Well + Being
I'm a dermatologist. Here's what the latest science says about eczema
By April W. Armstrong, MD The Washington Post
Published Sept. 8, 2025
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Q: What's the best treatment for eczema?
Eczema is a chronic inflammatory skin condition marked by red and persistently itchy skin. There's no cure for eczema, which affects about 10 percent of U.S. adults and children and can be difficult to treat.
But in recent years, treatment options have advanced significantly for both mild and severe cases. Scientists now understand that eczema can be driven by different immune pathways in different people, which helps explain why the condition varies so much from patient to patient.
Based on the latest studies and what I've seen in my own patients and research, the most effective treatments are ones that address three key areas: calming inflammation, relieving itch and restoring the skin barrier. This means keeping the skin hydrated and protected while also reducing the immune overactivity that drives flare-ups and the constant urge to scratch.
• What causes eczema?
Many people with eczema are born with a genetic predisposition that influences how their skin barrier is built. Think of healthy skin as a brick wall with mortar sealing every gap. In eczema, the mortar is imperfect, so moisture escapes, and irritants, allergens and microorganisms slip in. At the same time, a branch of the immune system known as the Th2 pathway is abnormally hyperactive, producing signals that drive ongoing inflammation in the skin.
This inflammation provokes relentless itch, which is often so intense that eczema is called "the itch that rashes" because the itching usually starts before the rash, and the scratching that follows makes the rash worse. Scratching may bring temporary relief, but it further damages the barrier, adds more inflammation and keeps the cycle going. Because barrier problems, immune overactivity and itch are so tightly linked, treating only one part rarely succeeds. Durable control requires therapies that improve the barrier while also calming the inflammation and breaking the vicious itch-scratch cycle.
• How can I prevent flare-ups?
For most, eczema often flares when patients skip their medications, the air is dry, the skin is washed too often, or stress or infections interfere with good skin care. Simple steps such as applying moisturizers regularly, choosing gentle cleansers labeled for sensitive skin and free of fragrance or dyes, using a humidifier in the winter, and limiting long hot showers or frequent hand-washing can all help reduce flares and support healthier skin. It also helps to wear gloves when doing household chores, such as washing dishes, to protect hands from irritation. These measures are valuable for patients at every level of severity.
For some people, contact with certain allergens such as fragrances, metals or ingredients in personal care products can make the skin worse. Common culprits include lanolin, cocamidopropyl betaine (found in cleansers), preservatives such as methylisothiazolinone, and hair dye chemicals such as p-phenylenediamine. Identifying and removing these triggers is an important step, and dermatologists can help by testing for potential allergens.
• Try these tips to treat mild eczema
Treatment for eczema depends largely on disease severity, and different approaches are often combined to achieve the best control. For mild eczema, I usually recommend beginning with topical therapies. Moisturizers are often the starting point, but many people with mild eczema also need topical medicated therapies to get their skin under control.
• How to pick the best moisturizer: For moisturizers, thick, fragrance-free creams and ointments work best when applied right after bathing or washing, because they help lock in moisture. When choosing a moisturizer, look for ingredients that help restore the skin barrier, such as ceramides, hyaluronic acid, or glycerin. Ingredients like petrolatum or dimethicone, which form a protective barrier on the skin, can also be very effective for locking in moisture. Using these products every day, even when the skin looks clear, can prevent flare-ups.
• Why you should be cautious about topical steroids: When moisturizers alone are not sufficient, medicated creams including topical corticosteroids traditionally have been used to calm inflammation. While effective, topical steroids can lead to side effects such as skin thinning, stretch marks, or changes in skin color when used long term, so they should generally be used for limited periods as directed by a health care professional.
• Nonsteroid topical medications can help, too: The newest innovations in topical therapy are nonsteroid topical medications, which avoid these risks. Most newer nonsteroid topical medications, including ruxolitinib, tapinarof, roflumilast and crisaborole, can be applied to eczema patches anywhere on the body, and they're especially useful for sensitive areas such as the face or skin folds. (These are available only with a prescription.)
• How injectable medicines are breaking new ground
What works for mild or limited eczema is often not enough for moderate or severe symptoms. But biologic therapies are changing the landscape for those in the latter group. These FDA-approved injectable medicines, such as dupilumab, tralokinumab, lebrikizumab and nemolizumab, block the inflammation and itch signals outside the cell that drive the disease. They work by targeting molecules called interleukins, or the receptors they bind to, which are key pathways that transmit inflammation and itch in eczema.
In eczema, the levels of certain interleukins are too high, fueling inflammation, itch and barrier damage. By lowering these signals outside the cells, biologics not only calm the overactive immune system and reduce itch, but also allow the skin barrier to heal. I have seen patients with moderate-to-severe eczema begin to feel comfortable in their skin for the first time after starting a biologic medicine.
• When to consider oral medications
Newer oral prescription medicines, such as upadacitinib and abrocitinib, address the different immune pathways for the disease by blocking several of the key signals inside the cells that fuel eczema. They act quickly, often bringing down itch within days, while also reducing inflammation and helping the skin barrier heal. These medicines can be very effective for people with widespread or severe eczema, but they require careful medical supervision. (As a researcher, I've participated in clinical trials of lebrikizumab, nemolizumab, tralokinumab, dupilumab, abrocitinib and upadacitinib. I also serve as a scientific consultant to their manufacturers and receive an honorarium for that work.)
• What treatments don't work for eczema?
Coconut oil, essential oils, and restrictive diets are often talked about, but they don't consistently improve eczema in studies. For example, a systematic review found no evidence supporting the use of exclusion diets, such as egg-free and milk-free ones, in people with atopic dermatitis - the most common form of eczema - and only limited benefit in infants with proven egg allergy.
That's why medical guidelines advise against the use of elimination diets for atopic dermatitis, citing the potential for harm, including increased the risk of food allergy and malnutrition, especially in infants and children.
Eczema can greatly impact quality of life, so I understand why patients may be eager to try these approaches. But my advice is to instead focus on proven therapies that have been rigorously studied. The good news is that we now have treatments that can truly make a difference. While it can take time to find the right regimen, sticking with evidence-based options gives the best chance for lasting relief.
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Dr. April Armstrong is Professor and Chief of Dermatology at University of California Los Angeles (UCLA). She is an internationally renowned dermatologist and clinical researcher in inflammatory skin diseases including psoriasis, atopic dermatitis, and HS. Dr. Armstrong also serves as Co-Director for Network Resources at the UCLA Clinical and Translational Research Institute.