Gentle skin care: A fundamental component of disease management is counseling patients on proper skin care—that is, the use of fragrance-free soaps and laundry detergents (avoiding fabric softeners); limiting baths to once daily in lukewarm water for no more than 10 min; avoiding the use of loofah sponges and washcloths, using only hands to apply soap (focusing on armpits, groin, feet); applying thick cream or ointment-based emollients to wet skin immediately after bathing.

Topical/systemic steroids: Typically, mid- to high-potency topical steroids may be required for 1–2 weeks at a time, with twice daily application to the body (low potency steroids are preferred for sensitive areas such as face, axillae, and groin). Potential side effects with long-term continuous use include skin atrophy, striae, and steroid acne. Systemic steroids are generally not preferred due to the high risk of rebound disease, as well as increased propensity towards adverse effects.

Topical immunomodulators: Topical non-steroidal immunomodulators such as tacrolimus and pimecrolimus have earned a major place in the therapeutic armamentarium, given their good safety profile and tolerability. However, there is a black box warning attached to these medications, and cost is prohibitive without insurance coverage.

Antibiotics/antibacterials: Plaques of eczema are known to carry staph aureus as a colonizer (which can worsen the disease and increase sensation of itch) so treatment should also aim to decrease this colonization, either via topical/systemic antibiotics where indicated, or measures such as twice weekly bleach baths (one-fourth cup of bleach added to a whole tub of warm water, soak for 10 min).

Antihistamines: Controlling itch is of major importance in atopic dermatitis management, since scratching can worsen the clinical appearance of the skin. Antihistamines are not reliably effective but should be tried (second generation non-sedating classes preferred).

Phototherapy: Narrow-band UVB can help to decrease symptoms and skin involvement in some patients with eczema, perhaps via an immunosuppressive mechanism.

Systemic immunosuppressives: For patients with severe or recalcitrant disease, systemic therapies such as methotrexate, mycophenolate mofetil, or cyclosporine can be helpful.