Beyond Itchy Skin: What Causes Eczema and How Do I Treat It?

Although it’s one of the most common skin conditions a dermatologist treats, eczema remains one of the most misunderstood. 

Many people think of it as simply dry, itchy skin and reach for a drugstore moisturizer. While that helps, eczema runs deeper than surface dryness, and for patients dealing with persistent or severe flares, effective treatment requires understanding what’s actually driving it.

Here’s what you need to know about eczema and the full range of options available to address it.

What Actually Causes Eczema?

Eczema, most commonly atopic dermatitis, stems from a combination of a compromised skin barrier and an overactive immune response. Healthy skin forms a tight protective barrier that locks moisture in and keeps irritants and allergens out. 

In people with eczema, that barrier has gaps, allowing moisture to escape and triggers to penetrate, which sets off an inflammatory cycle that produces the redness, itching, and irritation characteristic of a flare.

Genetics plays a significant role. Many patients with eczema also deal with asthma or seasonal allergies, a pattern known as the atopic triad. Common triggers include dry weather, sweat, certain fabrics, fragrances, detergents, stress, and specific foods, though triggers vary considerably from person to person.

Eczema is a chronic condition, meaning it doesn’t have a permanent cure. The goal of treatment is to calm active flares, repair the skin barrier, and reduce the frequency and severity of future episodes.

What Can I Manage at Home?

A consistent at-home routine forms the foundation of eczema management at every level of severity.

• Moisturize immediately after bathing with a fragrance-free cream or ointment to seal moisture into the skin before it evaporates.
• Use gentle, fragrance-free products for cleansing, laundry, and skincare. Fragrances and preservatives rank among the most common contact triggers.
• Keep showers lukewarm and brief, with minimal use of a gentle cleanser. Hot water strips the skin’s natural oils and worsens barrier dysfunction.
• Identify and avoid your triggers. A simple diary tracking flares alongside diet, activities, and products can reveal patterns over time.

For mild eczema, over-the-counter hydrocortisone cream addresses occasional flares, and consistent moisturizing keeps symptoms manageable. When that stops working, it’s time to see a dermatologist.

Prescription Topical Treatments

Prescription topicals form the backbone of treatment for moderate eczema and give dermatologists a significantly more powerful toolkit than anything available over the counter.

Topical corticosteroids remain the most commonly prescribed option for active flares. They reduce inflammation quickly and come in a range of strengths calibrated to the severity of symptoms and the sensitivity of the affected area. 

When used appropriately, these are safe treatments for even the youngest patients. Long-term or unsupervised use carries risks, so a dermatologist guides appropriate application.

For patients who need longer-term management without the side effects associated with steroids, non-steroidal options offer an important alternative. 

Topical calcineurin inhibitors like tacrolimus and pimecrolimus calm the immune response in the skin without thinning it, making them well-suited for sensitive areas like the face and eyelids. Newer non-steroidal options, including ruxolitinib, roflumilast, and tapinarof, expand what’s possible for patients who haven’t responded well to older topicals.

Oral and Injectable Treatments for Moderate to Severe Eczema

When topical treatments don’t provide adequate control, systemic treatments step in. This tier of care has expanded dramatically in recent years, giving dermatologists tools that simply didn’t exist a decade ago.

Oral corticosteroids can interrupt a severe flare quickly but work best as a short-term bridge rather than a long-term solution. Traditional immunosuppressants like cyclosporine and methotrexate have a longer track record for more persistent moderate-to-severe cases.

Biologics represent the most significant advance in eczema treatment in a generation. Dupixent (dupilumab), the most widely prescribed biologic for atopic dermatitis, targets the specific immune pathways that drive eczema inflammation rather than broadly suppressing the immune system. It is safe and approved for patients as young as 6 months old, often with dramatic and reportedly “life-changing” results.

Many patients experience dramatic, sustained improvement. Newer biologics, including tralokinumab and lebrikizumab, offer additional options for patients who need an alternative.

JAK inhibitors, both oral and topical, represent another newer class of treatment that works through a different mechanism and has shown strong results in clinical trials and clinical practice. Oral options like upadacitinib and abrocitinib give dermatologists additional flexibility for patients with moderate to severe concerns.

What to Expect from Treatment at Krauss Dermatology

Eczema management rarely follows a single straight path. The right combination of treatments depends on how severe your symptoms are, which areas of your body are affected, how you’ve responded to previous treatments, and what fits your lifestyle.

The team at Krauss Dermatology takes a thorough, individualized approach, identifying your triggers, assessing your current skin barrier health, and building a plan that addresses both active flares and long-term prevention. 

For patients with moderate to severe eczema, access to the newest biologics and JAK inhibitors means more options than ever before.

Schedule a consultation at our Wellesley Hills office and take the first step toward skin that stays calm.

Take the Next Step

If you have further questions about treating eczema, we encourage you to schedule a consultation at Krauss Dermatology. Call us at (781) 247-5593 or fill out our online contact form. We look forward to taking care of you.