5 Alternatives to Steroids for Eczema

Learn about alternatives to steroids for atopic dermatitis

Asian girl wearing green jacket playing with bubbles in a park
Credits: "Leo Rivas Micoud at Unsplash.com"

Steroids work well to treat eczema, but there are many side effects that can be concerning. Generally, steroids are safe to use but overuse can lead to side effects such as skin thinning.[1] Several studies show that many people are concerned about using topical steroids with estimates of “steroid worry” ranging from 38% to 81% of people.[2-4] When used appropriately, steroids are both safe and effective, but a growing number of people are seeking alternatives to steroids.

Here are five non-steroidal treatments for eczema to consider:

Alternative #1: Slightly Damp Clothes and Emollients

child with eczema wrapped in bathtub with towels
Credit: Daniel Mietchen at Wikimedia Common


Dry, itchy skin is a key characteristic of eczema. Emollients, commonly called moisturizers, are fatty or oily creams and ointments that help to retain moisture in the skin and reduce the amount of water loss. Wet wrapping is a type of hydrotherapy that has been used to treat dry skin for generations. After bathing, an emollient is applied over the wet skin and then wrapped in wet towels. Wet wrapping with emollients itself can reduce dry skin in eczema.[5]

In some cases, wet wrapping can be used with steroids to make it more effective when the eczema is flared. Wet wrapping allows for weaker steroids to be used because the wet wrapping can make the steroid work more effectively. Many physicians have used this method with topical steroids to reduce flares.[6] Chinese medical practitioners and naturopaths will also use this method in combination with herbal creams. 

It is important to have the guidance of a qualified health provider when applying, as to avoid side effects of treatment.  

Alternative #2: Use of Natural Oils for Eczema

 

* This Website is for general skin beauty, wellness, and health information only. This Website is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. The information provided on this Website should never be used to disregard, delay, or refuse treatment or advice from a physician or a qualified health provider.

