Eczema Knowledge Hub

Living with eczema can feel overwhelming at times, but the good news is that it can usually be managed with the right care. Treatment depends on whether eczema is mild, moderate, or severe, and it works best when taken step by step.^[1,2]

Step 1: Daily skincare — the foundation

The first and most important step is to repair and protect the skin barrier. Moisturisers are the cornerstone of eczema management, recommended for every person with eczema regardless of disease severity. This means:

• Applying fragrance-free moisturisers liberally at least twice a day, and always after bathing — including on days when the skin looks clear.
• Matching the moisturiser to the situation: lighter creams during the day, thicker creams or ointments at night or in colder, drier environments.
• Applying moisturiser within minutes of a lukewarm shower, while the skin is still slightly damp, to lock in hydration.
• Using gentle, soap-free cleansers that don't strip the skin barrier.

✨ Parent tip: If you're looking for a child-friendly option, you can explore our Calm & Hydrate Face Cream, developed specifically for sensitive young skin.

Step 2: Treating flare-ups — topical anti-inflammatory therapy

When the skin turns red, itchy, and inflamed, topical anti-inflammatory creams are needed alongside continuing moisturiser use. There is a clear order of preference:

First-line: Topical corticosteroids (TCS). Topical steroid creams remain the first-line treatment for eczema flares, with a strong and well-established evidence base. The right strength depends on the area being treated and severity — milder steroids for sensitive areas such as the face and skin folds, and stronger strengths for thicker-skin areas such as the body. When used correctly under medical guidance, topical steroids are safe and effective.

Second-line: Topical calcineurin inhibitors (TCIs). If a non-steroid option is preferred or required, topical calcineurin inhibitors — such as pimecrolimus cream or tacrolimus ointment — are the next choice. These are particularly well suited to sensitive areas like the face and eyelids, and are available from as young as 3 months (pimecrolimus) or 2 years (tacrolimus 0.03%).

Third-line: Topical phosphodiesterase-4 inhibitors (topical PDE4i). Newer non-steroid options, such as crisaborole ointment, may be considered when topical steroids and TCIs are not suitable or not tolerated.

Adjunctive: Oral antihistamines. The itch of eczema is driven mainly by immune and nerve pathways, not by histamine, so antihistamines have limited effectiveness for the itch itself. However, first-generation (sedating) antihistamines may help when itch is severely disrupting sleep, and antihistamines may be useful when eczema is accompanied by urticaria (hives) or hay fever. These are adjuncts to — not replacements for — proper topical treatment.

Step 3: Wet wrap therapy for difficult-to-control eczema

Wet wrap therapy may be considered when eczema is not responding adequately to standard treatment. It involves applying moisturiser and a topical corticosteroid to the skin, then wrapping it in a damp layer of bandages or clothing with a dry layer on top. This locks in moisture, improves absorption, and soothes itch — with duration typically ranging from one hour to overnight.

Important: only moisturisers or topical corticosteroids should be used with wet wraps. Using topical calcineurin inhibitors or PDE4 inhibitors under occlusion requires specialist dermatological advice, as safety data for these treatments under occlusion remains limited.^[1,3]

Wet wrap therapy is not suitable if the skin is very weepy or shows signs of infection. It should only be started once any active infection has been treated and is under control. It is also not suitable for lesions in sensitive areas or in areas that are difficult to wrap.

When eczema skin is prone to recurrent bacterial flares, some clinicians recommend dilute bleach baths — a very small amount of household bleach added to a full bath of water — to reduce bacterial load on the skin (particularly Staphylococcus aureus) and lower infection risk.^[2] This is an adjunctive measure most relevant when secondary infection is a recurrent concern, and should be discussed with your doctor.

Step 4: Specialist treatments for severe eczema

For people whose eczema stays severe despite these steps, referral to a specialist — such as a dermatologist — is the right next move. Options including light therapy (phototherapy) and medicines that work on the immune system are effective for severe eczema but are managed in specialist settings.

Eczema doesn't have a quick fix, but it can be managed. For most people, consistent moisturising and treating flares early with the right treatment make the biggest difference.