This page lists most of the available therapies for atopic dermatitis and a brief review of my experience with each. Treatment effectiveness tends to vary from patient-to-patient, so your response to these therapies may well differ from mine.

Generic Lotions

Over-the-counter creams and lotions are minimally effective at controlling my eczema. Example brands include Curel, Jergens, and Gold Bond that list glycerin, mineral oil, or dimethicone as their active ingredient. They might be helpful if I used them frequently (more than twice a day) over my entire body to raise the overall moisture level in my skin to prevent flare ups, but even then I have not noticed dramatic improvement. These type of creams are useless at soothing a rash that is already active. That is, a generic lotion does nothing to minimize or reduce an inflammatory response that has already begun. However, creams are good for moisturizing dry patches of my skin that are not caused by an eczema rash. My elbows and shins are often dry and flaky but not rashy. I use these lotions to moisturize after taking a shower to manage "ordinary" dryness.

Specialty Creams

These types of creams are typically marketed towards eczema sufferers and offer, as a step up from generic lotions, either higher purity (such as Eucerin) or including an extra ingredient (such as Aveeno or Cerave). Perhaps these higher-end products are better at soothing "ordinary" dryness but I have not found them to be any more effective for eczema compared to the generic lotions. I do not use these.

Ointments

Ointments typically contain petrolatum as their main ingredient. Vaseline is the branded name for petrolatum the way that Kleenex means tissues and Xerox means copies. Higher end ointments are offered by the specialty cream manufacturers. CereVe offers an ointment forumulation and Aquaphor is distributed by the same folks who make Eucerin. Ointments are much better at sealing in moisture than creams but are thick and uncomfortable to "wear" on the skin. Ointments are best used after a bath or shower to lock-in moisture but do *not* help to soothe the itch of an active rash. They are better than creams to help heal a patch of skin that was previously rashy; not inflamed now but perhaps broken and extra-dry. I have not found expensive ointments to be any better than cheaper, so I just use Vaseline.

Humectant Lotions

Most over-the-counter creams and lotions prevent moisture loss from the skin through the use of occlusives, which are comprised of hydrophobic (water repelling) substances such as petrolatum that act to "seal-in" moisture. Humectant creams, on the other hand, are made from hygroscopic (water loving) materials. These type of creams are absorbed into the upper layers of skin and draw moisture into that layer. Since the moisture is typically drawn from deeper tissue, there is the implication that overuse, or use when the body is dehydrated, may be bad for overall health. With this caveat, I have found that one type of humectant, ammonium hydroxide, is very effective in keeping my skin moist. The brand I use regularly is Am Lactin and occasionally the pharmacy generic knock-off. Am Lactin is almost magical in its ability to soften dry and scaly skin. Much more effective than occlusive tyCpe creams. A downside of Am Lactin is that since the active ingredient is an acid, it stings upon application to the skin, especially on broken or rashy skin. There is a silver lining to that in that the pain can distract from the itchiness of a flare-up.

Topical Cortisone / Hydrocortisone: Prescription and OTC

Cortisone creams and ointments have been very effective at quieting my eczema rashes, at least upon initial use. Cortisone acts to suppress the skin's inflammatory response, rather than the moisture related "barrier" properties of the skin. There are many grades of topical cortisone from the most potent that are never supposed to be applied to sensitive areas like the groin and eyelids, to the mildest over-the-counter varieties such as Cortaid. Unfortunately continuous use of cortisone decreases its effectiveness and long-term use can lead to fairly significant side effects. In fact I no longer use prescription strength cortisone because I've developed a sort-of "dependency" phobia as if it were an addictive drug. I still use OTC hydrocortisone (typically 1%) but I use it sparingly.

Oral Cortico-steroids

Cortisone is a type of cortico-steroid. These drugs are also formulated as pills and can be taken by mouth to suppress inflammation over the entire body. I have taken a course of prednisone once in my teen years after a particularly flare-up over much of my skin. It suppressed the rash very effectively. I have never taken prednisone again. The side effects of oral cortico-steroids are similar as to topical cortisone, but probably more severe.

