What exactly is eczema and why does it itch so much?
A. Eczema (also called atopic dermatitis) is a long-term condition where the outer layer of your skin doesn’t hold water well. Tiny cracks let moisture escape and let irritants sneak in. Your immune system tries to fix this leak and releases chemicals that make the skin red, dry, and incredibly itchy. Scratching feels good for a moment, but it damages the barrier even more, so the itch comes back stronger. Think of it like a leaky roof-water keeps dripping until the hole is patched and the wood dries out. Your “patch” is daily moisturizer and, during flares, anti-inflammatory creams that calm the overactive immune response so the barrier can heal. For most adults, eczema isn’t contagious, isn’t an allergy to just one thing, and can’t be cured outright, but with the right routine you can keep the roof sound and live almost flare-free.
Is eczema the same as dry skin?
No. Dry skin (scientifically called xerosis) can make your skin flaky, but it doesn’t always itch or turn red. Eczema is dry skin plus underlying inflammation. Imagine dry grass versus a patch of grass on fire-both lack water, but the second also has heat and smoke. That “fire” is what makes eczema so itchy and bumpy. You treat plain dry skin mainly with moisturizers. Eczema needs moisturizers plus medicines that put out the immune “fire,” such as hydrocortisone or Protopic. Ignoring the inflammation means you’ll keep chasing dryness without ever reaching comfort. Once the inflammation is quiet, moisturizers do their job much better.
What triggers adult eczema flares?
Common spark plugs include cold, dry winter air; hot showers; scented detergents; rough fabrics (wool); sweat; stress; and even the common cold. Unlike in kids, food is rarely the main driver in adults unless you feel a clear reaction within minutes to hours of eating. People often have multiple triggers that add up until the skin tips into a flare. The good news: removing some triggers (like switching to fragrance‑free detergent and shorter showers) often makes a big difference-you don’t need to live in a bubble.
Does untreated eczema really harm me, or is it just a comfort issue?
Leaving eczema to smolder can lead to chronic scratching, thickened “elephant” skin, loss of sleep, anxiety, and infections because germ‑fighting proteins leak out of damaged skin.
Can eczema turn into skin cancer?
The rash itself doesn’t transform into cancer. However, decades of heavy, unsupervised steroid use without breaks can thin the skin so much that pre‑cancer changes are harder to spot. Also, nonstop scratching can occasionally cause chronic wounds that need monitoring. Using medicines correctly and seeing your doctor once or twice a year keeps risks tiny.
Is eczema contagious? Can my partner catch it?
No. Eczema is a personal barrier problem and immune reaction. You can hug, share towels, or sleep beside someone without passing eczema on. If your skin crusts yellow or oozes, that means a secondary infection like staph bacteria-treat the infection, but even then the bacteria, not eczema, is contagious.
How is adult‑onset eczema different from the kind kids get?
Adults may show eczema first on hands, eyelids, or the head‑and‑neck area rather than the classic elbow and knee folds seen in children. Adult skin is thicker and has more chronic‑looking plaques. Also, adults often juggle work stress, alcohol, and hormones that can shift flares. Treatment basics are the same, but potency choices and lifestyle advice are tweaked to adult routines.
Will I ever “grow out” of it at my age?
Some adults do see eczema fade over years, especially if they nail down good routines and avoid smoking, but many keep a tendency for quick flares during stress or winter. Think of it like having sensitive teeth—they may bother you less as enamel strengthens, yet a bad ice‑cream hit can still hurt. With today’s treatments, most people have skin that looks and feels normal most of the time.
Does eczema mean I have a weak immune system?
Not exactly. Your immune system is over‑reactive in the skin, not weak. It fires off inflammation at mild triggers instead of staying calm. Systemically you can still fight colds and flu just fine. The goal of treatment is to retrain that over‑eager skin immunity so it reacts only when truly needed.
Is stress really a trigger or is that a myth?
