People with eczema may find relief from medicated creams that do not include steroids as a primary ingredient. While each may help relieve a person’s eczema symptoms, they may also cause side effects.
Eczema refers to a group of skin conditions that cause dry, irritated, and itchy skin and rashes. It affects more than 31 million Americans, and its most common form is atopic dermatitis.
Treatments for eczema
Several medicated, nonsteroid creams may also help with eczema. This article discusses some of these creams, their possible uses and side effects, and other possible treatment options.
When a person has atopic dermatitis, part of the inflammatory response that occurs is due to an increase of immune system messenger proteins, known as cytokines, in the skin and blood. Cytokines use the JAK-signal transducer and activators of transcription (JAK-STAT) pathway to communicate with the rest of the immune system, triggering inflammation.
JAK inhibitors target one or more of the JAK family members, of which there are four, to help block the signals through the JAK-STAT pathway and prevent inflammation relating to the cytokines.
Currently, there is one topical JAK inhibitor available in the United States for eczema that targets JAK1 and JAK2 — Opzelura (ruxolitinib 1.5%) cream. Healthcare professionals may prescribe the cream for a short duration for people with mild to moderate eczema who:
- did not respond to other therapies
- are 12 years of age or older
- do not have compromised immune systems
Side effects
According to the Food and Drug Administration (FDA), commonly reported adverse reactions of Opzelura for people with atopic dermatitis include:
- bronchitis
- nasopharyngitis, another name for the common cold
- diarrhea
- urticaria, or hives
- ear infection
- elevated count of eosinophils, a type of white blood cell that helps ward off infections
- runny nose
- folliculitis
- tonsillitis
A person should speak with a doctor if they experience any side effects after starting treatment.
PDE4 is a type of enzyme that works in the immune system to help produce cytokines. Medications that block or inhibit this enzyme help prevent the inflammatory response that occurs in different types of eczema.
Currently, the FDA has approved one type of topical PDE4 inhibitor for atopic dermatitis — crisaborole (Eucrisa). Healthcare professionals generally recommend it for people with mild to moderate atopic dermatitis who are 3 months of age or older.
Side effects
The most commonly reported side effect of Eucrisa is pain, which may include a stinging or burning sensation in the area of the skin where someone has applied the cream.
A person should speak with a healthcare professional if they experience any other side effects after starting a treatment or if the pain is severe and does not go away.
Topical calcineurin inhibitors help prevent certain cells in the immune system from activating, which in turn can help prevent eczema symptoms such as inflammation.
A person can apply topical calcineurin inhibitors to all affected areas of skin, including sensitive areas such as the eyelids and other thin areas of skin. It comes in different forms and concentrations that may be suitable for adults or children who are 2 years of age and older.
There are two types of topical calcineurin inhibitors, including tacrolimus ointment, such as Protopic, and pimecrolimus cream, such as Elidel. They each come in different formulas that affect their strength and usage.
Side effects
Topical calcineurin inhibitors may cause side effects. According to the National Eczema Society, the most commonly reported side effect is pain at the application site that typically goes away within 1 week of use.
Other possible side effects include:
- skin discoloration
- a sensation of warmth in the area of application
- a tingling sensation, or “pins and needles”
- folliculitis
- viral skin infections
Additionally, alcohol use may increase the rate of side effects such as facial flushing and skin irritation. Impetigo is also more common among children who use the medication.
According to the National Eczema Association, topical calcineurin inhibitors could lead to an increased risk of lymphoma if a person uses them for long periods. However, scientists have not established a causal link between the two.
A person should speak with a doctor if they experience any side effects after starting treatment.
A person may use a combination of medicated creams as well as moisturizers and self-care to manage their eczema. Some additional ways a person
- applying moisturizers daily and after bathing
- keeping fingernails short to help prevent scratching
- avoiding strong soaps and detergents that contain dyes, perfumes, or other additives
- avoiding scrubbing the skin too hard
- avoiding taking hot showers or baths
- recording and avoiding known eczema triggers
- using ointments such as petroleum jelly to help keep the skin lubricated
- avoiding scratching the skin or rash
In some cases, a person may find that steroid creams or ointments are more suitable for them. People should only use medicated creams following a healthcare professional’s guidance.
Several medicated, nonsteroid creams may help with eczema. However, they do have some risks and may cause side effects.
Most reported side effects are mild and include burning or stinging at the application site, but some creams may not suit everyone.
In addition to medicated creams, a person can take several self-care steps to help manage their symptoms. This may include using moisturizers daily and avoiding harsh soaps.
A person with eczema should speak with a healthcare professional to determine if any nonsteroid creams may be suitable for them and to discuss other treatment options.