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Managing Eczema by Treating Flare-ups

A “flare-up” or “flare” is when your child’s eczema suddenly gets worse. You may notice more redness, itching, dryness, or irritation than usual. These moments can feel frustrating, especially if they seem to come out of nowhere.

The good news is that most flares can be managed step by step—starting with simple care and adding treatments only if needed. Key takeaways from this page:

  • Moisturizing daily is key. Your child may also need stronger treatments or care from a specialist to get better control of symptoms. This often means using topical treatments (medicine put on the skin).
  • When extra care is needed for flare-ups, there are things you can do to control symptoms at home, such as wet wraps or dilute (mixed with lots of water) bleach baths. Talk to your healthcare team to make a plan for tackling flare-ups. Regular moisturizing and sticking with the recommended treatment plan can help reduce itching and prevent flares before they start.
  • If eczema becomes worse or “severe,” your healthcare team can help you decide how best to protect and manage your baby’s skin. With the right guidance, treatment plans can be adjusted safely and effectively as needed.
Baby in the bath getting washed by her parent.

Start With Moisturizers

Even during a flare, moisturizing remains the key part of care. Continue to use moisturizer every day and apply it generously to all of your child’s skin. 

For very mild flares, moisturizer alone may be enough to calm the skin.

Topical Treatments

Topical treatments are medicines that go on the skin. If the skin is still red, itchy, or inflamed, your healthcare team may recommend adding one.

Topical Corticosteroids (Steroid Creams)

If your baby’s skin is not getting better with moisturizer alone, it may be time to think about using a topical corticosteroid. These can be over-the-counter as well, but stronger prescription versions are available if your healthcare team thinks they’re needed. A common over-the-counter topical corticosteroid you may have heard of is hydrocortisone. These are commonly used and are good treatments for many babies’ eczema flares. 

Corticosteroids can be used in children 3 months and older to calm redness, reduce itching, and decrease swelling and inflammation. They are typically used once a day for about a week and then continued for a few days after the skin looks better to make sure the flare is completely gone.

Different parts of the body need different strengths. Sensitive areas like the face, neck, and skin folds are treated with lower-strength options, while the arms, legs, and body may need something a bit stronger. For more severe flares, stronger medications may be used for a short time under guidance from your provider.

It’s understandable to have concerns about using steroids, but when used correctly, side effects are uncommon. They do not typically change your child’s skin color, and your healthcare team will guide you on how to use them safely.

Topical Calcineurin Inhibitors (TCIs)

In some cases, especially for sensitive areas like the face or eyelids, your healthcare team may suggest a non-steroid option, such as a TCI, which can be used in kids 2 years and older. Although not quite as good as topical steroids, these are sometimes preferred as they do not thin the skin, cause stretch marks, or affect your child’s immune response. Some children may feel mild burning or itching at first, but this usually improves with time.

Other Topical Options

There are also newer non-steroid options that may be used for mild to moderate eczema, or in older children with more severe disease. Your healthcare team can help you decide if and when these are appropriate.

  • Used for mild to moderate eczema
  • One ointment version approved for children as young as 3 months and one cream version approved for ages 2 years and up
  • May be helpful for families who prefer to limit steroid use
  • Can sometimes cause brief stinging and may be more expensive
  • Used only for more severe eczema
  • Approved for children ages 2 years and older
  • Prescribed by specialists
  • Approved for ages 2 years and up
  • Good for long-term use without any limits on how long it can be used for or where it can be used
  • Not used routinely
  • Only recommended if there are signs of infection, like oozing, crusting, or worsening redness
  • Other options, like topical benadryl or topical over-the-counter antimicrobials, can sometimes cause contact allergy

How to Apply Prescription Treatments Correctly

How you apply treatments can make a big difference. In general, medications should be applied only to areas with eczema, using the amount recommended by your healthcare team.

It also helps to apply in the right order. Start with the medication on eczema areas, wait a few minutes, and then apply moisturizer to the rest of the skin. Mixing them together can make the medication less effective, so avoid complete mixing. A little overlap is fine.

Stopping Flares From Coming Back

If your child tends to get eczema in the same spots over and over, your healthcare team may recommend something called “proactive treatment.” This means applying a medicated cream 2-3 times a week, even when the skin looks clear, to those problem areas.

While it may feel unusual to treat skin that looks “normal,” this approach may reduce how often flares happen and help keep skin more stable over time.

Extra Support During Tough Flares

For more stubborn or severe flares, your healthcare team may recommend additional steps.

