Skip to content
How It Works
Explore
Ask a Question Resources Pricing
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Ask a Question
PubMed This is a summary of 20 peer-reviewed journal articles Updated
Dermatology

The Step-Up Approach to Eczema Treatment

At a Glance

Atopic eczema treatment follows a step-up ladder, starting with daily thick moisturizers and topical anti-inflammatory creams. For moderate-to-severe eczema, doctors now prefer targeted biologic injections or oral JAK inhibitors over long-term oral steroids to safely control inflammation.

Treating atopic eczema has shifted from simply “putting out fires” to a proactive, tiered approach that targets the underlying causes of the disease [1][2]. Doctors use a treatment ladder, starting with basic skin care and stepping up to more powerful medicines only when needed [1].

The Treatment Ladder

  1. The Foundation (Emollients): Consistent, daily use of thick moisturizers (emollients) is mandatory for all patients to repair the “leaky” skin barrier [1][2]. To maximize effectiveness, use the “soak and seal” method: gently pat the skin dry after bathing and apply a thick layer of moisturizer within 3 minutes to lock in hydration [1].
  2. Topical Anti-Inflammatories: For active flares, doctors prescribe topical corticosteroids (TCS). To avoid side effects like skin thinning, and the risk of Topical Steroid Withdrawal (TSW)—a severe rebound effect from prolonged or inappropriate use—“steroid-sparing” options are used for maintenance or sensitive areas [3]. These include topical calcineurin inhibitors (tacrolimus, pimecrolimus), which may cause temporary stinging or burning when first applied, and newer topical JAK inhibitors (ruxolitinib) [3][4][5].
  3. Phototherapy: If creams aren’t enough, controlled exposure to ultraviolet (UV) light can help reduce inflammation for some patients [6][7].
  4. Systemic Therapy: For moderate-to-severe disease, doctors move to “systemic” treatments that work throughout the entire body [6].

The Problem with Oral Steroids

While oral corticosteroids (like prednisone) can clear skin quickly, major consensus guidelines now strongly discourage their long-term use [8]. They carry a high risk of “rebound flares”—where the eczema returns much more severely as soon as the medication is stopped—and long-term side effects such as bone loss and cataracts [8].

Modern Targeted Therapies

For those who need systemic treatment, doctors now prefer targeted medicines that focus on specific “switches” in the immune system.

Biologics (Injections)

Medicines like dupilumab and tralokinumab target the signaling pathways of IL-4 and IL-13, the specific proteins that drive eczema inflammation [9][10].

  • Benefits: They are highly effective and have a strong safety profile for long-term use [11][12].
  • Delivery: Usually administered as an injection under the skin every few weeks [9].

Oral JAK Inhibitors (Pills)

Medicines like upadacitinib and abrocitinib are daily pills that block the “Janus kinase” (JAK) pathway [9][13].

  • Benefits: They often provide extremely rapid relief from itching, sometimes within days [14][15].
  • Safety & Monitoring: These medications carry “Black Box Warnings” because they may increase the risk of blood clots (DVT/PE), heart-related events, and serious infections [16][17].
  • Required Testing: Before starting and periodically during treatment, you will need blood tests to monitor your CBC (blood counts), liver enzymes, and lipid panel (cholesterol) [18][19]. You must also be screened for latent tuberculosis and shingles risk [15][20].

Back to Home

Common questions in this guide

How do I properly apply moisturizers for eczema?
For maximum effectiveness, doctors recommend the soak and seal method. Gently pat your skin dry after bathing and apply a thick layer of moisturizer within 3 minutes to lock in hydration and repair the leaky skin barrier.
What are steroid-sparing creams for eczema?
Steroid-sparing creams, such as topical calcineurin inhibitors and topical JAK inhibitors, reduce inflammation without the risk of skin thinning. Doctors often prescribe these for sensitive areas like the face or for long-term eczema maintenance.
Why do doctors avoid prescribing oral steroids for eczema?
While oral steroids like prednisone clear skin quickly, they can cause severe rebound flares where the eczema returns much worse after the medication is stopped. They also carry serious long-term risks, such as bone loss and cataracts.
What is the difference between eczema biologics and oral JAK inhibitors?
Biologics are given as injections under the skin every few weeks and safely target specific immune proteins over the long term. Oral JAK inhibitors are daily pills that provide rapid itch relief but require careful blood test monitoring due to higher safety risks.
What blood tests are needed before starting a JAK inhibitor for eczema?
Before starting an oral JAK inhibitor, you will need blood tests to check your complete blood count, liver enzymes, and cholesterol levels. You will also need to be screened for latent tuberculosis and your risk for shingles.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my disease severity, where do I fit in the 'tiered' treatment ladder?
  2. 2.If you are prescribing a topical corticosteroid, what is our 'steroid-sparing' plan for sensitive areas like my face?
  3. 3.Why are targeted biologics often preferred over oral prednisone for long-term control of moderate-to-severe eczema?
  4. 4.If we consider an oral JAK inhibitor, what specific blood tests will I need, and how frequently?
  5. 5.What is the strategy for preventing a 'rebound flare' if we have to use a systemic treatment?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (20)
  1. 1

    Atopic eczema.

    Brown SJ

    Clinical medicine (London, England) 2016; (16(1)):66-9 doi:10.7861/clinmedicine.16-1-66.

    PMID: 26833520
  2. 2

    Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations.

    , Chu DK, Schneider L, et al.

    Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 2024; (132(3)):274-312 doi:10.1016/j.anai.2023.11.009.