References

  1. Bower AJ, Arp Z, Zhao Y, et al. Longitudinal in vivo tracking of adverse effects following topical steroid treatment. Exp Dermatol.2016;25(5):362-367; PMID: 26739196.
  2. Lee JY, Her Y, Kim CW, et al. Topical Corticosteroid Phobia among Parents of Children with Atopic Eczema in Korea. Ann Dermatol.2015;27(5):499-506; PMID: 26512163.
  3. Kojima R, Fujiwara T, Matsuda A, et al. Factors associated with steroid phobia in caregivers of children with atopic dermatitis. Pediatr Dermatol.2013;30(1):29-35; PMID: 22747965.
  4. Aubert-Wastiaux H, Moret L, Le Rhun A, et al. Topical corticosteroid phobia in atopic dermatitis: a study of its nature, origins and frequency. Br J Dermatol.2011;165(4):808-814; PMID: 21671892.
  5. Lodén M, Maibach HI. Treatment of dry skin syndrome : the art and science of moisturizers. Heidelberg: Springer; 2012.
  6. Nicol NH, Boguniewicz M. Successful strategies in atopic dermatitis management. Dermatol Nurs.2008;Suppl:3-18; quiz 19; PMID: 19102292.
  7. Evangelista MT, Abad-Casintahan F, Lopez-Villafuerte L. The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial. Int J Dermatol.2014;53(1):100-108; PMID: 24320105.
  8. Verallo-Rowell VM, Dillague KM, Syah-Tjundawan BS. Novel antibacterial and emollient effects of coconut and virgin olive oils in adult atopic dermatitis. Dermatitis.2008;19(6):308-315; PMID: 19134433.
  9. Danby SG, AlEnezi T, Sultan A, et al. Effect of olive and sunflower seed oil on the adult skin barrier: implications for neonatal skin care. Pediatr Dermatol.2013;30(1):42-50; PMID: 22995032.
  10. Ziboh VA, Miller CC, Cho Y. Metabolism of polyunsaturated fatty acids by skin epidermal enzymes: generation of antiinflammatory and antiproliferative metabolites. Am J Clin Nutr.2000;71(1 Suppl):361S-366S; PMID: 10617998.
  11. Kanehara S, Ohtani T, Uede K, et al. Clinical effects of undershirts coated with borage oil on children with atopic dermatitis: a double-blind, placebo-controlled clinical trial. J Dermatol.2007;34(12):811-815; PMID: 18078406.
  12. Bamford JT, Ray S, Musekiwa A, et al. Oral evening primrose oil and borage oil for eczema. Cochrane Database Syst Rev.2013;10.1002/14651858.CD004416.pub2(4):CD004416; PMID: 23633319.
  13. Takwale A, Tan E, Agarwal S, et al. Efficacy and tolerability of borage oil in adults and children with atopic eczema: randomised, double blind, placebo controlled, parallel group trial. BMJ.2003;327(7428):1385; PMID: 14670885.
  14. Henz BM, Jablonska S, van de Kerkhof PC, et al. Double-blind, multicentre analysis of the efficacy of borage oil in patients with atopic eczema. Br J Dermatol.1999;140(4):685-688; PMID: 10233322.
  15. Lakshmi C. Allergic Contact Dermatitis (Type IV Hypersensitivity) and Type I Hypersensitivity Following Aromatherapy with Ayurvedic Oils (Dhanwantharam Thailam, Eladi Coconut Oil) Presenting as Generalized Erythema and Pruritus with Flexural Eczema. Indian J Dermatol.2014;59(3):283-286; PMID: 24891661.
  16. Akihisa T, Kojima N, Kikuchi T, et al. Anti-inflammatory and chemopreventive effects of triterpene cinnamates and acetates from shea fat. J Oleo Sci.2010;59(6):273-280; PMID: 20484832.
  17. Draelos ZD. A pilot study investigating the efficacy of botanical anti-inflammatory agents in an OTC eczema therapy. J Cosmet Dermatol.2016;15(2):117-119; PMID: 26596512.
  18. Hon KL, Tsang YC, Pong NH, et al. Patient acceptability, efficacy, and skin biophysiology of a cream and cleanser containing lipid complex with shea butter extract versus a ceramide product for eczema. Hong Kong Med J.2015;21(5):417-425; PMID: 26314567.
  19. Seite S, Flores GE, Henley JB, et al. Microbiome of affected and unaffected skin of patients with atopic dermatitis before and after emollient treatment. J Drugs Dermatol.2014;13(11):1365-1372; PMID: 25607704.
  20. Essengue Belibi SS, D; Olson, N. J. The Use of Shea Butter as an Emollient for Eczema. ournal of Allergy and Clinical Immunology, suppl. Supplement.123(2):S41; PMID.
  21. Cury Martins J, Martins C, Aoki V, et al. Topical tacrolimus for atopic dermatitis. Cochrane Database Syst Rev.2015;10.1002/14651858.CD009864.pub2(7):CD009864; PMID: 26132597.
  22. Ashcroft DM, Chen LC, Garside R, et al. Topical pimecrolimus for eczema. Cochrane Database Syst Rev.2007;10.1002/14651858.CD005500.pub2(4):CD005500; PMID: 17943859.
  23. Nankervis H, Thomas KS, Delamere FM, et al. What is the evidence-base for atopic eczema treatments? A summary of published randomised controlled trials. Br J Dermatol.2016;10.1111/bjd.14999PMID: 27547965.
  24. Cai SC, Li W, Tian EA, et al. Topical calcineurin inhibitors in eczema and cancer association: A cohort study. J Dermatolog Treat.2016;27(6):531-537; PMID: 27049893.
  25. Hui RL, Lide W, Chan J, et al. Association between exposure to topical tacrolimus or pimecrolimus and cancers. Ann Pharmacother.2009;43(12):1956-1963; PMID: 19903860.
  26. Dybboe R, Bandier J, Skov L, et al. The Role of the Skin Microbiome in Atopic Dermatitis: A Systematic Review. Br J Dermatol.2017;10.1111/bjd.15390PMID: 28207943.
  27. Salava A, Lauerma A. Role of the skin microbiome in atopic dermatitis. Clin Transl Allergy.2014;4:33; PMID: 25905004.
  28. Kong HH, Oh J, Deming C, et al. Temporal shifts in the skin microbiome associated with disease flares and treatment in children with atopic dermatitis. Genome Res.2012;22(5):850-859; PMID: 22310478.
  29. Marrs T, Flohr C. The role of skin and gut microbiota in the development of atopic eczema. Br J Dermatol.2016;175 Suppl 2:13-18; PMID: 27667310.