The Use of Topical Medications and Treatments for Eczema and Acne

If you suffer from eczema or acne, you know how frustrating it can be to find a treatment that works. While there are many options available, topical medications and treatments can be particularly effective for managing these skin conditions. From over-the-counter creams to prescription ointments, there are a variety of products that can help reduce inflammation, redness, and itching associated with eczema and acne. In this article, we’ll explore some of the most common topical treatments available for eczema and acne and provide tips for choosing the best option for your skin type and condition, but first lets us understand Eczema and Acne in more detail.

Eczema and acne are both skin conditions that cause very similar conditions. While acne causes pimples, eczema causes a type of discolored or red and bumpy rash, which may sometimes also appear like pimples.^(1, 2)

Eczema is also called atopic dermatitis, and it is most common in babies and children, though it can happen to anyone of any age. The underlying cause of eczema is not clearly understood even now, though it is believed that genetics, environmental factors, and the immune system all have a role to play in the development of eczema. You are more likely to get eczema if the condition runs in your family or if you or any other family member have an allergy, asthma, or hay fever. People with eczema often have very dry skin, especially on some parts of the body or face. This happens because of a skin barrier, which is not able to retain moisture properly. Some of the common symptoms of eczema include:^(3, 4)

• Dry skin
• Itchy rash
• Redness on the skin
• Leathery skin (a condition known as lichenification)
• Soreness
• Swelling
• Raised, pimple-like bumps or brownish-gray patches that may bleed or ooze fluid if scratched, or it may crust over.

Acne, on the other hand, impacts the oil glands that are present underneath the skin. There are certain tunnels under the skin that connects these oil glands to small holes known as pores on your skin’s surface. When these tunnels or the pores get clogged, you develop a pimple. Sometimes, these bumps can have pus inside them and be painful. Acne breakouts are most commonly observed on the face, back, neck, and shoulders.^(5, 6)

You are more likely to develop acne in the following conditions:

• If your parents had acne
• You wear a lot of greasy or poor-quality makeup and don’t wash your face or take off the makeup at night before going to bed
• You are undergoing hormonal changes like during puberty, pregnancy, and menopause
• You are under a lot of stress
• You are on certain types of medications, like steroids, which are powerful medications that help reduce inflammation in the body.

Most teenagers are prone to experiencing acne, and prompt treatment of acne can help them overcome the psychological and emotional effects associated with acne. Some of the common symptoms of acne include:^(7, 8)

• Pimples or pustules that are filled with pus, especially at the tips.
• Whiteheads
• Blackheads
• Small, tender, red bumps
• Larger, solid, and painful lumps underneath the skin
• Painful and pus-filled lumps underneath the skin

1. Topical Medications for Eczema – Corticosteroids

   People with eczema tend to go through periods of remission where they remain symptoms-free followed by flare-ups where their symptoms become severe. Eczema caused dry and itchy skin, which causes people to scratch or rub the affected area, which causes rashes, blisters, inflammation, and skin that oozes out clear liquid. People with eczema are also prone to getting fungal, bacterial, and viral infections since eczema breaks down the skin barrier, thus leaving you susceptible to such illnesses.⁽⁹⁾

   There is no cure for eczema, but there are certain treatment options that focus on relieving the symptoms and healing the skin to prevent any further damage. Treatments also try to prevent flare-ups of the symptoms.

   Medications, moisturizers, and many at-home skin care remedies are all integral parts of a well-designed treatment plan for eczema.⁽¹⁰⁾

   One of the most common topical treatments for eczema is corticosteroids. Using topical corticosteroids is typically the conventional go-to treatment for eczema, especially during periods of flare-ups.

   Corticosteroids are applied directly to the affected parts of the skin, and they are available in the form of creams, ointments, or lotions. These help in the following ways:⁽¹¹⁾

   • Corticosteroids help reduce inflammation of the skin.
   • They alleviate irritation and soreness.
   • They soothe allergic reactions.
   • They reduce itching as well as the desire to scratch the affected area thus preventing the eczema from worsening.

   Topical corticosteroids are available in different degrees of strength. One is the most powerful and seven is the weakest. These medications are most effective against eczema when they are applied within three minutes of showering or taking a bath. For example, the commonly used corticosteroid Vanos (with 0.1 percent fluocinonide) cream is classified as a super potent class 1 medication. On the other hand, over-the-counter hydrocortisone creams are classified as one of the least potent corticosteroid class 7 creams.^{(12, 13, 14)}

   However, it is important to keep in mind that topical corticosteroids for treating eczema should never be used as moisturizers and you should only apply them to those parts of the skin that are affected by eczema. It is important to keep in mind, though, that over a period of time, using these medications can cause changes in the color of the skin, thin the skin, or also result in the formation of stretch marks.

   In some rare cases, topical corticosteroids can get absorbed into the skin and enter the bloodstream. This causes many systemic side effects, meaning those that affect the entire body. These can be more severe and may include:

   • Worsening of diabetes
   • Cushing Syndrome (a condition that causes a wide variety of symptoms caused by the overproduction of the hormone cortisol in the body)
   • Eye problems like cataracts and glaucoma
   • Avascular necrosis (where the death of the bone tissue occurs because of loss of blood supply)
   • High blood pressure
   • Addiction to topical steroids
   • Blemishes like acne, pus-filled follicles, and bumps on the skin)
   • Adrenal suppression

   If you find that topical corticosteroids are not working and there is no change in your eczema, your doctor will prescribe another systemic corticosteroid, which is to be taken orally or through injection. However, systemic corticosteroids are only recommended for short periods of time as these medications can lead to many severe side effects, including hair loss, gastrointestinal issues, and osteoporosis.^{(15, 16, 17)}

2. Other Topical Medications for Eczema

   Another category of prescription-based topical medication for eczema is known as topical calcineurin inhibitors (TCIs). This includes pimecrolimus (brand name Elidel) and tacrolimus (brand name Protopic).⁽¹⁸⁾ TCIs do not contain steroids, and they control inflammation while also decreasing the flare-ups of eczema by suppressing the immune system.⁽¹⁹⁾

   TCIs do not cause that many severe side effects as topical corticosteroids do, but it is still recommended that you only use these drugs for a short period of time. You should also be aware that there is a possible cancer risk associated with these medications.

