Eczema Treatment: Effective, Evidence-Based Approaches

The itch that rashes. The endless cycle. The never ending plague. #Eczema, also called atopic dermatitis, affects millions worldwide, causing red, itchy, inflamed skin, sleep disturbances, and a reduced quality of life. If you’re searching for effective eczema treatment, it’s important to focus on evidence-backed approaches rather than quick fixes. In my realm of naturopathic medicine, the three (currently) most studied strategies to address the never-ending itch are topical colloidal oatmeal, phototherapy, and probiotics. Dive in deeper with me below as we uncover how of these works their magic.

Colloidal Oatmeal for Eczema: A First-Line, Skin-Barrier Support

One of the most effective eczema treatments starts with repairing the skin barrier. Eczema-prone skin is vulnerable to water loss, altered pH, inflammation, and increased colonization by bacteria like Staphylococcus. Colloidal oatmeal for eczema has been shown in lab and clinical studies to strengthen the skin barrier, increase hydration, normalize pH, improve microbiome diversity, and reduce itch, dryness, and redness. This makes it more than just a moisturizer—it’s a scientifically backed “emollient plus.”

Research highlights its effectiveness. In a randomized trial of 61 adults and teens with mild-to-moderate atopic dermatitis, a 1% colloidal oatmeal cream used for 14 days reduced the Eczema Area Severity Index (EASI) by 51% and the Atopic Dermatitis Severity Index (ADSI) by 54%. Another study on hand eczema found that combining 1% colloidal oatmeal with topical steroids significantly improved severity and quality-of-life scores over six weeks. Reviews show consistent improvement across ages 3 months to 60 years.

For practical use, apply a cream or lotion containing around 1% colloidal oatmeal twice daily on affected areas and as a maintenance moisturizer on healthy skin. Colloidal oatmeal baths two to three times per week—or daily during flares—can provide additional relief. While generally safe, those with oatmeal or nickel sensitivities should do a patch test first. Remember, colloidal oatmeal supports eczema management—it’s not a cure.

Phototherapy for Eczema: Clinic-Based Treatment for Moderate to Severe Cases

For moderate-to-severe eczema or cases unresponsive to topical care, phototherapy can be highly effective. Phototherapy for eczema uses controlled ultraviolet (UV) light, usually narrowband UVB, to reduce inflammation, modulate immune activity, and help clear lesions. Many patients experience reduced itch, fewer flare-ups, and improved skin texture when topical treatments alone aren’t enough.

Clinical studies show promising results. A review of multiple studies found that when phototherapy is combined with topical steroid creams, patients experience much less itching — dropping by more than half — and sleep improves significantly, with nighttime disruption also cut by more than half. While the overall evidence is modest, phototherapy can provide rapid, meaningful improvement for some patients. Treatments must be done under dermatologist supervision to monitor for side effects like sunburn, premature skin aging, and potential long-term cancer risk.

Phototherapy typically requires two to three sessions per week for several weeks, with a maintenance plan afterward. While home LED devices exist, clinic-based UVB phototherapy has stronger evidence. This advanced eczema treatment requires commitment and realistic expectations—it is not a simple OTC solution.

Probiotics for Eczema: Potential Adjunct with Mixed Evidence

The gut-skin axis suggests that gut microbiome imbalances may contribute to eczema. Probiotics, such as Lactobacillus rhamnosus GG, have been studied for eczema prevention and symptom reduction.

Research is mixed. A meta-analysis of 28 trials (6,705 participants) found a 22% lower risk of developing eczema in children under four using probiotics (risk ratio 0.78, 95% CI 0.71–0.88). However, other studies, including a placebo-controlled trial in infants, showed no significant therapeutic effect on established eczema.

Probiotics for eczema may offer modest benefits, especially in early life or for those with gut concerns, but they are not reliable as standalone treatments. If you choose to try probiotics, select well-studied strains, use them alongside conventional eczema care, and track any changes in flare frequency or severity.

Building a Practical, Evidence-Based Eczema Treatment Plan

Managing eczema effectively requires a multi-step approach. First, focus on skin barrier repair and trigger control. Use gentle, fragrance-free cleansers, take short lukewarm showers or baths, pat skin dry, and apply moisturizers promptly—ideally containing colloidal oatmeal. Identify triggers such as soaps, detergents, heat, sweat, or certain fabrics, and minimize exposure.

During flares, apply colloidal oatmeal creams twice daily and consider oatmeal baths two to three times per week. If eczema persists or is moderate-to-severe, consider removing food sensitivities and starting phototherapy to provide significant relief. Probiotics can serve as an adjunct, but expectations should be realistic—they are not primary therapy. Consistent monitoring of flare frequency, severity, and sleep disturbances, along with regular dermatology follow-ups, is essential.

Final Takeaways

If you live with eczema, start with barrier repair—use gentle cleansers and moisturizers with colloidal oatmeal. For further support, it may be time to remove food sensitivities and start phototherapy. Probiotics can offer additional support, particularly in early life or with gut concerns. If you want a tailored treatment plan addressing your individual skin needs, schedule a FREE consultation with one our our holistic practitioner at IVY Integrative today!

Until next time,

Author: Dr. Chelsea Birch, ND, RH (AHG), CBHT

References

1. Draelos ZD. Colloidal oatmeal: History, chemistry, and clinical properties. J Drugs Dermatol. 2018;17(9):1050–1054. Link

2. Vakharia PP, et al. Efficacy of colloidal oatmeal in atopic dermatitis: A review of clinical evidence. J Am Acad Dermatol. 2012;67:605–612. PubMed

3. National Eczema Association. Colloidal Oatmeal for Eczema. Link

4. Sidbury R, et al. Guidelines of care for the management of atopic dermatitis: Phototherapy and systemic therapy. J Am Acad Dermatol. 2014;71(2):327–349. PubMed

5. Hanifin JM, et al. Narrowband UVB phototherapy for atopic dermatitis. Dermatol Clin. 2013;31:273–285. PubMed

6. Doege K, et al. Probiotics for the prevention of eczema: Systematic review and meta-analysis. J Allergy Clin Immunol. 2018;141:1273–1286. PubMed

7. Kalliomäki M, et al. Probiotics in infancy for the prevention of atopic disease: A randomized placebo-controlled trial. Lancet. 2001;357:1076–1079. PubMed

Disclaimer:

This information is generalized and intended for educational purposes only. Due to potential individual contraindications, please see your primary care provider before implementing any strategies in these posts.