Eczema: Understanding Your Skin and How to Care for It
By Heather D. Rogers, MD, FAAD, Double Board-Certified Dermatologist
One of the most frustrating things about eczema is the inconsistency. Your skin tolerates a product for months, then suddenly it burns. A routine that seemed perfectly reasonable becomes too much, and adding another product only makes the situation worse. Understanding why eczema behaves this way and the biology behind it is essential to knowing how to manage it.
Eczema describes a group of inflammatory skin conditions, the most common of which is atopic dermatitis. In atopic dermatitis, impaired skin barrier function and immune-mediated inflammation reinforce one another: the skin loses moisture more readily, becomes more vulnerable to irritants, and develops inflammation that further compromises its ability to protect itself.
This is why eczema treatment requires both consistent barrier support and adequate control of inflammation. Moisturizing is essential, but persistently inflamed skin needs more than moisturizer.
Why Eczema Can Change Throughout Your Life
Eczema commonly begins in childhood and often improves as children get older, although the underlying susceptibility to dryness and irritation frequently remains. Some people continue to have eczema throughout adulthood; others go years without a flare before it returns, and some develop it for the first time as adults.
As skin ages, it becomes drier and less resilient, which changes how much it tolerates. The products you used comfortably in your twenties deserve reconsideration when they start irritating your skin in your forties. Continuing a routine simply because it used to work ignores what your skin is telling you now.
Why Is the Skin Barrier Important for Eczema?
Your skin barrier limits water loss while protecting you from environmental irritants and allergens. When that barrier is compromised, skin becomes dry, reactive, and itchy. Scratching provides temporary relief but creates further injury, perpetuating the cycle of itching and inflammation.
Daily moisturizing helps support the barrier and reduce the conditions that can contribute to another eczema flare. Consistent moisturizing is important, even when your skin looks healthy, because visible improvement does not eliminate the underlying predisposition to eczema.
Choose a fragrance-free cream or ointment with ingredients that support hydration and moisture retention. Glycerin attracts water into the skin, ceramides support its lipid barrier, and emollients such as squalane soften dry skin. Occlusive ingredients reduce water loss. Creams generally provide more protection than thin lotions, while ointments are particularly useful for severely dry or cracked areas.
I formulated Doctor Rogers Body Cream with ceramides for this reason: consistent barrier support is fundamental to maintaining comfortable skin. For particularly dry areas, I layer Restore Healing Balm over moisturizer, such as Doctor Rogers Face Cream, to help retain that hydration.
Every Doctor Rogers product, from our moisturizers and Restore Healing Balm to our Vitamin C serum, Day Preventive Treatment, and our cell turnover products, Night Repair Treatment and Body Repair Treatment, has earned the National Eczema Association Seal of Acceptance™. The Seal identifies products evaluated for suitability for eczema-prone skin. Individual ingredient allergies still matter, even when a product carries the Seal.
You do not have to use my products, but you do need to understand what you are putting on your skin and whether it is helping or hurting.
What to Do During an Eczema Flare
When your skin is inflamed, simplify your skincare routine. Stop exfoliating acids, retinoids, scrubs, and cosmetic treatments that sting or leave your skin feeling tight. This includes my Night Repair Treatment and Body Repair Treatment. These products have a purpose in a healthy skincare routine, but actively inflamed skin needs time to recover before you ask it to tolerate exfoliation again.
During an eczema flare, focus on gentle cleansing, a supportive moisturizer, and the medication prescribed to control your eczema. Maintain sun protection with shade, clothing, and a fragrance-free, broad-spectrum sunscreen with SPF 30 or higher; zinc oxide is a useful option for sensitive skin.
After the flare resolves, reintroduce cosmetic treatments one at a time and gradually. Let your skin's response determine the frequency rather than assuming that every product needs to be used every day.
How to Choose Skincare Ingredients for Eczema-Prone Skin
When choosing skincare for eczema-prone skin, ingredients matter. Fragrance and essential oils add exposure to common contact allergens without contributing to eczema treatment, which is why I exclude them from my recommendations. I also avoid lanolin when selecting products for eczema-prone skin because it is a recognized contact allergen, particularly relevant when the barrier is already damaged.
