Topical therapy is the foundation for most atopic dermatitis, especially when disease is mild-to-moderate or localized. Peak Skin Center commonly emphasizes barrier repair while using prescription topicals to calm inflammation and reduce itch.
Moisturizers and barrier repair therapy
Moisturizers help by strengthening the skin barrier, reducing water loss, and decreasing exposure to triggers that drive itch and inflammation. Symptom comfort often improves within several days, with more durable improvements in dryness and flare frequency over 2–4 weeks of consistent use. Side effects are uncommon but can include stinging on very inflamed skin or contact sensitivity to fragrance or preservatives in certain products.
Topical corticosteroids
Topical steroids reduce eczema inflammation by suppressing immune signaling in the skin, which decreases redness, swelling, and itch during flares. Many individuals notice itch reduction within 2–7 days, with visible clearing over 1–3 weeks depending on potency and location. Common side effects include temporary burning or irritation; with prolonged or repeated use, thinning of the skin, stretch marks, and easy bruising can occur, especially on the face and skin folds.
Topical calcineurin inhibitors (tacrolimus, pimecrolimus)
Calcineurin inhibitors reduce T-cell–driven inflammation without the skin-thinning risks associated with long-term steroid use, which makes them useful for sensitive areas such as the face, eyelids, neck, groin, and skin folds. Improvement is often seen within 1–3 weeks, with itch relief sometimes occurring earlier. Common side effects include temporary burning or stinging during the first several days of application.
Crisaborole (topical PDE-4 inhibitor)
Crisaborole decreases inflammatory signaling by inhibiting phosphodiesterase-4 (PDE-4), helping reduce redness and itch in mild-to-moderate atopic dermatitis. Benefits often emerge over 1–2 weeks, with continued improvement over 4–6 weeks. The most common side effect is application-site burning or stinging, particularly when used on actively inflamed skin.
Roflumilast cream (topical PDE-4 inhibitor)
Roflumilast cream is a steroid-free topical that also inhibits PDE-4, which can lower cytokine signaling involved in eczema inflammation and itch. It is FDA-approved for mild-to-moderate atopic dermatitis (formulation-dependent), and may be considered when a non-steroidal option is preferred for maintenance or sensitive sites. Improvement is often noticed within the first 1–2 weeks, with broader reduction in redness and roughness over 4–8 weeks. Common side effects can include application-site discomfort (burning or stinging), and some people report headache or upper respiratory symptoms.
Topical JAK inhibitor (ruxolitinib cream)
Ruxolitinib cream reduces inflammation by blocking Janus kinase (JAK) pathways that transmit itch- and inflammation-related cytokine signals. Itch reduction can occur within days in some cases, with clearer skin developing over 2–8 weeks. Common side effects include application-site reactions and acne-like bumps; because it is an immunomodulating medication, selection, duration, and follow-up are individualized.
Wet wrap therapy during flares
Wet wraps help rehydrate skin and improve barrier function while enhancing penetration of topical anti-inflammatory medications, which can reduce itch quickly during more intense flares. Benefits can appear within 2–3 days, and wraps are typically used for several days to about a week. Side effects may include irritation or folliculitis if used too long or too often; wraps combined with steroids require clinical guidance to avoid excessive absorption.