Bleach Baths

Research has shown that folks who suffer from atopic dermatitis tend to have skin colonized with a strain of streptococcus bacterial, more so than the average person. This type of bacteria is found on normal skin, but eczema sufferers, this strain often dominates over other bacterial species. Some have speculated that the bacterial load on the skin aggravates eczema and have recommended bleach baths to help the condition. A bleach bath involves taking a ten minute bath in water with added bleach. The bleach is ordinary stuff like liquid Clorox. A full bathtub (30 - 40 gallons) you can add about 1/2 cup of bleach. The concentration of bleach feels/smells similar to water in a swimming pool. Do not add too much bleach or use too little water, or your skin can get burned. Talk to your dermatologist first to make sure you don't have any special sensitivities to bleach. Or don't bother trying this technique. While there seems to be some clinical evidence for its effectiveness in children, I tried it for about a month, taking 2 - 3 beach baths per week, and I did not see a noticeable improvement.

Immunosuppressants: Protopic

Protopic typically comes in an ointment formulation and is a skin treatment based on the immunosuppressant tacrolimus. Immunosuppressants inhibigs some aspect of the immune system. Since immune reactions tend to be a complicated system of complex chemical reactions, there are a variety of immunosuppressants each targeting a different mechanism. Tacrolimus was first used to prevent rejection in liver transplants, and about a decade later approved for atopic dermatitis. Protopic has milder health effects than corticosteroids and can be used over long periods on sensitive areas like the groin and eyelids without fear of harming the skin. Research has indicated that protopics is as effective as corticosteroids, however in my own use I've found that protopic is not as fast at calming rashes nor does it quiet them as well as, say hydrocortisone. Also, paradoxically, applying protopic to an active rash actually increases its itchiness for me. For this reason I do not use it extensively. Once the rash has subsided, then continued application does not itch. This "protopic" itch is of a slightly different character than my normal eczema itch. Importantly, applying protopic to the rash makes it less weepy, even as the itchiness is more severe. This means that the rash is safer to scratch as the patch is smoother and more resistant to damage than my "normal" rashy skin.

Phototherapy

In 2016 I tried a course of phototherapy. This involved going to the dermatology office two-three times per week for short (less than 15 min) treatments over several months. Fortunately there is a phototherapy clinic close to my workplace so I went during my lunch time. The actual treatment consists of standing in a sort-of upright tanning booth and being exposed with "narrow-band" ultraviolet radiation for 2 - 5 minutes each session. A visit usually took between 10 - 15 minutes due to time for undressing / dressing and applying moisturizer. The "narrow-band" UV is generated by special fluorescent lamps that emit light in a small portion of the UV spectrum, at a wavelength of 311 nanometers. Other varieties of these types of lamps are designed to emit at other wavelengths, however 311 nanometers has been studied relative to skin cancer. The reports that I was able to find online showed no significant increase in skin cancer at the doses typical for treatment of skin diseases. I found phototherapy to be quite helpful in managing my eczema. The benefit was partial; I did not experience a full suppression of rashes. For me, the treatment was very effective in those areas of my skin where rashes were milder and more diffuse (on my torso, lower extremities, and back). In these areas my skin cleared up to the point of being "normal" skin. But in my problem areas (eyelids, inside elbow flexure, neck and shoulders) the eczema did not clear, although it did become easier to control with OTC cortisone in those problem areas. I experienced mild side-effects: sometimes after a treatment small patches of skin would temporarily flare up for a few hours and then subside. Also I got a fairly deep tan. It is possible to get sun-burnt using phototherapy, but if you diligently follow the caregiver's instructions this shouldn't happen.

Ambien

Ambien is not approved for use against eczema, as far as I know. And I do not recommend using Ambien as, for me, it led to some disturbing side effects including a loss of "muscle memory". Things I usually did automatically, I had to think about deliberately, such as which way to turn the key in my front door, the shifting pattern in my car's stick shift, or the ritual of lather, shampoo, conditioner, rinse in my showering routine (really!). So I don't use Ambien anymore, but it did do something for me unexpected and quite remarkable. I have trouble falling asleep due to bedtime itchiness, as do many atopic dermatitis sufferers. I was prescribed Ambien and skeptical that it would work, as my problem was not lack of sleepiness per se, but too much itchiness while trying to fall asleep. Well it did help me deal with the itchiness! But in a peculiar way. After taking Ambien, laying in bed, I would still feel the typical bothersome itchiness, but the urge to scratch the itch was greatly diminished. It is an interesting feeling, and not altogether unpleasant, having an itch but not needing to scratch it. It turns out that it's the scratching that was keeping me awake. If anyone in the pharmacological industry is reading this, I think this phenomenon is worth researching!

New Drugs

Two new drugs are in the pipeline as of the start of 2017. Eucrisa, which was FDA approved a few months ago, and Dupixent, which looks like it will receive final approval in 2017.