The enthusiasm for natural and plant-based skincare has created considerable confusion about this. A botanical ingredient is not automatically gentle, and an essential oil does not become less allergenic because it came from a plant. Evaluate the formulation and your response to it rather than relying on the language on the packaging.
Precision matters when discussing ingredients. Drying alcohols in leave-on products are different from fatty alcohols such as cetyl and cetearyl alcohol, which are useful emollients in moisturizers. Parabens are not a medical reason to reject an otherwise well-tolerated eczema product, and properly selected preservatives protect water-based formulations from contamination.
How to Test a New Skincare Product for Eczema-Prone Skin
Before introducing a new product, test it on a small area of unaffected skin twice daily for seven to ten days. This is a home tolerance test; formal patch testing is a diagnostic procedure performed by a dermatologist to identify contact allergies. Recurrent eyelid, facial, or hand eczema, particularly when it persists despite appropriate treatment, warrants consideration of allergic contact dermatitis.
How to Bathe and Shower with Eczema
Bathing can make eczema worse when hot water, prolonged soaking, or aggressive scrubbing further compromise an already vulnerable skin barrier. Keep baths and showers short, five to ten minutes, and use lukewarm water.
Use a gentle, fragrance-free cleanser where needed, pat the skin rather than rubbing it dry, and apply moisturizer immediately while your skin is still slightly damp. Reapply to dry areas throughout the day and after washing your hands. After swimming, rinse off chlorine or salt water and moisturize.
Why does moisturizing after bathing matter? Your skin has just absorbed water, and moisturizer helps hold it in before it evaporates.
How to Treat Inflammation During an Eczema Flare
Moisturizer alone may not be enough to treat an active eczema flare. A moisturizer supports barrier recovery, while anti-inflammatory medication controls the process interfering with that recovery. Repeatedly changing creams while an active flare continues prolongs the problem.
Hydrocortisone and Prescription Topical Corticosteroids
Over-the-counter hydrocortisone 1% is useful for mild, localized eczema flares, and an ointment formulation often stings less than a cream. Follow the package instructions, continue moisturizing, and seek assessment if the rash is not improving within a week. Use on the face, eyelids, groin, or an infant requires specific guidance from your clinician.
For more persistent inflammation, your dermatologist selects a prescription corticosteroid according to the location and severity of the eczema, your age, and the intended duration of treatment. Appropriately prescribed topical corticosteroids are effective and valuable medications. Inappropriate potency or prolonged use, especially on delicate skin, increases the risk of adverse effects such as skin thinning.
Follow the treatment plan closely enough to control the flare, then transition to the maintenance regimen recommended for you. Undertreating inflammation leaves the skin vulnerable to continued scratching and injury.
Nonsteroid Topical Medications for Eczema
Tacrolimus ointment and pimecrolimus cream reduce inflammation without causing steroid-related skin thinning, making them particularly useful for the face, eyelids, skin folds, and prescribed maintenance treatment. Temporary burning or stinging is common when they are first applied to inflamed skin.
Both carry an FDA boxed warning concerning cancer, but that warning needs to be understood in the context of the evidence. A large systematic review published in 2023 found no increase in overall cancer risk associated with their use.
Additional nonsteroid options include crisaborole, ruxolitinib, roflumilast, and tapinarof. The appropriate choice depends on age, the areas being treated, medical history, and each medication's prescribing requirements.
Systemic Treatments for Eczema
Eczema that remains inadequately controlled with topical therapy, or substantially interferes with sleep and daily functioning, deserves discussion of systemic treatment.
Injectable biologics, including dupilumab, tralokinumab, lebrikizumab, and nemolizumab, target specific immune signals involved in eczema. Oral JAK inhibitors, including upadacitinib and abrocitinib, provide another approach and require careful patient selection and monitoring. Age eligibility and treatment requirements vary by medication. Prescription phototherapy is also an option.
Prednisone and other systemic corticosteroids are poor choices for routine eczema management because of their adverse effects and the rebound flares that frequently follow discontinuation. Current dermatology guidelines recommend against their routine use for atopic dermatitis.
