Common Eczema And Psoriasis Treatments— and Their Side Effects

Skin conditions like eczema and psoriasis are chronic, which means they require ongoing management to maintain the skin’s balance and integrity. The goal of any type of therapy for eczema or psoriasis is to maximize the asymptomatic period between flares.

“The pharmacology behind treating skin conditions such as eczema and psoriasis is well-established,” says Dr. John Papastergiou, BScPhm, PhD, RPh and Assistant Professor at both the University of Toronto’s Leslie Dan Faculty of Pharmacy and the University of Waterloo’s School of Pharmacy. However, it’s important to understand the different roles various types of medications play, as well as the potential side effects associated with each. “Generally, patients with a chronic skin condition start with the over-the-counter options before progressing to prescription-based treatments as the disease worsens or spreads to cover more of the body,” Dr. Papastergiou adds.

Over-the-counter Therapies

When a skin condition first makes its presence known, most patients are seeking relief from symptoms like dryness, itching and flaking. It’s important to remember that over-the-counter treatments only relieve the symptoms themselves rather than addressing the source of these skin conditions. Although these treatments are available without a prescription, it’s wise to consult with your doctor before adding any OTC drug into your skincare routine.

Bleach baths: Often recommended for eczema patients, soaking in a bath with just a small amount of added bleach, once or twice a week, may help soothe the itching and rash—especially in combination with diligent moisturizer use.

Downsides: Bleach baths can over-dry the skin and be painful if skin is cracked.

Salicylic acid: A common skincare ingredient, salicylic acid helps promote the skin’s natural exfoliation process to help reduce the scaling associated with psoriasis. It may also be used with other topical therapies to enhance their penetration.

Downsides: Salicylic acid is unlikely to provide meaningful improvement on its own. Salicylic acid shampoos for scalp psoriasis may lead to hair damage.

Pramoxine: Found in many over-the-counter eczema lotions and creams, this anesthetic has numbing properties that reduce the sensation of itch. 

Downsides: Relief from this anesthetic is temporary.

Hydrocortisone: This very mild steroid can be used to improve itching, irritation and inflammation caused by eczema and psoriasis.

Downsides: Hydrocortisone rarely offers effective, long-term symptom management. It’s essential to follow directions for application frequency to avoid side effects.

Prescription Therapies

Once eczema and psoriasis progress beyond the mild phase and perhaps begin to spread to cover a larger part of the body, prescription-based treatments are often necessary to manage and minimize flare-ups.

Topical steroids: Available in much stronger concentrations by prescription, these treatments relieve itching and inflammation quickly.

Downsides: The potential side effects associated with topical steroids include loss of effectiveness over time (which requires increasing dosage to maintain relief), thinning of the skin with long-term use and Topical Steroid Withdrawal Syndrome.

Topical JAK/calcineurin/PDE4 inhibitors: These well-established treatments come in varying strengths.

• JAK inhibitors: These drugs block the enzymes necessary for transmitting immune signals that trigger skin inflammation, redness and rashes.

Downsides: JAK inhibitors may not be appropriate for long-term, ongoing use or immunocompromised patients.

• Calcineurin inhibitors: Topical calcineurin inhibitors (TCIs) are nonsteroidal medications that work by stopping certain cells of the immune system from “switching on.” TCIs help calm eczema symptoms such as redness and itch and inflammation. These medications also minimize psoriasis flares and reduce scales—especially in areas with thin skin where topical steroids can be too irritating or potentially harmful.

Downsides: In 2006, the FDA implemented a black box warning for TCIs regarding long-term safety and a possible risk of lymphoma (a type of blood cancer).

• PDE4 inhibitors: Designed to block a specific type of enzyme that is involved in the inflammation process, this is one of the newest topical treatments for eczema and psoriasis.

Downsides: A small number of patients have reported burning or stinging after application. Other possible side effects include a worsening of eczema or psoriasis symptoms or skin infection.  

Oral antihistamines: Available in higher strengths by prescription (and in lesser strengths over the counter), antihistamines effectively reduce itching. These medications can help if itching associated with flare-ups makes it difficult to sleep.

Downsides: Itch relief is temporary, and these medications do not address the source of inflammation.

Oral immunosuppressants/JAK inhibitors: These oral prescription-based treatments for moderate-to-severe eczema and severe psoriasis target immune system activity that leads to skin inflammation.

Downsides: These drugs may not be safe when pregnant or breastfeeding and may require ongoing testing to monitor blood pressure and kidney function. 

Oral steroids: Although a potential treatment option for severe, persistent eczema and psoriasis, the American Academy of Dermatology advises that oral steroid treatment should be exclusively reserved for “acute, severe exacerbations and as a short-term bridge therapy to other systemic, steroid-sparing therapy.” 

Downsides: Long-term oral steroid use (i.e., more than one month) has been associated with serious side effects like skin thinning, infections, hair loss, weight gain, high blood pressure, glaucoma, cataracts and more.

Biologics: Delivered via injection, biologics essentially use human DNA to treat certain diseases at the immune system level. These drugs block protein messengers from binding to their cell receptors to stop or limit the immune system’s response. A calmer immune system means lower or less severe inflammation and therefore fewer eczema and psoriasis symptoms.

Downsides: Biologics should be used with caution as they have the potential to suppress the immune system and increase the risk of serious infections.

Systemic medications: These oral and injectable treatments are considered “off label”, which means that they are used to treat eczema and psoriasis despite being FDA-approved for treating other conditions. They are generally used for a short period of time to get eczema and psoriasis under control before tapering off or switching to topical medication for long-term management.

