The Complete Guide to Eczema Treatments: Creams, Pills, and Injections

If you or your child lives with eczema, you know just how much it can affect daily life. The relentless itching, red or inflamed skin, sleep disruption, and self-consciousness can feel overwhelming. Eczema, also known as atopic dermatitis, is more than just a skin condition—it’s a complex immune issue that affects the whole body.

Thankfully, there are now more treatment options than ever before. From creams and ointments to tablets and even injectable medications, the goal of all eczema treatments is to reduce inflammation, calm the immune system, and restore the skin barrier. Whilst medications can be incredibly effective, they aren’t designed for long-term use and users need to focus on the origins of the inflammation so that they are ready and able to transition from the medication when their medical practitioner advises them to. 

Having a knowledge of all the different treatments currently on offer, can be helpful, so in this article, I’ll cover the main types of eczema treatments, how they work, and what to be aware of, especially when it comes to nutrient needs. I’ll also share what you can do nutritionally to support your skin from the inside out.

Topical Eczema Treatments: The First Line of Defence

Most eczema treatment starts with something topical, something applied directly to the skin.

Moisturisers (Emollients)

These are essential. Moisturisers help trap moisture, soothe itching, and protect the skin barrier. Used consistently, they can reduce the frequency and severity of flares. While they don’t treat the underlying causes of eczema, they are a critical daily habit that should never be underestimated.

Steroid Creams (Topical Corticosteroids)

These are often prescribed to bring quick relief during flares. Steroid creams reduce inflammation in the skin and are available in different strengths. They’re useful, but not meant for long-term, everyday use. Over time, they can thin the skin or cause it to become dependent on them, leading to something known as topical steroid withdrawal (TSW). You can read more about TSW in my previous article.

Steroids can also subtly affect the body’s nutrient levels, especially vitamin D and calcium, particularly if used over large areas or under dressings.

Non-Steroid Prescription Creams

For those who need an alternative to steroids, there are now some good options. These include creams like tacrolimus or pimecrolimus (known as calcineurin inhibitors), which reduce immune activity in the skin. Others, like crisaborole or ruxolitinib, work on different inflammation pathways but aim for a similar result, less redness, less itching, and stronger skin.

Some of these newer creams, such as tapinarof (sold as Vtama), also work by improving how the skin handles oxidative stress, something that plays a big role in eczema.

Systemic Eczema Treatments: Tablets for Moderate to Severe Eczema

When eczema becomes widespread, severe, or unresponsive to creams, doctors may prescribe oral medications. These affect the immune system more broadly.

JAK Inhibitors

These are newer tablets that help block overactive immune signals involved in eczema. Medications like upadacitinib (Rinvoq) or abrocitinib (Cibinqo) have shown impressive results in many people. However, because they affect the immune system, they can slightly increase the risk of infections. They may also affect iron, folate, and B vitamin levels over time, so it’s worth being mindful of your nutrient intake if you’re taking these drugs.

Older Immunosuppressants

Drugs like methotrexate, azathioprine, or cyclosporine have been used for many years to calm eczema by suppressing the immune system. They’re generally reserved for severe cases because they can have significant side effects. For example, methotrexate can interfere with folate, a key B vitamin, while cyclosporine can deplete magnesium and affect kidney health.

These medications require regular monitoring, and ideally, some nutritional support to counteract their impact.

Injectable Biologics: Targeted and Tailored

Biologics are a newer type of treatment and are changing the landscape for people with moderate to severe eczema.

Dupilumab (Dupixent)

This was the first biologic approved for eczema and is still one of the most used. It targets two specific immune messengers—IL-4 and IL-13—which are heavily involved in eczema inflammation. For many people, this injection (usually given every two weeks) has made a huge difference to their skin and quality of life.

Other New Biologics

Other newer injectable options include tralokinumab, lebrikizumab, and nemolizumab. These all work in slightly different ways but aim to reduce inflammation and itching by targeting specific parts of the immune system.

Although biologics are usually well-tolerated, they can cause side effects like conjunctivitis or injection site irritation. Supporting the skin barrier and immune system through food can be helpful alongside these treatments.

Emerging Therapies: The Microbiome Connection

Research is now looking beyond inflammation alone and asking, what else is going on in eczema?  One answer is the skin microbiome, the delicate ecosystem of bacteria that live on the skin.

In people with eczema, the microbiome is often imbalanced. Good bacteria are reduced, while unhelpful strains like Staphylococcus aureus can thrive. New therapies aim to restore this balance using live bacteria applied to the skin, though these are still largely in the research stage.

Other treatments, like AhR-agonists (such as tapinarof), aim to reduce oxidative stress and improve skin barrier function in ways that go beyond inflammation alone.

Combination Approaches Are Common

In practice, most people use a combination of treatments, such as a moisturiser alongside a steroid cream during a flare, or an injection combined with a non-steroidal cream and a daily emollient. These combinations can be highly effective, but they still don’t address the deeper question: why is the skin so inflamed in the first place?

Medications Are Powerful—but What Happens When They Stop?

I see many people who’ve had great results with eczema medications, only to struggle when they try to come off them. Flares return, sometimes worse than before, and the cycle starts again.

This isn’t a failure of medication, it’s a sign that the body hasn’t yet rebuilt the systems that support healthy skin: immune regulation, gut integrity, stress resilience, and nutrient sufficiency. This is where nutrition and lifestyle support can play an essential role.

How to Support Your Skin from the Inside Out

You don’t have to change everything overnight—but knowing what to support is a powerful first step. Here are some key areas I work on with clients who want to build stronger, more resilient skin:

1. Skin Barrier Nutrients

Nutrients like omega-3 fats, zinc, and vitamin A help strengthen the skin and reduce dryness. These are often low in people with eczema or those who’ve been on long-term medication.

2. Anti-inflammatory Foods

A diet rich in colourful fruit, vegetables, herbs, and spices can help calm the inflammation driving eczema. Think berries, leafy greens, turmeric, and extra virgin olive oil.

3. Gut Health

Many people with eczema have underlying digestive imbalances. While this doesn’t mean you need to go on a restrictive diet, it does mean supporting gut integrity and microbial diversity is key.

4. Immune Resilience

Chronic stress, poor sleep, and blood sugar spikes can all increase inflammation. Small changes—like better sleep routines, gentle movement, and mindful eating—can help bring balance.

Final Thoughts

Medications have their place, and for many people, they can be life-changing, however, they work best when paired with long-term strategies that support the body’s own healing capacity.

Eczema isn’t just a skin issue; it’s a full-body condition with many layers, which from my clinical experience, responds best to a whole-body approach.

If you’re considering coming off medication or simply want to feel more confident in managing your skin, nutrition can be your greatest ally. I offer personalised, evidence-based support for people who are ready to break free from the Eczema Trap, whether that’s for yourself or your child.

You don’t have to do this alone.