One option is a dilute bleach bath, which can help reduce bacteria on the skin and lower the risk of infection. This is usually only suggested for moderate to severe eczema and should always be done with guidance for safety reasons.

  • Use plain, unscented household bleach
  • Add ¼ cup bleach to a half-filled standard tub
  • Use lukewarm water
  • Soak 5–10 minutes
  • Keep water out of eyes and mouth
  • Rinse with clean water
  • Pat dry gently
  • Apply medicine and moisturizer right away

Another option for moderate to severe flares is wet wrap therapy. This helps lock in moisture, reduce itching, and allow treatments to work more effectively. Wet wraps are typically used for short periods and with guidance.

  1. Apply prescribed medicine or thick moisturizer
  2. Cover skin with damp cotton cloth or pajamas
  3. Add a dry layer on top
  4. Leave on for 20–30 minutes (or overnight if your provider says it’s okay)

Safety Notes

Wet wraps can make medications stronger, so it’s important to be careful when using them. Stick to low- or mid-strength steroid creams and only apply them to small areas of the skin. This method should be used for a short period—typically no more than 4 to 7 days. Avoid using strong steroid medications under wraps unless your healthcare team specifically tells you to do so. If the skin starts to look worse or shows signs of infection, stop using the wraps and contact your provider right away.

Optional Additions

Diluted white vinegar may sometimes be added to the wet layer for an antimicrobial effect, but only do this if told by your healthcare team. If so, try for ⅛ cup vinegar for every 2 cups tap water.

Treatments for Severe Eczema

If your child’s eczema is not improving with creams and daily care, or if flares are frequent and difficult to control, a specialist may recommend additional treatments. These options are carefully monitored and are generally for children who need extra support beyond topical care.

Allergen immunotherapy, sometimes called “allergy shots” or tablets, helps retrain the immune system so it reacts less strongly to allergens over time. This treatment works slowly over time and can take months to show benefits. It does not directly treat the skin itself, but it may be helpful for children who have eczema along with allergies or asthma. This is often done at the same time as topical eczema treatments.

Monoclonal antibody medicines are another option that targets specific parts of the immune system that drive inflammation. These treatments often work faster than allergy shots and are given as injections every few weeks. An approved option is dupilumab for children 6 months and older. These medications are generally considered safe and effective when managed under specialist care.

Probiotics and Eczema

Probiotics are often described as “good bacteria” that may support both gut and skin health. Some newer skincare products now include beneficial bacteria intended to help balance the skin’s natural environment. Early research suggests there may be some benefit, but these products are still being studied and are not yet fully proven.

Oral probiotics, taken by mouth, have also been studied in eczema. Some research shows they may lead to mild improvement when used over a longer period of time, including helping with bad symptoms and lowering the need for topical corticosteroids. However, probiotics have not been proven to prevent eczema, and they should not be used as a replacement for standard medical treatments.

Overall, probiotics may be considered as an add-on to a child’s eczema care plan, but it is important to always talk with your healthcare team before starting them.

Itch Control

It’s important to work as a team for control of the itch. Telling children to “stop scratching” doesn’t help. Using distraction techniques, applying moisturizers, doing mind body relaxation may help. If your child is having trouble sleeping due to itching please discuss with your health care team.

For families managing eczema, getting rid of triggers at home can play an important role in helping prevent flare-ups. It is helpful to avoid clothing made from wool or other rough fabrics that may irritate your child’s skin. Try to limit exposure to common environmental allergens when possible, and choose gentle, fragrance-free soaps and detergents instead of harsh products that can dry out the skin. Keeping your child cool is also important, since overheating and sweating often make itching worse.

The best way to relieve itching is to actively treat eczema when it happens. This usually includes regular use of moisturizers, prescription creams if they are recommended, and any other treatments your child’s healthcare team has prescribed. Staying consistent with treatment can help keep symptoms under better control.

In some cases, antihistamines may be recommended, especially if your child has both eczema and allergies. Non-drowsy options such as cetirizine (Zyrtec) or loratadine (Claritin) are usually chosen for everyday or longer-term use. Sedating antihistamines (that can make you drowsy) like diphenhydramine (Benadryl) are used less often and are usually reserved for specific situations, such as helping with sleep during severe itching.

Older Children

Some treatments are only used on children who are older, so it won’t matter too much for your baby now. However, in the future, someone on your healthcare team may mention some of the following:

  • Monoclonal antibodies, like tralokinumab, lebrikizumab, or nemolizumab (done at the same time as topical steroids) for ages 12 years and older
  • Systemic treatments, like upadacitinib and abrocitinib for ages 12 years and older, done by a specialist and requiring laboratory monitoring for safety