A person may be able to treat eczema without steroids. Possible treatment options include topical calcineurin inhibitors, crisaborole, JAK inhibitors, and more.

Corticosteroids (steroids) are a common eczema treatment They work by reducing inflammation and itching from eczema, which gives the skin a chance to heal. This treatment is typically for short-term use only.

If you use steroids longer than directed and then stop abruptly, high potency steroid creams can cause a condition called topical steroid withdrawal syndrome. Symptoms include:

  • burning, stinging, and bright red skin
  • swelling
  • skin sensitivity
  • pimple-like bumps (papules)
  • nodules (deeper bumps)
  • pustules

As a result, many people seek alternatives to steroid creams for the treatment of their eczema. There are a variety of options to consider.

Read on to learn about steroid-free ways to treat eczema.

Topical calcineurin inhibitors (TCIs) are prescription medications that can treat eczema in both adults and children ages 2 and up who haven’t seen results from topical steroids and other conventional therapies, or who can’t take those treatments.

You apply this steroid-free eczema treatment directly to the skin. TCIs for eczema come in two forms:

  • tacrolimus ointment (Protopic), for moderate to severe eczema
  • pimecrolimus cream (Elidel), for mild to moderate eczema

TCIs work by stopping the activity of certain cells in the immune system. That helps reduce inflammation and relieve certain eczema symptoms, including itchy skin.

According to the National Eczema Society, TCIs for eczema may be suitable for brief periods to treat flares. They can also be for long term use to prevent flares. TCIs are generally safe and well-tolerated over the short term.

A common side effect of TCIs is a mild burning or stinging after applying the medication to the skin. This should last for about 15 to 20 minutes, according to the National Eczema Society.

This type of medication is relatively new, so the long-term risks are still unknown. However, the Food and Drug Administration (FDA) has implemented black box warnings on TCIs due to a possible risk of lymphoma, which is a type of blood cancer.

Talk with your dermatologist or a healthcare professional about whether the benefits of this medication outweigh the possible risks for you.

Crisaborole (Eucrisa) is an alternative to steroids for mild to moderate eczema. It works by blocking the production of an enzyme that helps regulate inflammation in the skin, which can provide relief from mild to moderate eczema symptoms.

This eczema treatment comes as an ointment that you apply to the skin, typically twice per day. It can be used by both adults and children as young as 3 months old.

The most common side effect of crisaborole is burning or stinging at the application site. This sensation typically goes away after you use the medication for a while. The medication can be used continuously over the long term, or intermittently when you experience an eczema flare.

Your doctor can recommend how long you should use this medication.

Janus kinase (JAK) inhibitors are relatively new in the treatment of eczema, and they don’t contain steroids.

They work by preventing a type of protein called cytokines from attaching to certain receptors in the body that cause overactivity in the immune system. This helps reduce inflammation and the severity of eczema symptoms.

You can take JAK inhibitors orally or apply them topically as a cream directly to the skin, depending on which type your doctor prescribes. JAK inhibitors approved to treat eczema include:

  • abrocitinib (Cibinqo)
  • upadacitinib (Rinvoq)
  • ruxolitinib (Opzelura)

These medications are typically for people with moderate to severe eczema who haven’t experienced positive results from other medications. While abrocitinib is only available to adults, updacitinib and ruxolitinib can be used in adolescents 12 years of age or older.

JAK inhibitors can be very effective at reducing eczema symptoms, according to a 2021 research review. However, there are some potential side effects, including:

  • nausea
  • swelling of the nasal passages
  • swelling in the back of the throat
  • headache
  • upper respiratory tract infection

Side effects with JAK inhibitors tend to be mild and get less intense over time, but you should still let a healthcare professional know if you experience any side effects.

JAK inhibitors also present additional risks with long term use. This is especially true with the oral versions of the medication. Rare but serious complications may include:

  • heart attack and stroke
  • blood clots
  • certain types of cancer

Because these medications suppress the immune system, you may be more likely to develop infections when using them.

Talk with a doctor about whether JAK inhibitors are the right alternative to steroids for your eczema, and discuss ways to reduce your risk of infections and other side effects.

It is now possible to treat eczema with two injectable medications:

  • dupilumab (Dupixent), available for adults and children ages 6 months and up
  • tralokinumab-ldrm (Adbry), available for adults and children over the age of 12 years

Injectable treatments for eczema do not contain steroids. They’re part of a class of medications called biologics, which are made from living cells or organisms.

They work by blocking overactivity in the immune system, which helps reduce inflammation. Injectables for eczema are typically for people with more severe symptoms that haven’t responded to other treatments.

These medications come in pre-filled syringes that your doctor can inject, or you may be able to inject them on your own at home. Redness and soreness at the injection site are common side effects, but these symptoms are usually mild.

Mild infections, including pink eye and upper respiratory tract infections, can also happen. In rare cases, certain types of eye conditions can develop while using these medications, so it’s important to let your doctor know about any vision changes you experience.

In addition to oral and topical medications, light therapy, or phototherapy, may help treat eczema flares without steroids. This treatment is typically for adults and children with moderate to severe eczema who haven’t experienced improvements with other treatments.

Phototherapy exposes all or parts of the body to ultraviolet (UV) light in a controlled setting, usually at a dermatologist’s office or another healthcare facility. Treatment can take anywhere from 30 seconds to 15 minutes.

Most people with eczema will need to receive two or three phototherapy treatments every week for a few weeks or months until symptoms improve.

Phototherapy helps eczema symptoms by reducing inflammation in the skin. While experts aren’t exactly sure how phototherapy works, a 2021 research review found that the treatment can reduce itchiness and the visible symptoms of eczema. It may also reduce the need to use other medications, such as steroids for eczema.

Some possible side effects of phototherapy are:

  • sunburn-like reactions
  • dry skin
  • premature skin aging

As with any UV exposure, phototherapy may increase the likelihood of developing skin cancer with repeated exposure. If sunlight triggers your eczema symptoms, you should avoid phototherapy.

What can I use instead of topical steroids for eczema?

If you want an alternative to topical steroids for eczema, there are many options to choose from, including:

  • nonsteroidal ointments and creams
  • oral and topical JAK inhibitors
  • injectable biologics
  • phototherapy

While topical steroids for eczema can cause side effects, other medications come with their own risks as well. Talk with your doctor about what to expect when switching eczema treatments and the pros and cons of various medications.

Can eczema be treated without steroids?

You may also be able to manage mild eczema symptoms without steroids or other medications. Some techniques include:

  • regularly moisturizing your skin
  • avoiding known eczema triggers
  • bathing in water that’s lukewarm, not hot
  • finding fragrance-free alternatives to harsh skin and body products

If at-home remedies don’t help your eczema symptoms, you may consider trying a medication recommended by a healthcare professional.

What can be used instead of cortisone cream?

Nonsteroidal skin creams and ointments can be used in place of cortisone cream to treat symptoms of eczema. Crisaborole and TCIs can be useful for both adults and children to help reduce inflammation and relieve itch.

Topical steroids are one of the first-line treatment options for eczema, but they can cause side effects and should only be used as directed by a healthcare professional. Fortunately, there are a variety of alternatives to steroids that can be used to treat eczema, including:

  • TCIs
  • crisaborole
  • JAK inhibitors
  • biologics
  • phototherapy

A doctor can make a specific treatment recommendation for you based on your age, treatment history, and the severity of your symptoms. Keep in mind that every eczema treatment comes with potential risks.