    PMID: 38108679
  3. 3

    A practical algorithm for the treatment of mild-to-moderate atopic dermatitis (AD) in pediatric patients in Europe: expert recommendations.

    Augustin M, Luger T, Pincelli C, et al.

    The Journal of dermatological treatment 2025; (36(1)):2503281 doi:10.1080/09546634.2025.2503281.

    PMID: 40400338
  4. 4

    Atopic Dermatitis in Adults: Focus on Topical Therapy.

    Marshall LL

    The Senior care pharmacist 2025; (40(3)):123-134 doi:10.4140/TCP.n.2025.123.

    PMID: 40016629
  5. 5

    Guidelines of care for the management of atopic dermatitis in adults with topical therapies.

    Sidbury R, Alikhan A, Bercovitch L, et al.

    Journal of the American Academy of Dermatology 2023; (89(1)):e1-e20 doi:10.1016/j.jaad.2022.12.029.

    PMID: 36641009
  6. 6

    The management of severe eczema in pregnancy.

    Keeling E, Smith CH, Woolf RT

    Clinical medicine (London, England) 2025; (25(1)):100282 doi:10.1016/j.clinme.2024.100282.

    PMID: 39733910
  7. 7

    Systemic treatments in the management of atopic dermatitis: A systematic review and meta-analysis.

    Siegels D, Heratizadeh A, Abraham S, et al.

    Allergy 2021; (76(4)):1053-1076 doi:10.1111/all.14631.

    PMID: 33074565
  8. 8

    Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement.

    Drucker AM, Eyerich K, de Bruin-Weller MS, et al.

    The British journal of dermatology 2018; (178(3)):768-775 doi:10.1111/bjd.15928.

    PMID: 28865094
  9. 9

    Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies.

    Davis DMR, Drucker AM, Alikhan A, et al.

    Journal of the American Academy of Dermatology 2024; (90(2)):e43-e56 doi:10.1016/j.jaad.2023.08.102.

    PMID: 37943240
  10. 10

    The IL-13-OVOL1-FLG axis in atopic dermatitis.

    Furue K, Ito T, Tsuji G, et al.

    Immunology 2019; (158(4)):281-286 doi:10.1111/imm.13120.

    PMID: 31509236
  11. 11

    Systemic Biologic Management of Atopic Dermatitis.

    Dao DD, Flowers RH

    Advances in experimental medicine and biology 2024; (1447()):139-149 doi:10.1007/978-3-031-54513-9_13.

    PMID: 38724791
  12. 12

    The Impact of Dupilumab on Psychological Wellbeing in Moderate-to-Severe Atopic Dermatitis Patients: A Phase IV Clinical Trial.

    Johnson CE, Elhage KG, Spencer RK, et al.

    The Journal of clinical and aesthetic dermatology 2026; (19(3)):15-19.

    PMID: 42027418
  13. 13

    Efficacy and Safety of Abrocitinib in an Elderly Chinese Population with Moderate-to-Severe Atopic Dermatitis: A Non-randomized Controlled Trial.

    Zhang Q, Zhu Y, Yang L, et al.

    Acta dermato-venereologica 2025; (105()):adv44200 doi:10.2340/actadv.v105.44200.

    PMID: 41403263
  14. 14

    Treatment of atopic dermatitis: Recently approved drugs and advanced clinical development programs.

    Müller S, Maintz L, Bieber T

    Allergy 2024; (79(6)):1501-1515 doi:10.1111/all.16009.

    PMID: 38186219
  15. 15

    Efficacy and Safety of JAK1 Inhibitor Abrocitinib in Atopic Dermatitis.

    Iznardo H, Roé E, Serra-Baldrich E, Puig L

    Pharmaceutics 2023; (15(2)) doi:10.3390/pharmaceutics15020385.

    PMID: 36839707
  16. 16

    JAK in the [Black] Box: A Dermatology Perspective on Systemic JAK Inhibitor Safety.

    Elmariah SB, Smith JS, Merola JF

    American journal of clinical dermatology 2022; (23(4)):427-431 doi:10.1007/s40257-022-00701-3.

    PMID: 35679017
  17. 17

    Treatment of atopic dermatitis with upadacitinib: adcare single center experience.

    Fomina DS, Mukhina OA, Mikhailova VI, et al.

    Frontiers in medicine 2024; (11()):1385720 doi:10.3389/fmed.2024.1385720.

    PMID: 38695023
  18. 18

    Optimizing Abrocitinib Use for Atopic Dermatitis in India: Expert Recommendations for Patient Selection, Dosing, and Long‑Term Remission.

    Kandhari S, De A, Shankar K, et al.

    Clinical, cosmetic and investigational dermatology 2026; (19()):611587 doi:10.2147/CCID.S611587.

    PMID: 42382839
  19. 19

    Practical Recommendations on Laboratory Monitoring in Patients with Atopic Dermatitis on Oral JAK Inhibitors.

    Kirchhof MG, Prajapati VH, Gooderham M, et al.

    Dermatology and therapy 2024; (14(9)):2653-2668 doi:10.1007/s13555-024-01243-8.

    PMID: 39115712
  20. 20

    Consensus on the Use of JAKinibs for Atopic Dermatitis in Australia and New Zealand. An eDelphi by the Australasian Medical Dermatology Group.

    Rademaker M, Foley P, Armour K, et al.

    The Australasian journal of dermatology 2025; (66(5)):e287-e296 doi:10.1111/ajd.14525.

    PMID: 40366066

This page explains the step-up approach to eczema treatment for educational purposes only. Always consult your dermatologist to determine the safest and most effective treatment plan for your specific skin condition.

Get notified when new evidence is published on atopic eczema.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.