“With mild eczema, people often have less of their body involved and have mild itching localized to those areas,” says Elbuluk. And remember, eczema is sort of an enigma, so while problem patches traditionally include the aforementioned spots, any area can be affected. Finney notes that in infants, flare-ups often occur on the cheeks or torso, while in adults, the hands and eyelids can also become eczema hot spots.
Treatment for mild eczema can be kept somewhat localized. “The goal is to keep the skin barrier in as good shape as possible with moisturizers and to help reduce inflammation with anti-inflammatory cortisone and non-cortisone cream,” says Joshua Zeichner, a board-certified dermatologist based in New York City.
Marnie Nussbaum, a board-certified dermatologist based in New York City, also suggests keeping showers short — like, five-minutes-short — and using lukewarm water. Patients with mild eczema can use a gentle cleanser that’s pH-balanced. Then after showering, pat the skin dry and apply a moisturizing lotion with thick emollients to lock in moisture.
Severity Level 2: Moderate
Unlike mild eczema, which typically doesn’t stray beyond specific problem areas, moderate eczema becomes less targeted. “It’s often affecting more of the body with more severe itching, and having more significant effects on the person’s quality of life,” says Elbuluk.
Sometimes, Finney adds, the itching can get so uncomfortable that patients who have had eczema for a long period of time will present with thickened, darker skin in those areas, a hallmark feature of rubbing. And in patients with darker skin types, dermatologists often see accentuation with small bumps around the hair follicles.
Because moderate eczema affects larger areas of the skin, Zeichner says that it’s especially important for patients to apply potent, over-the-counter moisturizers to the entire body, not just where they are experiencing breakouts. “Stick to unscented moisturizers and cleansers, as fragrances may lead to skin reactions,” he says.
And while you may see flakes on the skin, resist the urge to exfoliate. “Using manual scrubs or chemical exfoliators on an already-disrupted skin barrier can make matters worse, leading to more dryness and irritation,” adds Zeichner. “Instead, give your skin what it needs, which is hydration.” For a true, total-body approach, Nussbaum suggests using a humidifier, which can be useful in maintaining a hydrating environment.
Severity Level 3: Severe
In severe cases, eczema can, unfortunately, become so much more than that itch that rashes. “Severe eczema can also get to the point of having inflamed skin that also gets infected, depending on how injured the skin has become,” says Elbuluk. Any infections should be treated, and at this point, professionals will often propose systemic medications that can provide some relief.
“When necessary, topical corticosteroids are also helpful and non-steroidal, anti-inflammatory topical medications may also provide benefit,” says Hadley King, a board-certified dermatologist based in New York City.
Finney explains that newer treatments like light therapy, immunosuppressive medications, and biologic drugs can also be used. Even in the most severe cases, dermatologists are confident they’re able to keep eczema at bay, particularly with breakthrough research coming out of the dermatological space. Finney mentions a new class of medications called JAK inhibitors that work to mitigate the inflammatory pathways that are overstimulated and cause eczema symptoms. The treatment, which comes in both oral and topical forms, is headed to the Food and Drug Administration (FDA) for review. “There’s no cure for eczema,” says King, “but there are great strategies and medications for helping to control it.”