What to Do When Eczema or Atopic Dermatitis Drive You Crazy

The symptoms drive you to distraction. Eczema or atopic dermatitis can cause itchy red skin. The rash can show up on hands, wrists, arms, legs, face, neck or scalp. The itching can be especially awful at night. If you have been watching television recently, you have no doubt seen advertisements for drugs to treat eczema.

Managing Eczema or Atopic Dermatitis:

People who don’t suffer from eczema  or atopic dermatitis may have a hard time understanding the fuss. The commercials for prescription medications mention itch and imply that the associated redness and scaling is embarrassing.

A study in Austria and Switzerland found that patients often don’t get a prompt diagnosis of this immune-related skin condition (Journal of Dermatological Treatment, Dec. 2024). In the meantime, they suffer moderate to severe itching and reduced quality of life. Despite treatment, the patients in this study were still having trouble with their sleep, mental health, social life and work productivity.

What Causes Eczema?

Scientists are still working to understand exactly why some people have such difficulty with eczema. It seems to be an autoimmune condition in which the body’s immune system begins to attack some cells in the skin. The balance of microbes on the skin, in the digestive tract and in the lungs may all contribute to make certain individuals particularly susceptible (Scandinavian Journal of Immunology, Oct. 21, 2024).

Deficiencies in the skin’s barrier function may make eczema worse. In addition, people who have other conditions such as seasonal allergies, chronic sinus inflammation, asthma or food allergies seem to be more likely to experience the irritation, rash and itch that signals eczema (International Journal of Molecular Sciences, Sep. 25, 2024).

Simple Suggestions for Self Care:

Fortunately, there are several steps to try before jumping straight to the pricey medications advertised on TV. First of all, patients should try to avoid soaking the affected parts (such as hands) in hot water or using harsh detergents. These can dry the skin and disrupt its barrier, making eczema worse, while a gentle nonsoap cleanser like CeraVe or Cetaphil should be fine. The National Eczema Association suggests a quick lukewarm bath rather than a long hot bath or shower.

Could Supplements Help?

Some research suggests that probiotic supplements, particularly those containing a Lactobacillus species as an ingredient, may help alleviate symptoms without triggering serious side effects (Cureus, July 18, 2024).  Dermatologists have debated whether omega-3 fats of the sort found in fish oil might be helpful. One recent randomized trial suggests that it can ease eczema or atopic dermatitis in children (Nutrients, Aug. 24, 2024).  The benefits for adults are not as clear.

What About Prescriptions?

By now, you may have gotten the picture of why the powerful prescription drugs in TV commercials might be so appealing. People in these spots are having fun snorkeling, riding horses, roller skating and surfing. Their eczema does not seem to be slowing them down at all. Who wouldn’t want a life like that? At this point, dupilumab (Dupixent) is among the standard treatments for atopic dermatitis. Others are discussed below. Several other prescription medications are vying to overtake it.

Upadacitinib (Rinvoq) is probably appropriate in some situations. The prescribing information for dermatologists specifies that it should be reserved for people who have not responded to other treatments, including biologics. Presumably that is because Rinvoq has the potential to cause some very serious side effects.

These are mentioned in the ad, but rather quickly, so if you missed them, here they are:

“Rinvoq can lower your ability to fight infections including TB. Serious infections and blood clots, some fatal, cancers including lymphoma and skin, heart attack, stroke and GI tears occur. People 50 and older with a heart disease risk factor have an increased risk of death. Serious allergic reactions can occur. Tell your doctor if you are or may become pregnant.”

Eczema can be extremely uncomfortable. It is, however, not lethal. We think people should exhaust all other options before considering a medication that could cause cancer, heart attacks or strokes.

Just Call Me Job:

Q. I had a very bad case of atopic dermatitis when I was in my teens. It cleared up after that until recently. Now it’s back with a vengeance.

I told my dermatologist to call me Job like the afflicted man in the Bible. She said there is a condition called Job syndrome but I wasn’t that bad yet.

Nothing she has prescribed has provided much relief, including clindamycin and Halog cream. Can you suggest anything else?

A. Eczema or atopic dermatitis is a serious allergic skin condition. It can be extremely uncomfortable, and scratching may expose the skin to infection. That may be why your doctor prescribed the antibiotic clindamycin. Halog is a strong cortisone-type cream.

Job Syndrome is a Real Condition:

For those who may have forgotten their Bible story about Job in the land of Uz, here is the synopsis:

Job was known as a very good guy. He lived an upright life and avoided misdeeds. He was quite wealthy and had a wonderful family. But his life became challenged. His animals were attacked. His children were killed and his life was turned upside down. Finally, Satan caused his skin to develop boils from head to toe. We won’t reveal how the story ends, but suffice it to say that Job suffered mightily for quite awhile.