Do Antihistamines Help Eczema?
Antihistamines do not treat the underlying inflammation of eczema or reliably relieve eczema itch, because eczema itch is not primarily histamine-driven. Medications such as cetirizine, loratadine, and diphenhydramine may have a role when a patient also has hives or seasonal allergies, but taking them for eczema does not address its underlying biology.
A clinician sometimes recommends a sedating antihistamine briefly when sleep disruption is severe. Controlling the eczema remains the priority.
Home Care for Eczema: Cool Compresses, Oatmeal, and Plant Oils
Cool compresses and colloidal oatmeal can provide comfort for dry, itchy skin. Apply a clean, cool, damp cloth briefly, then moisturize. For an oatmeal bath, use a commercial colloidal oatmeal product according to its instructions, keep the water lukewarm, and moisturize afterward. Avoid oatmeal if you have an oat allergy, and be careful because it makes the tub slippery.
Plant Oils for Eczema-Prone Skin
Castor oil is a key ingredient in the Restore Healing Balm I formulated because of its emollient properties. It softens skin and supports moisture retention, and the finished balm provides a protective layer over compromised skin. Those are useful functions in eczema care. However, laboratory findings about individual fatty acids do not establish that castor oil treats eczema inflammation or prevents infection.
Coconut and sunflower oils are also used as emollients, but introducing multiple oils or homemade botanical mixtures during a flare creates unnecessary opportunities for irritation. A consistent, well-tolerated formulation makes it easier to understand how your skin is responding.
What Can Trigger Eczema Flares?
Dry air, overheating, sweat, harsh cleansers, and friction can aggravate eczema. To reduce these everyday triggers, choose soft, breathable clothing, avoid wool against affected skin, and use fragrance-free laundry detergent without scented fabric softeners or dryer sheets. Rinse off sweat and moisturize afterward.
A humidifier can add moisture to a dry bedroom, but it needs regular cleaning, and excessive humidity encourages mold and dust mites. Stress also intensifies itching and the scratch cycle, so sleep, exercise, and manageable ways to reduce stress belong alongside skincare and medication in your treatment plan. If your eczema flares every winter, read my guide to winter eczema and what to do about it.
Food Allergies and Eczema
Food allergies occur more often in people with atopic dermatitis, but eliminating dairy, gluten, eggs, or other tolerated foods is not a general eczema treatment. Avoiding foods without a diagnosed allergy can create additional problems, particularly for growing children. Suspected food allergy needs clinical evaluation, especially when a food causes an immediate reaction such as hives, swelling, vomiting, or breathing difficulty. Breathing difficulty or throat swelling requires emergency care.
When to See a Dermatologist for Eczema
Persistent eczema flares, interrupted sleep, frequent reliance on hydrocortisone, and recurrent facial or eyelid eczema are reasons to see a dermatologist. When a rash fails to respond to an appropriate treatment plan, the diagnosis needs reconsideration, including whether contact allergy is contributing.
Increasing pain, warmth, swelling, pus, spreading redness, or fever can be signs of infection and require prompt medical assessment. Clusters of painful blisters or open sores need same-day medical care, especially near the eyes.
Once the flare clears, continue gentle cleansing, consistent moisturizing, and the maintenance treatment prescribed for you. Managing eczema requires understanding what your skin needs over time: a routine that protects its barrier and treatment that adequately controls inflammation.
Frequently Asked Questions About Eczema
Can Moisturizer Alone Treat an Eczema Flare?
No. Moisturizer supports barrier recovery, but persistently inflamed skin needs more than moisturizer. Anti-inflammatory medication controls the inflammation interfering with that recovery. During an eczema flare, focus on gentle cleansing, a supportive moisturizer, and the medication prescribed to control your eczema.
Should You Moisturize Eczema-Prone Skin Every Day?
Yes. Daily moisturizing supports the skin barrier and reduces the conditions that encourage another flare. Continue moisturizing even when your skin looks healthy because visible improvement does not eliminate the underlying predisposition to eczema.
How Should You Bathe or Shower with Eczema?