   Another class of topical drugs for eczema is known as PDE4 inhibitors which work by blocking the enzyme known as phosphodiesterase 4 (PDE4) from overproducing inflammation in the body. As of today, there is only one PDE4 inhibitor available on the market that is approved by the US Food and Drug Administration (FDA) for the treatment of eczema and it is known as crisaborole (brand name Eucrisa).^(20, 21)

   Then there is the skin cream known by the brand name Opzelura (ruxolitinib), which is the first topical Janus kinase (JAK) inhibitor for treating eczema. This is another FDA-approved treatment. However, the FDA has issued a boxed warning on this drug as it may increase the risk of all-cause mortality, and also boost the risk of developing a heart attack, stroke, dangerous infections, certain cancers like lymphoma, and thrombosis or blood clots.^(22, 23)

   There is also another treatment for severe eczema known as wet wrap therapy. In some cases, this treatment is administered in the hospital as it involves applying topical medications (corticosteroids) and moisturizers to the affected areas and sealing them up by wrapping them with wet gauze.⁽²⁴⁾

3. Topical Medications for Acne

   Just like topical medications are used for treating eczema or atopic dermatitis, there are several topical treatments available for managing the symptoms of acne as well. The most commonly prescribed topical medications for acne include:^(25, 26)

1. Retinoids and other retinoid-like drugs

   The most commonly used topical medication for acne is known as retinoids. Drugs that contain retinoic acids or tretinoin are used in the treatment of moderate acne. These are available in various forms, including gels, lotions, and creams. Some of the commonly prescribed examples include tretinoin (brand name Retin-A and Avita), tazarotene (brand name Avage, Tazorac, and others), and adapalene (brand name Differin). All these medicines are derived from vitamin A.

   These medications are typically applied in the evening and usually three times a week in the beginning. As your skin becomes used to these medications, you will then start to use them daily. Retinoids help prevent the clogging of hair follicles. However, you need to ensure that you do not use tretinoin at the same time as another commonly used acne medication, benzoyl peroxide.^(27, 28)

   A word of caution is that topical retinoids increase the skin’s sensitivity to the sun. They also make the skin dry and can cause redness, especially in people who have black or brown skin. Adapalene is usually found to be tolerated the best in such cases.⁽²⁹⁾

2. Azelaic Acid and Salicylic Acid

   Azelaic acid and salicylic acid are other commonly prescribed topical treatments for acne. Azelaic acid is a natural acid produced by yeast. It is known for its potent antibacterial properties. When a 20 percent azelaic acid cream or gel is used twice a day, it has been found to be as effective as many of the other conventional treatments for acne. Prescription azelaic acid (brand names Finacea and Azelex) is often a safe option during pregnancy and breastfeeding, making it a popular treatment for women who develop acne during their pregnancy. It is also used for the management of discoloration that takes place in some types of acne. Side effects of azelaic acid include minor skin irritation and redness on the skin.^{(30, 31, 32)}

   On the other hand, salicylic acid is used to prevent clogged hair follicles and is available on the market as both leave-on and wash-off products. However, studies have found that it might have limited effectiveness in the treatment of acne. Side effects of using salicylic acid may include minor skin irritation and skin discoloration or hyperpigmentation.^(33, 34) 

3. Topical Antibiotics

   Topical antibiotics are also used to treat acne. Antibiotics applied topically work by killing off any excess skin bacteria and also help reduce the inflammation and redness of the skin. When you start using this treatment, for the first couple of months you are likely to be prescribed both a retinoid and an antibiotic in combination, with the retinoid to be applied in the evening and the antibiotic to be used in the morning.

   The antibiotics are also often used in combination with benzoyl peroxide to reduce the chances of developing antibiotic resistance. Some of the commonly used antibiotics include erythromycin with benzoyl peroxide (brand name Benzamycin) and clindamycin with benzoyl peroxide (brand names Duac, Clindac, Benzaclin, and others). It is important to note, though, that topical antibiotics are not recommended to be used alone.^(35, 36)

4. Dapsone

   Dapsone, sold under the brand name of Aczone, is a 5 percent gel that is to be used twice a day and is usually recommended for inflammatory acne, especially in women. Side effects of this topical medication include dryness and redness of the skin.

   It must be noted that while there are many other topical medications for treating acne, there is very limited evidence that supports the use of sulfur, zinc, resorcinol, aluminum chloride, nicotinamide, or sulfacetamide sodium as a topical treatment for acne.

Eczema and acne are both skin conditions that can cause a lot of distress to people. Acne occurs when the hair follicles get clogged with dead skin cells and oil, causing pimples, blackheads, or whiteheads. Eczema, or atopic dermatitis, is a term used to refer to a group of conditions that cause the skin to become irritated or inflamed, often causing rashes, itching, and dry skin. A dermatologist will be able to diagnose whether you have eczema or acne by looking at your skin and running certain tests and taking a detailed family history.

There are many different treatments for both eczema and acne, including many effective topical treatments. The exact treatment that will be best for your individual case will be determined by your doctor in order to help you manage the symptoms. Remember, that taking good care of your skin can go a long way in helping control both eczema and acne.

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