Stress is a proven amplifier. When you’re stressed, your body releases cortisol and adrenaline, which change blood flow and skin immunity-making it itchier and slower to heal. Stress also leads to poorer sleep and more scratching. You don’t need monk‑level calm, but small habits like 10‑minute mindfulness sessions, regular exercise, or simply sticking to a bedtime routine can noticeably cut flares.
TeleTest Flare-Treatment Steroid Cheat-Sheet
Do food allergies cause eczema? Should I cut out dairy or gluten?
Usually, no. Food allergies can worsen eczema but don’t cause it.
Only ~10% of eczema in kids is triggered by foods
Cutting out food without a proper test may harm growth
Can eczema cause long-term skin damage?
Yes, if not treated. Repeated flares and scratching can lead to:
Thickened, leathery skin (lichenification)
Colour changes (dark or pale patches)
Scars or chronic infection
Treating flares early helps prevent this.
Flare-Treatment Steroid Cheat-Sheet
Keep this table handy-it shows the exact creams and ointments our doctors prescribe, ordered from the gentlest to the strongest so you can match the tube in your hand to the right body part.
Strength
Medicine
Brand
Where it's used
Ultra-High
Clobetasol propionate 0.05 % ointment
Dermovate®
Very thick, stubborn patches on hands or feet; use only for a short 10-day burst.
High
Betamethasone dipropionate 0.05 % ointment
Diprosone® ointment
Strong option for tough patches on arms or legs; limit to 10 days.
Medium-High
Betamethasone valerate 0.1 % ointment
Betaderm® 0.1 % ointment
Step-up cream for rough, thicker areas that didn’t clear with mid-strength cream.
Medium
Mometasone furoate 0.1 % cream / lotion
Elocom®
Reliable everyday strength for most body flares; lotion works well on the scalp.
Medium
Betamethasone valerate 0.1 % cream / lotion
Betaderm® 0.1 %
Good middle strength for flares on arms, legs, or chest/back when hydrocortisone is too mild.
Low
Desonide 0.05 % cream / ointment
DesOwen®, generic
Gentle choice for folds or mild flares on sensitive skin.
Least Potent
Hydrocortisone 1 % cream / ointment
Emo-Cort®, Cortate®
Safest starter for face, neck, or groin flares; very low risk of skin-thinning when used as directed.
Treatment Choices
We've tried to simplify the treatment process and provide transparency so you know what your options are. Choose your body area, then pick Option 1, 2, or 3 for your preferred regimen.
Don't worry if you don't know which treatment to select - our doctor's will guide you through the process as it's meant to be simple, streamlined with clear instructions on how to evaluate your response.
If you don't know what treatment you need - don't worry - our physicians will provide a preferred treatment approach based on your current skin and previous responses to treatment.
Pick-Your-Plan: Flare Treatment
Body Area(s)
Plan
Type
Medication Strength
Form
How to apply
Duration - Flare Phase
FaceGroin / Genitals / Under-breast
A
Steroid only
Hydrocortisone 1 %
Cream
Thin layer 2 × /day
10 days, then stop
B
Steroid + Non-steroid
Hydrocortisone 1 % → Protopic 0.1 %
Cream → Oint.
Hydrocortisone 2 × /day × 10 d → then start Protopic 2 × /day
Protopic up to 12 weeks or until clear
C
Non-steroid (Eucrisa)
Eucrisa 2 % (new)
Ointment
Thin layer 2 × /day
Until clear, max 52 weeks
D
Non-steroid (Protopic)
Protopic 0.1 %
Ointment
Thin layer 2 × /day
Until clear, max 12 weeks
Eyelids / Around eyes
D
Non-steroid (Protopic)
Protopic 0.1 %
Ointment
Thin layer 2 × /day
Until clear, max 12 weeks
Neck
• Skin-folds (elbows, knees, armpits, top of hands and feet)
What should I do when my eczema flares up suddenly?
