluvio) 		 30 mg pre-filled pen  US:  $4,240/30 mg  ≥12 years39 

tralokinumab
(Adbry [US]
Adtralza [Canada])

250 mg self-injectable pre-filled syringes

US: $3,350/250 mg

Canada: $1,900/250 mg

≥12 years22,36

Janus kinase (JAK) inhibitors suppress cytokine signaling to improve itching and inflammation of eczema.28,35

  • Topical ruxolitinib is indicated for short-term intermittent use (US) of mild/moderate eczema, if other therapies are inadequate or can’t be used.29,33
  • Topical delgocitinib is indicated for moderate to severe chronic hand eczema if topical corticosteroids are inadequate or not advisable.
  • Oral abrocitinib and upadacitinib are indicated for refractory moderate/severe eczema if other systemic therapies are inadequate or can’t be used.19,21,33,35
  • Topical JAK inhibitors (except Canadian labeling for Anzupgo) carry the same boxed warnings as oral JAK inhibitors for serious infections, all-cause mortality, malignancies, major cardiovascular events, and thrombosis.19,21,29,34,35 Some topical JAK inhibitors have been linked to case reports of thrombosis, shingles, serious infections, and nonmelanoma skin cancer.29,41

Availability

Costa

Approved age

abrocitinib
(Cibinqo)

50 mg, 100 mg, 200 mg tablets

100 mg once daily dose:

US: $5,300 Canada: $1,530

≥12 years19,34
delgocitinib 
(Anzupgo)

 2% (20 mg/g) cream  US:  $1,990/30 g
Canada:  $690/60 g 
 		 ≥18 years41,42 

ruxolitinib
(Opzelura)

1.5% cream

US: $1,950/60 g Canada: $1,130/100 g

≥12 years29,33

upadacitinib
(Rinvoq)

ER tablets

US: $5,670 (15 or 30 mg)

Canada: $1,630 (15 mg) or $2,425 (30 mg)

≥12 years 21,35

Topical antimicrobials are not generally recommended for the treatment of eczema due to lack of efficacy, possible risk of contact dermatitis, and the potential for development of antimicrobial resistance.9 May be considered for a limited infection of eczema lesions.7

  • The most common organism is Staphylococcus aureus. Oral antibiotics (e.g., cephalexin) are only indicated for widespread skin infections.4
    • In Canada, a topical antimicrobial plus corticosteroid product (Fucidin H, Fucibet) may be more convenient; however, using two separate products may be less expensive. Choose based on the potency of the steroid required.
  • Available products:a 
    • mupirocin (Bactroban [brand discontinued], generics); US: ~$15/15 g (ointment); ~$170/15 g (cream); Canada: ~$15/30 g
    • Canada: fusidic acid (Fucidin, $28/30 g), fusidic acid/ hydrocortisone (Fucidin H, $50/30 g), fusidic acid/ betamethasone (Fucibet $55/30 g)

Other medications or therapies considered for the management of eczema:

  • Wet-wrap therapy (a method of occlusive therapy) with or without a topical steroid can be considered to decrease disease severity and maintain hydration during flares.2,9,10 There is an increased risk of HPA axis suppression if high-potency steroids are used with occlusive therapy.
  • Short courses of oral corticosteroids may be used for severe flares.6,30
  • Reserve oral immunosuppressants (e.g., azathioprine, cyclosporine), and phototherapy for symptoms not controlled with other treatments.6,9,30
  • Avoid using topical antihistamines to treat eczema, due to the lack of efficacy data and the possible risk of contact dermatitis.9,10
  • Topical coal tar products have limited data in the treatment of eczema. They may be as effective as topical hydrocortisone 1% but may cause itching and soreness, and are therefore not recommended.31,32







Abbreviations: ADR = adverse drug reaction; HPA = hypothalamic pituitary axis.

