First-line treatments are moisturizers to restore the skin barrier. Use emollients (e.g., glycol stearate), occlusive agents (e.g., petrolatum), and humectants (e.g., glycerol) generously, 2–3 times daily and after bathing. For flares, second-line treatments include wet wrap therapy with low-potency corticosteroids, such as hydrocortisone 1% cream, to reduce inflammation. Severe or resistant cases may require prescription-strength topical medications, systemic corticosteroids, or biologics like dupilumab for long-term control.
January 11, 2025

Eczema: American Academy of Dermatology Guidelines

Evidence-Based Over-The-Counter Guide

William Shen

William Shen

Co-founder & CPO

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This guide is based on the 2023 American Academy of Dermatology updated guidelines.

Eczema (Atopic Dermatitis) is a chronic inflammatory skin condition characterized by itching, redness, and dry skin. Treatment focuses on maintaining skin hydration, reducing inflammation, and addressing triggers.

Topical over-the-counter medication may be sufficient for mild eczema symptoms. Dry skin results from a dysfunctional epidermal barrier, so all first-line recommendations are moisturizers. Application of moisturizers is an integral part of the treatment of patients with eczema as there is strong evidence that their use can reduce disease severity and the need for pharmacologic intervention.

First-line recommendations:

  • Emollients (eg, glycol and glyceryl stearate, soy sterols): Maintain skin barrier function and reduce dryness. Apply generously 2-3 times daily and after bathing. Popular example: Aveeno Moisture Repair Body Cream (FDA M016).

  • Occlusive agents (eg, petrolatum, dimethicone, mineral oil): Form a layer to slow evaporation of water. Popular example: Aquaphor Healing Ointment (FDA M016).

  • Humectants (eg, glycerol, lactic acid, urea): attract and hold water. Popular example: Cetaphil Hydrating Moisturizing Cream (FDA CFR 182.1320).

Second-line recommendations:

  • Wet wrap therapy (WWT) is an effective treatment for atopic dermatitis flares. It involves applying a topical agent, usually a low- or mid-potency corticosteroid such as hydrocortisone 1% cream (FDA M017), followed by a moistened first layer (e.g., cotton gauze or bandages) and a dry second layer. WWT can be used for 1 hour to 1 day at a time. 

  • Topical corticosteroids: Reduce inflammation and pruritus. Low-potency topical corticosteroids are available OTC. Dose depends on severity and site. In mild cases: Hydrocortisone 1% cream (FDA M017) once or twice daily.

Prescription medications:

  • Higher strength topical medications: betamethasone valerate, topical calcineurin inhibitors (e.g., tacrolimus, pimecrolimus)

  • Systemic corticosteroids: For severe flares unresponsive to topical therapy. Use short-term due to side effects.

  • Biologic agents (e.g., dupilumab): For moderate-to-severe cases resistant to conventional treatments.

Citation:

Sidbury, R., Alikhan, A., Bercovitch, L., Cohen, D. E., Darr, J. M., Drucker, A. M., ... & Davis, D. M. (2023). Guidelines of care for the management of atopic dermatitis in adults with topical therapies. Journal of the American Academy of Dermatology, 89(1), e1-e20. https://doi.org/10.1016/j.jaad.2022.12.029

Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014; 71(1): p.116-132. doi: 10.1016/j.jaad.2014.03.023

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Levels of evidence considered:

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