You need to act fast with a 2-step plan:
Control inflammation:
Use a prescribed anti-inflammatory cream or ointment (usually a topical steroid)
Apply twice daily until the skin is clear or nearly clear (usually 5–10 days)
Repair the barrier:
Apply a thick moisturizer right after the steroid, or at least 30 minutes later
Do this 2–3 times per day, even when not flari
How do I know if my flare needs steroid cream or just moisturizer?
Use steroid creams when:
The skin is red, swollen, or warm
It’s itchy even after moisturizing
There are signs of broken skin or oozing
Your usual moisturizer isn’t helping within 1–2 day
Are steroid creams safe to use? Won’t they thin my skin?
When used correctly, they’re very safe:
Choose the right potency for the body part (e.g. mild for face, stronger for hands)
Use short bursts (5–10 days) during flares
Take 1–2 day breaks during long courses (weekend-only dosing)
Skin thinning is rare when used under medical guidance.
Can I use my steroid cream every day long-term?
No—but you can use it during:
Active flares for up to 2 weeks
Maintenance regimens, like twice-weekly applications on flare-prone spots (called “weekend therapy”)
Long-term daily use can lead to thinning. That’s why flare suppression + moisturizers are key.
What if the flare isn’t going away with steroid cream?
If it’s been:
More than 2 weeks of prescribed use with no change
Or symptoms come back within 2 days of stopping
...then you may need:
A different class of topical (e.g. calcineurin or PDE-4 inhibitor)
Stronger steroid for short-term rescue
Check for infection that may be interfering with healing
Talk to your TeleTest physician if your flare isn’t responding.
Are there non-steroid options for flares?
Yes, especially for sensitive skin or long-term areas like the face:
Calcineurin inhibitors (tacrolimus or pimecrolimus)
Safe on face, eyelids, and folds
May cause stinging at first
Not associated with skin thinning
PDE-4 inhibitors (like roflumilast or crisaborole)
Newer options, safe on face and body
Used for mild-to-moderate eczema
They’re slower than steroids but better for long-term use or delicate areas.
How fast should a flare respond to treatment?
Most flares improve significantly within:
48–72 hours of correct treatment
Full clearing may take 7–14 days
If it worsens or spreads rapidly, infection may be present
Can I use antihistamines for flares?
They don’t treat the eczema itself, but can help with itch and sleep:
Use non-drowsy ones (e.g., cetirizine or loratadine) during the day
Use sedating ones (e.g., diphenhydramine or hydroxyzine) at night if itching keeps you awake
Not meant for long-term use—use as-needed only
Maintenance-Phase Plans
Start only if the same spot flares again within 4 weeks or flares 2 times in 3 months.
Stop once the area has stayed clear for 12 consecutive weeks.
Body Areas
Plan A (Steroid)
How & When
Plan B (No steroid)
How & When
✱ Special Notes
Thin-skin / sensitive
• Face • front of neck • groin / genitals • under-breast • armpits • elbow & knee folds
Hydrocortisone 1 % cream
Thin layer 2 × / week
Protopic 0.1 % ointment
Thin layer 2 × / week
For eyelids use Plan B only—no steroid here
Regular body skin
Trunk • arms • legs • backs of hands / tops of feet
Betamethasone valerate 0.05 % ointment
Thin layer every weekend (Sat & Sun)
Protopic 0.1 % ointment
Thin layer 2 × / week
Thick skin
Palms • soles
Betamethasone valerate 0.05 % ointment
Thin layer 2 × / week
Protopic 0.1 % ointment
Thin layer 2 × / week
Cotton gloves/socks on steroid nights help penetration
Scalp / hair-bearing
Mometasone 0.1 % lotion
Apply every weekend to itchy spots
Protopic 0.1 % ointment
Dab along part lines 2 × / week
Keep lotion off face to avoid steroid spread
Common Triggers and Prevention
What things in my daily routine might be flaring my eczema?
Common triggers include:
Fragranced soaps and body washes
Long, hot showers
Detergents or fabric softeners
Wool or scratchy clothing
Dry air (especially in winter)
Sweat and overheating
Emotional stress or lack of sleep
Keeping a symptom journal can help you link specific flares to products or habits.
