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. 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
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.
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. 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
The use of natural oils on the skin is becoming increasingly popular as a simple alternative to steroid cream to moisturize the skin. The good news is that several studies have been performed to look at how well natural oils work on those with eczema:
Seem to be helpful
- Topical Coconut Oil has been shown to improve eczema (superior to olive oil)[7,8] and have antibacterial effects.
- Topical Sunflower Seed Oil was shown to be helpful when used in those with eczema. This study compared it to olive oil and showed that sunflower seed oil was superior to olive oil. Sunflower seed oil is rich in linoleic acid, which has anti-inflammatory properties and helps maintain the skin’s normal barrier function.
- Topical Borage Seed Oil has been shown to be beneficial when used with a coated undershirt. Those who wore a coated undershirt experienced reduced itching and redness of the skin. Borage oil contains Gamma Linoleic Acid, a fatty acid in the skin that is deficient in those with eczema.
Do not seem to be helpful
- Oral Borage Oil does not seem to improve eczema.[12-14]
- Topical Olive Oil was not helpful when used on the skin and actually led the skin to worsen. In head-to-head studies, it has been shown to be worse than either sunflower seed oil or coconut oil.[7,8]
While natural oils are gaining popularity, they can still have side effects. It is important to use cold-pressed and organic oils, as the refined oils may have more chemicals in them. In some people, natural oils can lead to an allergic form of eczema known as contact dermatitis that can actually worsen eczema. Oils should be tested on a small area of the body and discussed with a health provider before they are used over the entire body.
Alternative #3: Use of Shea Butter for Eczema
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Shea butter comes from the nut of the African Karite tree. It has long been used as a traditional remedy for dry and itchy skin, skin toning, and anti-aging practices. Shea butter contains many fatty acids that help nourish dry skin, encourage skin repair, and has been shown to have anti-inflammatory and skin protective characteristics. Read more about the science of shea butter.
Shea butter containing creams have been shown to reduce eczema inflammation and irritation.[17-19] One small case report has shown that shea butter was better than petroleum jelly at reducing eczema and influencing skin smoothness.
Alternative #4: Use of Calcineurin Inhibitor Medications
Credit: Meiloorun at Wikimedia Commons
While steroids are the mainstay of anti-inflammatory therapy for the skin, the calcineurin inhibitor medications are an alternative anti-inflammatory that is also effective for treating eczema.[21-23] The two forms of topical calcineurin inhibitors are known as tacrolimus (brand name Protopic®) and pimecrolimus (brand name Elidel®). The calcineurin inhibitors are more potent than mild topical steroids but less potent than strong topical steroids.[21,22] A large meta-analysis review (where the authors look at multiple studies to put together the evidence) showed that tacrolimus may be more potent than pimecrolimus when used for eczema.
Calcineurin inhibitor medications require a prescription and should be discussed with a physician. Dermatologists will use calcineurin inhibitors as an alternative to topical steroids so that steroid use can be reduced. One of the drawbacks with topical calcineurin inhibitors is that they tend to be more expensive than steroids based on each patient’s insurance plan.
One of the controversial concerns with topical calcineurin inhibitors is that they may be associated with a higher risk of developing cancers. However, studies have shown that there is no overall increase in the development of cancers with the use of topical calcineurin inhibitors.[24,25]
Alternative #5: Regular Use of Dilute Bleach Baths
The skin has a natural community of bacteria on the skin known as the microbiome. People with healthy skin tend to have a diverse microbiome, meaning that they have many different bacteria that are present in a balanced way. However, the community of bacteria on the skin is constantly shifting in those with eczema. During eczema flares, the skin’s bacterial community becomes dominant in Staphylococcus aureus,[27,28] although it is not clear if S. aureus is a direct cause for eczema to worsen. Nevertheless, bleach baths are touted as an effective way of keeping the skin’s bacteria in check to prevent any one bacteria from growing out of control.
Dilute bleach baths are similar to a swimming pool. To make a dilute bleach bath:
Mix ¼ cup of household bleach (typically contains 3-6% chlorine at the time of manufacture) into a full adult bathtub of water (40 gallons). Bleach baths should last approximately 10 minutes and should be done two to three times weekly. The skin should be thoroughly rinsed with plain water at the end of the soak. After gently patting the skin dry, apply a moisturizer within 2-3 minutes to retain moisture in the skin.
Learn more about the science of bleach baths for eczema.
Are Steroids Bad for the Skin?
It depends. If steroids are overused, they can cause side effects. However, they are also effective at controlling eczema. Steroids should never be used as the only approach to treat eczema. They should be used along with other approaches, such as those described above. The approaches described here can be used as a way to reduce steroid usage. When an outbreak of eczema is bad, it is important to discuss steroids as an effective option in the treatment plan when seeing a healthcare professional.
Learn more about eczema in children from eczema expert and board-certified dermatologist, Dr. Vivian Shi or by downloading our Guide to Managing Eczema in Children eBook.