Job syndrome was first identified in 1966. It is a very unusual immune disorder that is manifested by severe skin rashes and abscesses. Another name for this condition is Hyperimmunoglobulin E syndrome (HIES). It often requires long-term antibiotic treatment to prevent serious staph infections of the skin. It is indeed a trial. Eczema, also called atopic dermatitis, can be challenging, but not quite as bad as Job syndrome.

What to Do for Eczema or Atopic Dermatitis?

Your doctor might prescribe a medication to calm your overactive immune reaction in your skin. Two topical immune-suppressing drugs have been used for years: tacrolimus (Protopic) and pimecrolimus (Elidel). Common side effects include temporary itching and burning. Other reactions include headache, upper respiratory tract infection, swollen glands and viral skin infections (cold sores, shingles or warts).

Newer Drug Treatments:

Two options are crisaborole (Eucrisa) and dupilumab (Dupixent). Crisaborole is an ointment, while dupilumab is an injection.

Dupilumab is significantly more effective than placebo at calming symptoms of atopic dermatitis. However, it is pricey. It can also trigger troublesome eye symptoms such as conjunctivitis and keratitis (QuarterWatch, Dec. 2018).

One reader let us know about a pricey new treatment that worked well. We are concerned about potential side effects, however.

Opzelura Cream Is Powerful:

Q. I’ve had eczema for years, and it did not respond to any treatment I tried. Finally, I found a dermatologist willing to prescribe Opzelura cream. Within a week all my red itchy patches were cleared! When any new patches start, I apply the cream and they are gone in a few days. What do you know about this treatment?

A. This drug is called a JAK (janus kinase) inhibitor. That puts it in the same category as Rinvoq (upadacitinib) and Cibinqo (abrocitinib).
Opzelura (ruxolitinib) is a topical cream that is better than placebo for eliminating the itch of atopic dermatitis (eczema).

It does carry a black box warning, however. Prescribers are warned about an increased risk of infection or malignancies that are associated with JAK inhibitors. These might be more of a problem with systemic medications such as Xeljanz or Rinvoq. Still, major adverse cardiovascular events and death prompt us to think twice.

Side effects of the cream include sore throat and runny nose. The biggest challenge is likely to be the cost. The list price at GoodRx is over $2,000 for one 60 gram tube.

Treating Less Severe Eczema or Atopic Dermatitis:

There are several home remedies that readers have suggested for eczema or atopic dermatitis. We have no way of assessing what would be best for any given individual since no one approach works for everyone.

We suspect that disturbances in the skin microbiome may be partially responsible for eczema. Doctors call this dysbiosis. It means that the microbial ecology of the skin has been disrupted.

Old-Fashioned Amber Listerine:

Listerine contains a variety of essential oils including eucalyptol, menthol and thymol. These ingredients have both antifungal and antibacterial activity. Perhaps dabbing a little Listerine with a cotton ball helps reestablish a better skin microbiota to help overcome eczema. Here is a link to the question: Will Listerine Soothe Your Itchy Eczema?

Noczema for Eczema:

For decades Noczema was considered one of the best skin creams on the market. There were even suggestions that the name Noczema was derived from the phrase “knocking eczema.” Folklore has it that “no eczema” became Noczema.

Noxzema contains some of the same ingredients found in Listerine: eucalyptus and menthol. There is also camphor, which helps control itching through special sensory neurons in the skin. Here are some links to stories from readers:

Noxzema Relieved Eczema

Noxzema Stopped Nose from Itching Uncontrollably

Coconut Oil for Eczema or Atopic Dermatitis?

This remedy seems very greasy to us, but there is some science to support this approach.

One reader says it worked wonders for intractable eczema.

Try Coconut Oil on the Skin to Relieve Itchy Eczema

Marijuana AND Coconut Oil?

We heard from Fred in the Upper Peninsula of Michigan.

He shared this intriguing story:

“I’ve had eczema for my entire life, and I’m 63. Two years ago I received a medical cannabis (marijuana) card. I mixed up a combination of 60 ozs. of food grade coconut oil and 3 ozs. high grade marijuana.

“I brought oil to a liquid using a double boiler and added marijuana to liquid oil. I slow cooked oil for 2 hours. I then strained oil from marijuana using a strainer. I then poured oil in mason jars. Everyday I put this oil on dry skin including scalp after I showered.

“There’s only one word to describe the effect RELIEF.”

Share your own eczema or atopic dermatitis story in the comment section below.