Is Canadian winter really that bad for eczema?
Yes. Winter is the worst season for most eczema patients:
Cold air dries out your skin barrier
Indoor heating reduces humidity to <30%
Dry skin leads to more itch and inflammation
Use a humidifier indoors and moisturize several times daily during winter.
Should I stop using all soaps?
No-but you do need to switch to gentle products:
Use pH-balanced or syndet cleansers (like Cetaphil or Spectro)
Avoid bubble baths, bar soaps, and anything with fragrance
Clean only soiled or odour-prone areas - don’t scrub head-to-toe daily
Are laundry detergents a problem?
Yes, especially:
Fragranced detergents
Detergents with added enzymes or dyes
Fabric softeners or dryer sheets
Instead, choose:
“Free & clear” or baby-safe brands
Add an extra rinse cycle to remove residue
What kind of clothes should I wear to avoid flare-ups?
Better choices:
100% cotton or silk
Tagless shirts and seamless socks
Loose-fitting layers
Avoid:
Wool, especially next to skin
Polyester or acrylic
Tight clothing that rubs or traps sweat
Should I avoid swimming in chlorinated pools?
Not necessarily. In fact:
Short pool sessions may help reduce Staph bacteria
Rinse off within 5 minutes, then moisturize
Apply a thin layer of petroleum jelly before entering as a barrier
Daily Skin Care & Emollients
What’s the #1 thing I should do every day to control eczema?
Moisturize. It's the single most effective non-drug treatment. Regular emollient use:
Strengthens the skin barrier
Reduces water loss
Cuts the number of flares by 30–50%
Apply generously—think of it like a daily prescription.
Which is better: lotion, cream, or ointment?
Here’s how they compare:
Type
Best For
Notes
Ointments
Severe dryness, winter skin
Most effective but greasy
Creams
Everyday use
Good balance of hydration + comfort
Lotions
Mild eczema or hairy areas
Less moisturizing, evaporates faster
How much should I use per week?
Adults with moderate eczema need:
At least 250–500 g per week
A golf ball–sized amount covers both arms or both lower legs
If a small tube lasts weeks, you're probably underusing it.
When should I apply moisturizer—before or after showering?
Right after bathing, within 3 minutes:
Use lukewarm water—not hot
Pat skin gently (don’t rub dry)
Apply a thick layer of emollient while skin is still damp (“soak and seal” method)
What if moisturizer stings? Should I stop using it?
Try this first:
Switch to an ointment or cream without urea or fragrance
Apply emollient after steroid cream if your skin is inflamed
Test a small area first
Stinging often fades after a few days once the barrier improves.
What ingredients should I look for in a moisturizer?
Helpful ingredients:
Ceramides (restore skin barrier)
Colloidal oatmeal (soothes itch)
Glycerin or urea (draw water into skin)
Petrolatum (seals in moisture)
Avoid:
Fragrance or essential oils
Alcohol-based gels
Preservatives like methylisothiazolinone (MI)
Are “natural” products better?
Not always. Natural doesn’t mean non-irritating. For example:
Coconut oil (cold-pressed) may help mild eczema
Tea tree oil often causes allergic reactions
Always do a patch test before using a new product
Can I use moisturizer on my face and eyelids too?
Yes—but choose:
Lighter creams or gel-creams for day use
Avoid heavy ointments on oily skin
Avoid getting creams into the eyes
Use a product labelled “non-comedogenic” and patch-test near the jawline.
How can I stay consistent with skin care when I’m busy?
Here are practical tips:
Keep a small tube in your bag, car, or desk
Set reminders on your phone
Pair moisturizing with another habit (e.g., brushing teeth)
Use a pump bottle for easier access
Consistency matters more than the brand.
How Much Cream To Use: The Finger-Tip Unit Rule
What is the “finger-tip unit” and how does it help me apply the right amount of cream?
