Treating severe eczema can be difficult. However, certain treatment options, such as phototherapy and immunosuppressant drugs, may help manage symptoms.

Eczema is a common group of skin conditions that result in inflamed, itchy patches on the skin. In severe cases, these patches may cause constant discomfort and open weeping sores. The most common form of the condition is atopic dermatitis.

Doctors cannot cure eczema, but treatments can reduce the severity of rashes and inflammation.

This article will look at the treatment options for severe eczema in adults and children.

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Severe eczema can significantly affect a person’s quality of life. A person with the condition may experience symptoms that:

  • do not respond to standard treatments
  • covers a large area of their body
  • flare up for extended periods
  • cause unbearable itching or pain

Eczema appears pink or red on those with light or fair skin tones, with silvery-white scales. On medium skin tones, it can appear salmon-colored with silvery-white scales. On darker skin tones, eczema could look violet with gray scaling. It can also appear dark brown and difficult to see.

Discover how eczema appears in People of Color.

A person with severe eczema should speak with their doctor to develop a personalized treatment plan. This may include some or all of the following.

Home treatments

Treatment commonly involves using over-the-counter creams or emollients on the affected areas. Doctors may also recommend trying coping strategies, such as avoiding:

  • itching
  • regular contact with water
  • cosmetic products containing irritants

Some people may find that their eczema does not respond to initial treatments. In these cases, talking with a doctor is essential. Without proper treatment, the condition can cause the skin to crack, increasing the risk of infection.

A doctor might prescribe further treatment if a person’s eczema does not respond to initial treatments.

Wet wraps

Wet wrap therapy involves applying damp strips of fabric onto the skin where eczema is flaring up. This aims to increase the skin’s moisture content and prevent the skin from becoming dry and cracked.

To use this therapy, a person applies medicines or moisturizers onto the skin and then wraps clean, water-soaked gauze or fabric around the area. This helps maximize how long the lotions stay in contact with the skin.

It can help to apply a dry layer on top of this treatment to stop the wraps from drying out.

The best time to use wet wraps is just after bathing and moisturizing. People can leave the wraps on for a few hours or overnight.


Phototherapy can reduce the body’s inflammation response and ease the symptoms of eczema and other similar skin conditions. This treatment involves exposing the skin to UV light in a controlled environment.

During phototherapy, a person enters a machine that emits UVB light for a few seconds or minutes. Healthcare professionals can target phototherapy to specific areas.

People usually need to continue phototherapy treatments for several months. They can reduce the frequency of their treatments once their symptoms start to improve.

A 2021 study concluded that phototherapy is effective in reducing atopic dermatitis symptoms. It may also reduce someone’s need for topical steroids and other treatments.

Phototherapy can help:

  • relieve itchiness
  • reduce inflammation
  • increase vitamin D in the skin

Immunosuppressing drugs

The body’s immune response plays a key role in the development of eczema symptoms. To treat severe eczema, doctors may prescribe medications to suppress a person’s immune response. These may take the form of oral tablets or topical ointments.

Immunosuppressive drugs for eczema include:

While these medications can help reduce eczema symptoms, more research is necessary to assess their efficacy in treating chronic and severe conditions, according to a 2020 meta-analysis.

Other medications

If other treatments are ineffective, doctors may prescribe Dupixent (dupilumab) or Adbry (tralokinumab). These medications can treat the symptoms of eczema by decreasing skin inflammation.

Doctors may also prescribe the vitamin A derivative called alitretinoin.

Eczema is a common condition among children and babies.

A challenge for parents and caregivers is that infants are unable to control the urge to scratch their eczema. Scratching is one of the main factors that worsen eczema and can lead to infections.

Wet wraps may be particularly helpful for children and babies, as they can prevent the individual from scratching the affected areas.

The treatments for infants are similar to adults and focus on moisturizers and anti-inflammatories. The National Eczema Association (NEA) also recommends avoiding key triggers, such as:

  • not addressing dry skin
  • irritants
  • heat and sweating
  • allergens

The exact cause of eczema is unclear. It most likely results from a combination of genetic and external factors. People with a family history of eczema have a higher risk of developing the condition. Additionally, those with an overactive immune system may experience more severe inflammatory responses to irritants.

Learn more about the genetic basis of eczema.

Risk factors

While the exact causes of eczema are unclear, certain risk factors may make people more likely to develop the condition.

A family history of atopic dermatitis is one of the strongest risk factors for the condition.

Other risk factors include:

  • having overly dry skin
  • having an overactive immune system
  • living in areas of extreme humidity or cold

Environmental irritants can trigger eczema flares. These include:

According to the NEA, anxiety and stress can also be triggers of eczema. This means a “vicious cycle” can develop, with eczema making a person’s anxiety and stress worse and anxiety and stress affecting eczema.

Evidence also exists that links eczema to mental health issues.

Although there is no cure for the condition, people can manage its physical and mental health effects, and many different treatments are available.

Eczema is a chronic condition, and there is no cure currently. It is more common in children, and symptoms often lessen in adulthood.

However, adults can also develop eczema, which is often more severe than childhood forms of the condition. Adult eczema typically involves periods of flare-ups when it is worse and periods of remission when it gets better.

Because doctors cannot cure the condition, treatments focus on a person managing symptoms. Doctors can also recommend that someone with eczema make changes to their everyday life to avoid key triggers.

Doctors may classify eczema as severe when it covers a large area of a person’s body, is resistant to treatment, or when flares last a long time.

People with severe eczema can try intensive treatment methods, including wet wraps, phototherapy, and therapies that reduce immune system function. They can also take steps to look after their mental health.

Eczema is more common in children and tends to get better as a person gets older. There is no cure for the condition, but people can manage their symptoms and treat or prevent flares from affecting their quality of life.