  1. Pricing based on wholesale acquisition cost (WAC) of a 60 g tube (topical) or as indicated (oral, injectable), unless otherwise noted. US medication pricing by Elsevier, accessed December 2024 (accessed June 2025 for Nemluvio and Vtama, November 2025 for Anzupgo)
  2. For a skin area of about two adult hand palms, some experts suggest measuring an appropriate amount of cream or ointment from the tube onto the index finger from the tip of the finger to the first joint (equals about 0.5 g).7,9 For dispensing and application amount estimates, see our technician tutorial, A Guide to Selecting Topical Dosage Forms.
  3. For a bleach bath, mix one-half cup of household bleach in a full tub of water, soak for up to ten minutes, then rinse thoroughly with clean water.11 Use two or three times per week, or up to daily.10,11

Levels of Evidence

In accordance with our goal of providing Evidence-Based information, we are citing the LEVEL OF EVIDENCE for the clinical recommendations we publish.

Level

Definition

Study Quality

A

Good-quality patient-oriented evidence.*
  1. High-quality randomized controlled trial (RCT)
  2. Systematic review (SR)/Meta-analysis of RCTs with consistent findings
  3. All-or-none study

B

Inconsistent or limited-quality patient-oriented evidence.*
  1. Lower-quality RCT
  2. SR/Meta-analysis with low-quality clinical trials or of studies with inconsistent findings
  3. Cohort study
  4. Case control study

C

Consensus; usual practice; expert opinion; disease-oriented evidence (e.g., physiologic or surrogate endpoints); case series for studies of diagnosis, treatment, prevention, or screening.

*Outcomes that matter to patients (e.g., morbidity, mortality, symptom improvement, quality of life).

[Adapted from Ebell MH, Siwek J, Weiss BD, et al. Strength of Recommendation Taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician 2004;69:548-56. https://www.aafp.org/pubs/afp/issues/2004/0201/p548.html.]

