Eczema in adults: a calm, step-by-step treatment plan

Atopic dermatitis in adults: daily skin care, the creams AAD guidelines recommend, and the biologic and JAK-inhibitor options for moderate to severe eczema.

Written by Dr. Neera Nathan, MD, MSHS, board-certified dermatologist Last updated Sources cited Editorial policy

Medical dermatology 8 min readPublished Reviewed

Key takeaways

  • Daily moisturizer is a strongly recommended treatment, not an optional extra.
  • Steroid, calcineurin-inhibitor, PDE-4 and JAK-inhibitor creams all have strong recommendations for adults.
  • For eczema that creams don't control, biologic injections and JAK-inhibitor pills are strongly recommended options.
  • Itch that keeps you awake is a good reason to step treatment up.

What eczema is

Atopic dermatitis, the most common type of eczema, is a long-term inflammatory skin condition. The skin barrier is weaker than usual, so moisture escapes and irritants get in more easily. The result is dry, intensely itchy skin that flares and settles over time.1

On lighter skin, flares usually look red. On brown and Black skin, they may look darker brown, purple or gray, and can leave lighter or darker patches after they heal. Itch, often worse at night, is the common thread.

Step 1: daily skin care

The 2023 AAD guideline gives moisturizers a strong recommendation for adults with eczema.2 In practice:

  • Use a fragrance-free cream or ointment at least once a day, and after bathing.
  • Take short, lukewarm showers or baths with a gentle cleanser. Bathing has a conditional recommendation.2
  • Pat skin dry and moisturize within a few minutes.
  • Notice your triggers, such as harsh soaps, wool, sweat, stress or dry winter air.

Step 2: prescription creams

For flares and for long-term control, the AAD strongly recommends these topical treatments in adults:2

  • Topical corticosteroids. The strength is matched to the body area. Milder ones go on the face and skin folds.
  • Topical calcineurin inhibitors (tacrolimus, pimecrolimus). These are steroid-free and useful on the face and eyelids.
  • Topical PDE-4 inhibitors (crisaborole) and the topical JAK inhibitor ruxolitinib.

A 2025 focused update added strong recommendations for two newer creams, tapinarof and roflumilast.3 The same review recommended against routine use of topical antimicrobials, antiseptics and antihistamines for eczema.2

Many people do well with "proactive" treatment: using a prescription cream twice a week on usual trouble spots, even when the skin looks clear, to prevent the next flare.

Step 3: when creams aren't enough

For moderate to severe eczema that creams don't control, the 2024 AAD guideline strongly recommends biologic injections (dupilumab, tralokinumab) and oral JAK inhibitors (abrocitinib and upadacitinib; the guideline also covers baricitinib, which is not FDA-approved for eczema in the U.S.).4 The 2025 update added strong recommendations for two more biologics, lebrikizumab and nemolizumab, used alongside topical therapy.3

Phototherapy and older immune-suppressing pills (azathioprine, cyclosporine, methotrexate, mycophenolate) have conditional recommendations. The guideline recommends against oral steroids for eczema because flares often rebound when they stop.4

Oral JAK inhibitors carry FDA boxed warnings, so choosing one involves a careful talk about your health history, lab monitoring and risks.

Living with it

  • Keep nails short, and try cool compresses when itch peaks.
  • Treat sleep loss as a real symptom. It's a reason to step treatment up.
  • Ask about patch testing if a rash keeps appearing where products touch your skin.

When to see a doctor

See a doctor promptly if eczema becomes painful, weepy or crusted, or develops clusters of punched-out sores or blisters, which can mean infection. Also book a visit if itch keeps you awake or over-the-counter care hasn't helped within a few weeks.

Sources

  1. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Atopic Dermatitis. View source
  2. Sidbury R, Alikhan A, Bercovitch L, et al. Guidelines of care for the management of atopic dermatitis in adults with topical therapies. J Am Acad Dermatol. 2023;89(1):e1-e20. doi:10.1016/j.jaad.2022.12.029 View source
  3. Davis DMR, Frazer-Green L, Alikhan A, et al. Focused update: Guidelines of care for the management of atopic dermatitis in adults. J Am Acad Dermatol. 2025. doi:10.1016/j.jaad.2025.05.1386 View source
  4. Davis DMR, Drucker AM, Alikhan A, et al. Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies. J Am Acad Dermatol. 2024;90(2):e43-e56. doi:10.1016/j.jaad.2023.08.102 View source

About the author

Dr. Neera Nathan, MD, MSHS

Harvard-trained, board-certified dermatologist and fellowship-trained Mohs surgeon with Dermatology & Skin Health.

Full profile Editorial policy

This article is general education for adults and isn't a substitute for personal medical advice. In an emergency, call 911.

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