A finger-tip unit (FTU) is a practical way to measure how much topical cream or ointment to use. One FTU equals the amount of product squeezed out from a standard tube (5 mm nozzle) along the length of an adult's fingertip—from the tip to the first joint. This amount is roughly 0.5 grams and should be enough to cover an area of skin about the size of two adult palms (including the fingers).
How many FTUs should I use for different body parts?
Here’s a general guide for adults:
Face and neck: 2.5 FTUs
One arm (front and back, including hand): 4 FTUs
One leg (front and back, including foot): 8 FTUs
Trunk (front): 7 FTUs
Trunk (back and buttocks): 7 FTUs
Genital area: 0.5 FTU
What happens if I use too little or too much cream?
Using too little may result in poor control of your skin condition, while overuse—especially with corticosteroids—can raise the risk of side effects like skin thinning. The FTU method helps ensure consistent, effective, and safe application.
Medications
Topical Steroids
How do steroid creams actually work?
They reduce skin inflammation by:
Blocking immune pathways that drive redness, swelling, and itch
Repairing skin barrier indirectly by reducing flare activity
Calming symptoms quickly—often within 1–2 days
Are there risks with using steroid creams too often?
Yes—if overused or used incorrectly, they can cause:
Thinning of the skin (atrophy)
Stretch marks or spider veins in sensitive areas
Acne or rosacea (especially on the face)
Rare suppression of natural cortisol if used over large areas long-term
These risks are low when used as prescribed for short flare control.
How long can I use a steroid cream safely?
General safe limits:
Low-potency steroids (e.g., hydrocortisone 1%): up to 4 weeks continuous use
Medium or high-potency: usually 7–14 days per flare, with breaks
For ongoing prevention: twice-weekly use in high-risk areas is safe (called "maintenance therapy")
Can I use the same steroid cream on my face and hands?
No—different areas need different strengths:
Body Area
Recommended Potency
Eyelids/face
Low (e.g., hydrocortisone)
Arms, legs, trunk
Medium (e.g., betamethasone)
Hands, feet
Medium to high
Thick skin (palms, soles)
High (e.g., clobetasol)
Using a high-strength steroid on the face can cause damage—always check with your TeleTest physician.
What are calcineurin creams, and when are they used?
These are non-steroid prescription creams that reduce inflammation by blocking a different immune signal (calcineurin).
Used when:
Skin is too sensitive for steroids (e.g., face, eyelids, folds)
You're using steroids too often or for too long
Long-term flare prevention is neede
Do they have side effects?
Common side effects:
Stinging or burning the first few days—usually gets better
Rare mild redness or warmth after application
Not linked to skin thinning
They’re considered safe for long-term use, including in children ≥ 2 years old.
What’s the difference between tacrolimus and pimecrolimus?
Medication
Common Brand
Strength
Use
Tacrolimus
Protopic®
0.03% or 0.1%
Moderate-severe eczema
Pimecrolimus
Elidel®
1% cream
Mild-moderate eczema
Tacrolimus is stronger; pimecrolimus is milder and often used in young children or milder cases. TeleTest physicians generally advise Protopic as it's more effective.
PDE-4 Inhibitors (Crisaborole, Roflumilast)
What are PDE-4 inhibitors and how do they help eczema?
They block phosphodiesterase-4 (PDE-4), an enzyme involved in skin inflammation.
Benefits:
Targeted treatment for mild to moderate eczema
Safe on the face, eyelids, and sensitive areas
Steroid-free and safe for long-term use
What are the pros and cons compared to steroid creams?
Pros:
No risk of skin thinning
Safe for daily, long-term use
Ideal for steroid-sensitive patients
Cons:
Can cause burning or itching at first
May take longer to show full effect (up to 2 weeks)
Some are not covered by insurance or are more expensive
Tacrolimus (Protopic)
What is tacrolimus, and how does it work?
Tacrolimus is a non-steroidal prescription ointment used to treat moderate to severe eczema. It blocks calcineurin, an enzyme that triggers inflammatory cytokines like IL-4 and IL-13. It’s ideal for delicate skin areas—such as the face, eyelids, and folds—where steroids may cause thinning or pigmentation changes but it can be used anywhere.