References

  1. Dupilumab (Dupixent): CADTH Reimbursement Recommendation: Indication: For the treatment of patients aged 6 months and older with moderate-to-severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2023 Oct. Report No.: SR0774.
  2. Schoch JJ, Anderson KR, Jones AE, Tollefson MM; Section on Dermatology. Atopic Dermatitis: Update on Skin-Directed Management: Clinical Report. Pediatrics. 2025 May 19:e2025071812. Epub ahead of print.
  3. Eichenfield LF, Boguniewicz M, Simpson EL, et al. Translating Atopic Dermatitis Management Guidelines Into Practice for Primary Care Providers. Pediatrics. 2015 Sep;136(3):554-65.
  4. Sun D, Ong PY. Infectious Complications in Atopic Dermatitis. Immunol Allergy Clin North Am. 2017 Feb;37(1):75-93. Erratum in: Immunol Allergy Clin North Am. 2017 May;37(2):xiii.
  5. American Academy of Dermatology. Childhood eczema: triggers can cause eczema to flare. https://www.aad.org/public/diseases/eczema/childhood/triggers. (Accessed December 14, 2024).
  6. Watson W, Kapur S. Atopic dermatitis. Allergy Asthma Clin Immunol. 2011 Nov 10;7 Suppl 1(Suppl 1):S4.
  7. Kent KA, Clark CA. Skin Deep: Simplifying Practice Guidelines for Children With Atopic Dermatitis. J Pediatr Health Care. 2018 Sep-Oct;32(5):507-514.
  8. American Academy of Dermatology. Atopic dermatitis: self-care. https://www.aad.org/public/diseases/eczema/atopic-dermatitis#tips. (Accessed December 14, 2024).
  9. Sidbury R, Alikhan A, Bercovitch L, et al. Guidelines of care for the management of atopic dermatitis in adults with topical therapies. J Am Acad Dermatol. 2023 Jul;89(1):e1-e20.
  10. Mohan GC, Lio PA. Comparison of Dermatology and Allergy Guidelines for Atopic Dermatitis Management. JAMA Dermatol. 2015 Sep;151(9):1009-13.
  11. National Eczema Association. Eczema and bathing. https://nationaleczema.org/eczema/treatment/bathing/. (Accessed December 14, 2024).
  12. Waldman AR, Ahluwalia J, Udkoff J, et al. Atopic Dermatitis. Pediatr Rev. 2018 Apr;39(4):180-193.
  13. Gilliam AE, Madden N, Sendowski M, et al. Use of Eczema Action Plans (EAPs) to improve parental understanding of treatment regimens in pediatric atopic dermatitis (AD): A randomized controlled trial. J Am Acad Dermatol. 2016 Feb;74(2):375-7.e1-3.
  14. Chopra R, Vakharia PP, Sacotte R, Silverberg JI. Efficacy of bleach baths in reducing severity of atopic dermatitis: A systematic review and meta-analysis. Ann Allergy Asthma Immunol. 2017 Nov;119(5):435-440.
  15. Product information for Protopic. Leo Pharma. Madison, NJ 07940. February 2019.
  16. Product monograph for Protopic. Leo Pharma. Thornhill, ON L3T 7W8. August 2021.
  17. Product information for Elidel. Bausch Health. Bridgewater, NJ 08807. September 2020.
  18. Product monograph for Elidel. Bausch Health, Canada. Laval, QC H7L 4A8. January 2020.
  19. Product information for Cibinqo. Pfizer Laboratories. New York, NY 10017. December 2023.
  20. Weidinger S, Baurecht H, Schmitt J. A 5-year randomized trial on the safety and efficacy of pimecrolimus in atopic dermatitis: a critical appraisal. Br J Dermatol. 2017 Oct;177(4):999-1003.
  21. Product information for Rinvoq. AbbVie. North Chicago, IL 60064. April 2024.
  22. Product information for Adbry. LEO Pharma. Madison, NJ 07940.  June 2024.
  23. Product information for Eucrisa. Pfizer Laboratories. New York, NY 10017. January 2024.
  24. Product monograph for Eucrisa. Pfizer Canada. Kirkland, QC H9J 2M5. August 2023.
  25. Paller AS, Tom WL, Lebwohl MG, et al. Efficacy and safety of crisaborole ointment, a novel, nonsteroidal phosphodiesterase 4 (PDE4) inhibitor for the topical treatment of atopic dermatitis (AD) in children and adults. J Am Acad Dermatol. 2016 Sep;75(3):494-503.e6. Epub 2016 Jul 11. Erratum in: J Am Acad Dermatol. 2017 Apr;76(4):777.
  26. Product information for Dupixent. Sanofi-Aventis US. Bridgewater, NJ 08807. September 2024.
  27. Product monograph for Dupixent. Sanofi-Aventis Canada. Toronto, ON M2R 3T4. November 2024.
  28. Kim BS, Howell MD, Sun K, et al. Treatment of atopic dermatitis with ruxolitinib cream (JAK1/JAK2 inhibitor) or triamcinolone cream. J Allergy Clin Immunol. 2020 Feb;145(2):572-582.
  29. Product information for Opzelura. Incyte. Wilmington, DE 19803. September 2025.
  30. Lee JH, Son SW, Cho SH. A Comprehensive Review of the Treatment of Atopic Eczema. Allergy Asthma Immunol Res. 2016 May;8(3):181-90.
  31. Slutsky JB, Clark RA, Remedios AA, Klein PA. An evidence-based review of the efficacy of coal tar preparations in the treatment of psoriasis and atopic dermatitis. J Drugs Dermatol. 2010 Oct;9(10):1258-64.
  32. Munkvad M. A comparative trial of Clinitar versus hydrocortisone cream in the treatment of atopic eczema. Br J Dermatol. 1989 Dec;121(6):763-6.
  33. Product monograph for Opzelura. Innomar Strategies. Oakville, ON L6L 0C4. October 2025.
  34. Product monograph for Cibinqo. Pfizer Canada. Kirkland QC H9J 2M5. November 2024.
  35. Product monograph for Rinvoq. AbbVie. St-Laurent, QC H4S 1Z1. July 2024.
  36. Product monograph for Adtralza. LEO Pharma. Toronto, ON M2H 3S8. August 2023.
  37. Product information for Zoryve. Arcutis Biotherapeutics. Westlake Village, CA 91361. July 2024.
  38. Product monograph for Zoryve. Arcutis Canada. North York, ON. M2N 5P6. March 2025.
  39. Product information for Nemluvio. Galderma Laboratories. Dallas, TX 75201. December 2024.
  40. Product information for Vtama. Dermavant Sciences. Long Beach, CA 90806. December 2024.
  41. Product information for Anzupgo. Leo Pharma. Madison, NJ 07940. July 2025.
  42. Product monograph for Anzupgo. Leo Pharma. Toronto, ON M5C 1H6. August 2025.

Cite this document as follows: Clinical Resource, Managing Eczema. Pharmacist’s Letter/Pharmacy Technician’s Letter/Prescriber Insights. December 2024. [401260]


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