How Do You Treat Severe Eczema?

Severe eczema can affect sleep, work, school, relationships and mental health. The good news is that there are more effective treatments available today than ever before. The right choice depends on how much skin is affected, where, your age and what has already been tried.

Step 1: Get the basics right

Every treatment plan for severe eczema starts with the foundations:

• generous daily moisturisers, applied several times a day
• a soap substitute for washing
• identifying and reducing triggers
• topical anti-inflammatory treatment at the right strength, in the right amount, for long enough

When these basics are done properly, many people who believe they have "treatment-resistant" eczema improve considerably.

Step 2: Treat inflammation and bacteria together

Severe eczema is very often heavily colonised by Staphylococcus aureus. Combined topical treatment that targets inflammation, bacteria and the skin barrier at the same time – such as the Aron regimen – can be effective for many patients. Where infection is widespread, a short course of oral antibiotics may also be needed.

Step 3: Specialist treatments

When topical treatment is not enough, dermatologists may consider:

• Phototherapy – controlled ultraviolet light treatment, usually two to three times a week for several weeks
• Oral immunosuppressants – such as ciclosporin, methotrexate or azathioprine, which need blood test monitoring
• Biologic injections – such as dupilumab, which target specific parts of the immune response
• JAK inhibitor tablets – newer oral treatments for moderate to severe eczema

These treatments can be very effective but carry their own side effects and monitoring requirements, and access varies by country and health system.

When severe eczema needs urgent attention

Seek urgent medical help if eczema suddenly becomes painful with clusters of small blisters or punched-out sores (which can indicate eczema herpeticum), if you feel feverish or unwell, or if the skin is spreading red, hot and swollen.

How eczema-doc can help

Many patients with severe eczema come to eczema-doc after trying multiple creams without lasting results. We offer a detailed review and an individualised topical treatment plan, with follow-up at two and four weeks. If your eczema needs treatment beyond what we provide, we will tell you and advise on next steps.

Learn more about our treatment for severe eczema.

Book a video consultation to discuss your severe eczema.

This article is for general information and does not replace individual medical advice.

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