Moderate to severe eczema management strategies

ESC spoke with Quebec City-based dermatologist and researcher Dr. Julien Ringuet to learn more about how eczema is managed and what treatment options exist beyond topical corticosteroids.

In recent years, treatments for atopic dermatitis (AD), commonly known as eczema, have come a long way, with the introduction of new topical treatments and immune system treatments, including injections (needles) and oral medications (pills) to treat AD.

Atopic dermatitis:

• Affects all ages but often appears in childhood
• It is a chronic skin condition 
• Usually starts in childhood, but can begin in adulthood
• May go away, but it also may not
• Can be classified as mild, moderate and severe
• Can be well managed with skincare, lifestyle modifications, and treatments

A patient with AD may need to try different treatments to find the appropriate medication. 

For decades, the main treatment for eczema has been topical corticosteroids. While they can work quickly to reduce skin inflammation, they are not suitable for everyone and may not be effective for severe or widespread eczema. The good news is that there have been many treatment advances in recent years, offering patients more options.

What are non-steroidal topical treatments?

You may have heard about “steroid-free” or “non-steroidal” treatments for eczema.  This usually refers to a topical treatment that reduces inflammation, but without the use of topical corticosteroids. These medicines instead target other pathways in the skin and can be used to treat inflammation when flares occur.

In Canada, at the time of the publication in the fall of 2025, there are many classes of steroid-free topical medicines:

• Topical Calcineurin Inhibitors (e.g. Eldiel® and Protopic®)
• Topical PDE4 Inhibitors (e.g. Eucria® and Zoryve®)
• Topical JAK Inhibitors (e.g. Anzupgo® for hand eczema, and Opzelura®)

In addition to topical treatment, sometimes when eczema is more widespread or severe, a specialist, such as a dermatologist, may recommend a systemic treatment – meaning a treatment taken by pill or needle and works on the whole body.

In Canada, at the time of publication in the fall of 2025, there are many classes of systemic treatments:

• Older oral medicines that are not approved for eczema but were used before we had newer treatments (e.g. Cyclosporine, Methotrexate)
• Phototherapy – light therapy that works to quiet down the immune system
• Biologic medicines taken by injection (e.g. Adralza®, Dupilumab®, Ebglyss®)
• Oral JAK inhibitors taken as a pill (e.g. Cibinqo®, Rinvoq®)

The good news is that there are many new treatments for eczema, and the treatment pathway is long, offering great hope to patients. 

Eczema Society of Canada thanks Quebec-based dermatologist and researcher Dr. Julien Ringuet, MD, MSc, FRCPC, for his contribution to this educational content.

This content was created as part of the 2025 Life with Eczema educational program.

Disclaimer: Information provided in this resource does not constitute medical advice and is not intended to be used as a diagnostic tool. The information is up-to-date at time of publication. All medications, interventions, and treatment plans have risks and benefits, and it is important that individuals discuss their or their child’s specific healthcare needs with a qualified healthcare professional.