Keep baths and showers short, five to ten minutes, and use lukewarm water. Use a gentle, fragrance-free cleanser where needed, pat rather than rub your skin dry, and apply moisturizer immediately while your skin is still slightly damp.
Do Antihistamines Help Eczema Itching?
Antihistamines do not treat eczema inflammation or reliably relieve the itching because eczema itch is not primarily histamine-driven. They have a role when you also have hives or seasonal allergies. A clinician may sometimes recommend a sedating antihistamine briefly when sleep disruption is severe, but controlling the eczema remains the priority.
When Should You See a Dermatologist for Eczema?
Persistent eczema flares, interrupted sleep, frequent reliance on hydrocortisone, and recurrent facial or eyelid eczema are reasons to see a dermatologist. A rash that does not respond to an appropriate treatment plan also needs reconsideration, including whether contact allergy is contributing.
What Skincare Ingredients Should You Avoid with Eczema?
Fragrance, essential oils, and lanolin are common contact allergens and are worth avoiding when your skin barrier is compromised. A botanical ingredient is not automatically gentle, so judge a product by its formulation and how your skin responds, not by the language on the packaging.
Are Doctor Rogers Products Suitable for Eczema-Prone Skin?
Every Doctor Rogers product has earned the National Eczema Association Seal of Acceptance™, which identifies products evaluated for suitability for eczema-prone skin. Individual ingredient allergies still matter, so test any new product on a small area of unaffected skin before using it more widely.
References
1. "Atopic Dermatitis Clinical Guideline." American Academy of Dermatology. Accessed 5 Oct. 2026. https://www.aad.org/member/clinical-quality/guidelines/atopic-dermatitis
2. Devasenapathy, Niveditha, et al. "Cancer Risk with Topical Calcineurin Inhibitors, Pimecrolimus and Tacrolimus, for Atopic Dermatitis: A Systematic Review and Meta-Analysis." The Lancet Child & Adolescent Health, vol. 7, no. 1, 2023, pp. 13-25. https://pubmed.ncbi.nlm.nih.gov/36370744/
3. "Eczema-Friendly Product Directory: Doctor Rogers." National Eczema Association. Accessed 5 Oct. 2026. https://nationaleczema.org/eczema-products/?page=1&s=doctor+rogers
4. "Eczema Treatment: Antihistamines." American Academy of Dermatology. Accessed 5 Oct. 2026. https://www.aad.org/public/diseases/eczema/childhood/treating/antihistamines
5. Ludmann, Paula. "Eczema Types: Atopic Dermatitis Skin Care." American Academy of Dermatology, 10 Oct. 2023. https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis/atopic-dermatitis-coping
6. Singh, Anne Marie, et al. "Atopic Dermatitis and Food Allergy: Best Practices and Knowledge Gaps: A Work Group Report from the AAAAI Allergic Skin Diseases Committee and Leadership Institute Project." Journal of Allergy and Clinical Immunology: In Practice, vol. 10, no. 3, 2022, pp. 697-706. https://www.aaaai.org/Aaaai/media/Media-Library-PDFs/Allergist%20Resources/Statements%20and%20Practice%20Parameters/Atopic-Dermatitis-and-Food-Allergy-Best-Practices-and-Knowledge-Gaps-March-2022.pdf
About the Author
Dr. Heather D. Rogers, MD is a double board-certified procedural dermatologist and Mohs surgeon and the co-founder of Modern Dermatology in Seattle, where she sees patients full-time. She is nationally recognized for her expertise in skin health, aging, and skin cancer prevention, and for her clear, evidence-based skincare guidance. Dr. Rogers serves on the American Academy of Dermatology Media Team, the Credo Beauty Council, the Sorette for Motherhood Scientific Advisory Board, and the NewBeauty Brain Trust.
She is the founder of Doctor Rogers Skincare, a dermatologist-developed line reflecting her less-is-more, science-backed approach to healthy skin. Dr. Rogers is a graduate of Stanford University, the University of Washington School of Medicine, and completed her dermatology training at Columbia University Medical Center.
Instagram: @drheatherrogers
Practice: mdinseattle.com
Skincare: doctorrogers.com
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