By Michael H. Gold, MD, FAAD, board-certified dermatologist and founder of Gold Skin Care Center Published October 23, 2026
Key takeaways
If eczema still flares after consistent skin care and correctly used prescription creams, it is time to talk about stepping up treatment, not just using more cream.
Options include newer non-steroid creams, light therapy, injectable biologics, and JAK inhibitors taken by mouth. Each works differently and suits different patients.
Biologics target specific parts of the immune response and are FDA-approved for moderate to severe atopic dermatitis, with one approved from 6 months of age.
Oral JAK inhibitors can work quickly but carry an FDA boxed warning, so they require careful patient selection and monitoring.
If you have moderate or severe eczema that keeps coming back despite good skin care and prescription creams, you have more options today than at any point in my career. For people who have tried "everything," the right next step is often a treatment that works on the immune system itself, such as a biologic, or a structured course of light therapy. The choice depends on how severe your eczema is, where it appears, your age, your other health conditions, and how you prefer to be treated.
Over the years, our clinical research center has taken part in studies of eczema treatments, so I have watched these options develop firsthand. This Eczema Awareness Month, I want to explain them plainly, including the trade-offs.
Signs your eczema needs more than creams
Consider an appointment to talk about stepping up treatment if:
You use prescription steroid creams most days and still have flares
Eczema covers large areas of your body, or affects your hands, face, or eyelids in ways that disrupt daily life
Itching wakes you up at night or affects work, school, or mood
You have had repeated skin infections
You are cycling through oral steroids for flares (these can help briefly but are not a good long-term plan)
Before stepping up, it is worth confirming the basics: that the diagnosis is right (conditions such as contact dermatitis can look like eczema and are treated differently), that creams are being used in the right strength and amount, and that daily moisturizing is consistent. Sometimes that review alone makes a difference.
Step 1: newer non-steroid prescription creams
Not every "advanced" treatment is a shot or a pill. Several newer prescription creams work without steroids and can be used on sensitive areas like the face and skin folds. According to the American Academy of Dermatology's overview of atopic dermatitis treatment:
Ruxolitinib cream (Opzelura®) is a topical JAK inhibitor FDA-approved for patients 2 and older with mild to moderate atopic dermatitis.
Tapinarof cream (Vtama®) is approved for patients 2 and older with mild, moderate, or severe atopic dermatitis.
Roflumilast cream (Zoryve®) is approved for patients 2 and older with mild to moderate atopic dermatitis.
Topical calcineurin inhibitors (pimecrolimus cream and tacrolimus ointment) and crisaborole ointment remain useful non-steroid options.
These are a good fit for people whose eczema is limited to certain areas but keeps recurring, or who want to reduce how much topical steroid they use.
Step 2: light therapy (phototherapy)
Light therapy uses controlled doses of ultraviolet light to calm inflammation in the skin. At Gold Skin Care Center, we offer narrowband UVB phototherapy for more widespread eczema and targeted excimer laser treatment (XTRAC and Exci308) for stubborn, localized patches. You can read more on our eczema and atopic dermatitis page.
The main trade-off is time. The AAD notes that light therapy usually requires two to three treatments a week for the period your dermatologist prescribes. For people who live or work near our Green Hills office and can keep that schedule, phototherapy is a well-established option that avoids injections and daily pills.
Step 3: biologic injections
Biologics are medications that block a specific signal in the immune response that drives eczema inflammation. They are given as injections under the skin, usually at home after you are taught how. According to the AAD, biologics FDA-approved for moderate to severe atopic dermatitis that is not well controlled with treatments applied to the skin include:
Dupilumab (Dupixent®): approved for patients 6 months of age and older.
Tralokinumab (Adbry®) and lebrikizumab (Ebglyss®): approved for patients 12 and older who weigh at least 88 pounds.
Nemolizumab (Nemluvio®): approved for patients 12 and older.
What to expect: biologics usually improve eczema gradually over weeks to months rather than overnight. They do not suppress the whole immune system the way older systemic medicines can, and routine lab monitoring is generally not required for most of them. Each has its own side effects; for example, eye irritation or conjunctivitis is a known side effect of some. Your provider will review the specific risks of the medication you are considering.
Step 4: oral JAK inhibitors
JAK inhibitors are pills that reduce inflammation by blocking signals inside immune cells. The AAD notes that abrocitinib (Cibinqo®) and upadacitinib (Rinvoq®) are FDA-approved for patients 12 and older with moderate to severe atopic dermatitis that has not responded well to other treatments, including other systemic medicines.
Many patients notice relief from itch quickly with JAK inhibitors. The trade-off is safety. The FDA requires a boxed warning on JAK inhibitors about increased risk of serious heart-related events, cancer, blood clots, and death, based on studies in other inflammatory conditions. That does not mean they are wrong for everyone. It means they are best for carefully selected patients, with a full review of personal and family health history and regular lab monitoring. The AAD's guide to JAK inhibitors explains more.
How to choose: a side-by-side view
Other factors I weigh with patients include age, pregnancy plans, other conditions such as asthma, how much of the body is affected, and plain preference. Some people strongly prefer a monthly injection to a daily pill; others would rather come in for light treatments than inject.
Insurance and prior authorization
Advanced eczema treatments are medical treatments, and Gold Skin Care Center accepts most major insurance plans, including Medicare and Medicaid, for medical dermatology. Biologics and JAK inhibitors often require prior authorization, meaning your plan reviews your history before approving coverage. Our team helps with that paperwork. Documenting what you have already tried, and for how long, makes the process smoother, so bring that history to your visit.
A note on clinical research
Through the Tennessee Clinical Research Center, which I lead, our team has been involved in clinical studies of eczema treatments. That experience helps us explain how these medications were tested and what the results mean. Clinical trial participation is always voluntary, depends on eligibility, and is separate from routine care. If you are curious about research, you can learn more on the TCRC website.
What to do next
Write down what you have tried: each prescription, how long you used it, and how it worked.
Bring photos of your worst flares.
Schedule an appointment with our medical dermatology team by calling (615) 383-2400 or using our scheduling form.
If you are managing eczema for a child, my parent's guide to eczema in children covers age-specific care. New to the practice? Here is what to expect at your first dermatology appointment.
Frequently asked questions
Is there a cure for eczema? Not yet. Atopic dermatitis is a chronic condition, but today's treatments can control it well for many people, with fewer flares and far less itching.
How long does it take a biologic to work? Improvement is usually gradual over several weeks to a few months. Your provider will set a timeline for judging whether it is working.
Are biologics safe for children? Dupilumab is FDA-approved for children as young as 6 months with moderate to severe atopic dermatitis. Other biologics are approved from age 12. Your child's provider will review benefits and risks with you.
Can I stop my creams once I start a biologic? Many people still use creams and moisturizer alongside a biologic, especially during flares. Do not stop any treatment without talking to your provider.
This article is for general education and is not medical advice. Results vary, and every treatment carries risks. An appointment with a board-certified dermatologist or qualified dermatology provider is the best way to learn which options are right for you.
About the author
Michael H. Gold, MD, FAAD, is a board-certified dermatologist and dermatologic surgeon and the founder and medical director of Gold Skin Care Center in Nashville, which he established in 1990. He also founded the Tennessee Clinical Research Center and holds appointments as Clinical Assistant Professor at Vanderbilt University School of Nursing and Adjunct Assistant Professor at Meharry Medical College School of Medicine. Read Dr. Gold's full bio.