Downsides: These are serious drugs with serious potential for side effects, including infections, certain cancers, kidney damage, high blood pressure and more. 

How Phoilex Fits In

Phoilex represents a proven-effective, plant-based approach that works inside and out to restore balance to the skin. Our Active ReLeaf Spot Gel and Liverty Dynamic Drops can be used to calm and soothe the skin on their own, and they are also safe to use in conjunction with other over-the-counter and prescription-based therapies.

Dr. Papastergiou explains, “In many cases, a patient is advised to stop using a particular therapy when a certain level of improvement is achieved. The big question patients have is, what happens between these therapies? During this time, Phoilex works to maximize the asymptomatic period. What we’re seeing is that Phoilex helps increase the time before another course of treatment is necessary.”

Phoilex Active ReLeaf Spot Gel steps in when eczema and psoriasis flare up as well by protecting and drawing moisture to the skin. “The goal of any topical product is to restore integrity to the upper layers of skin, because skin that is more intact will experience less dryness and flaking, and your skin will get better quicker,” says Dr. Papastergiou.

The addition of our Liverty Dynamic Drops allows for a comprehensive, inside-out approach to improving the health and appearance of the skin. This ingestible daily tincture is also formulated with calming CBD to mitigate the negative effects that stress can have on skin conditions. It also works to support the liver so it can perform its essential toxin-filtering functions that help keep inflammation at bay.

Phoilex Active ReLeaf Spot Gel is powered by our proprietary Phyto-Active Blend™ of seven botanicals with powerful antioxidant and anti-inflammatory properties. This unique mix of ingredients has been clinically shown to provide hydrating, healing and soothing benefits when the skin is both calm and experiencing a flare.

Dr. Papastergiou emphasizes, “There are a ton of over-the-counter treatments that claim to do many things, yet very few of them are associated with any scientific evidence. At Phoilex, we’ve made the effort to establish our products’ efficacy, and the benefits are clear.”

 

Frequently Asked Questions

Q: What's the difference between treating eczema symptoms and addressing the root cause?

A: Over-the-counter treatments like bleach baths, salicylic acid, and pramoxine primarily relieve symptoms such as dryness, itching, and flaking, rather than addressing the underlying source of eczema or psoriasis. Prescription treatments, particularly biologics and immunosuppressants, work at a deeper level by targeting the immune system dysfunction that causes these chronic skin conditions. Understanding this distinction helps patients set realistic expectations for each treatment type.

Q: When should I move from over-the-counter treatments to prescription medications for my skin condition?

A: According to Dr. Papastergiou, patients typically start with over-the-counter options and progress to prescription-based treatments as the disease worsens or spreads to cover more of the body. If OTC treatments aren't providing adequate symptom relief after consistent use, or if your condition is significantly impacting your quality of life, it's time to consult with a dermatologist about prescription options. The goal is to maximize the asymptomatic period between flares through appropriate treatment escalation.

Q: Are topical corticosteroids safe for long-term use on eczema and psoriasis?

A: While topical corticosteroids are effective first-line prescription treatments for both eczema and psoriasis, long-term use can lead to significant side effects including skin thinning, stretch marks, and increased risk of skin infections. These medications should be used strategically during flare-ups rather than continuously, and always under medical supervision. Your doctor can help you develop a treatment plan that balances effectiveness with safety.

Q: What are the main side effects of biologic medications for psoriasis?

A: Biologic medications like Humira, Enbrel, and Stelara work by targeting specific parts of the immune system, which can increase susceptibility to infections and may raise the risk of certain cancers with long-term use. These treatments require regular monitoring through blood tests and medical check-ups to catch potential complications early. Despite these risks, biologics can be life-changing for patients with moderate to severe psoriasis who haven't responded to other treatments.

Q: Can I use salicylic acid with other psoriasis treatments?

A: Yes, salicylic acid is often used in combination with other topical therapies to enhance their penetration into the skin by removing scales and dead skin cells. However, salicylic acid alone is unlikely to provide meaningful improvement and works best as part of a comprehensive treatment plan. Be sure to consult with your healthcare provider about the proper order and timing of applying multiple topical treatments.

Q: Why do bleach baths help with eczema symptoms?

A: Bleach baths help soothe eczema itching and rashes by reducing bacteria on the skin's surface, particularly Staphylococcus aureus which commonly colonizes eczema-affected skin. When used once or twice weekly with just a small amount of bleach and followed by diligent moisturizer application, they can provide symptom relief. However, they can over-dry the skin and be painful if skin is cracked, so they're not suitable for everyone.

Q: What's the difference between immunosuppressants and biologics for treating severe skin conditions?

A: Immunosuppressants like methotrexate and cyclosporine broadly suppress the entire immune system, while biologics target specific immune system components involved in eczema or psoriasis. This targeted approach of biologics often results in fewer side effects compared to traditional immunosuppressants, though both medication classes require careful medical monitoring. Biologics are typically reserved for moderate to severe cases that haven't responded to other treatments due to their higher cost and administration requirements.

Q: Should I consult a doctor before using over-the-counter eczema or psoriasis treatments?

A: Yes, even though these treatments are available without a prescription, it's wise to consult with your doctor before adding any OTC drug into your skincare routine. A healthcare provider can help you choose the most appropriate treatment for your specific condition, ensure it won't interact with other medications you're taking, and provide guidance on proper usage. This consultation can also help you avoid wasting time and money on treatments that may not be effective for your particular situation.