How long has tacrolimus been studied and used?
It has been available in Canada since the early 2000s
Clinical trials followed patients for up to 4 years without major safety issues
Long-term studies show no increase in skin cancer or systemic immunosuppression when used appropriately
How long can I use it in real life?
Tacrolimus is approved for intermittent or long-term use. Most patients use it:
Twice daily during flares (5–14 days)
Then as-needed, or twice weekly for maintenance on frequently affected areas
Some patients use it for years, especially on the face or eyelids, without complications.
Does it sting? Is that normal?
Yes—up to 50% of patients feel:
Stinging or burning for the first few days
This usually improves within 3–7 days
Applying moisturizer 30 minutes before may help reduce this effect
Pimecrolimus (Elidel)
What is pimecrolimus used for? How is it different from tacrolimus?
Pimecrolimus is a 1% cream approved for mild-to-moderate eczema, especially in children ≥ 2 years old. It’s:
Less potent than tacrolimus
Associated with less stinging
Ideal for face, neck, eyelids, and infants and toddlers with thin skin
How long has pimecrolimus been around?
Approved in Canada since 2003
Safety studies tracked children for over 5 years with no serious side effects
No evidence of systemic immune suppression or long-term risks when used correctly
How long can I safely use pimecrolimus?
It can be used:
Twice daily during flares, for 1–3 weeks
Long-term intermittently, especially for maintenance therapy
It's safe for months to years, especially in steroid-sensitive areas
Medication Effectiveness
How long does tacrolimus (Protopic) keep eczema under control?
In a 12-month European study, adults using tacrolimus 0.1% ointment twice weekly experienced a median flare-free period of 142 days, compared to 15 days with placebo.
Reference:
Thaçi, D., Salgo, R., & Weidinger, G. (2008). Proactive treatment of atopic dermatitis in adults with 0.1% tacrolimus ointment: a randomized, double-blind, vehicle-controlled study. Journal of the American Academy of Dermatology, 58(6), 990-999
How effective is crisaborole (Eucrisa) in maintaining eczema remission?
In a 52-week study, patients using crisaborole 2% ointment once daily had a median flare-free period of 111 days, versus 30 days with vehicle.
Reference:
Paller, A. S., Tom, W. L., Lebwohl, M. G., Blumenthal, R. L., Boguniewicz, M., Call, R. S., ... & Simpson, E. L. (2023). Once-daily crisaborole ointment, 2%, as a long-term maintenance treatment in patients aged 3 months and older with mild-to-moderate atopic dermatitis: A randomized, double-blind, vehicle-controlled study. Journal of the American Academy of Dermatology, 88(4), 748-756.
What is the duration of disease control with roflumilast (Zoryve) 0.15% cream?
In a 56-week open-label extension study, patients who switched to twice-weekly application after achieving clear skin maintained disease control for a median of 281 days.
Reference:
Simpson, E. L., Eichenfield, L. F., Papp, K. A., Lebwohl, M. G., Gooderham, M. J., & Blauvelt, A. (2025). Long-term safety and efficacy with roflumilast cream 0.15% in patients aged ≥6 years with atopic dermatitis: A phase 3 open-label extension trial. Dermatitis, 36(1), 45-53.
How do these treatments compare to proactive steroid therapy?
A study on fluticasone propionate 0.05% cream applied twice weekly showed a median flare-free period of over 16 weeks, compared to 6 weeks with emollient alone.
Reference:
Berth-Jones, J., Damstra, R. J., Golsch, S., Livden, J., Van Hootegem, J. M., Van der Willigen, A. H., ... & Parker, C. A. (2003). Twice weekly fluticasone propionate added to emollient maintenance treatment to reduce risk of relapse in atopic dermatitis: Randomised, double blind, parallel group study. BMJ, 326(7403), 1367
Summary of Flare-Free Intervals:
These are references to study data but results may vary:
Tacrolimus (Protopic): ~142 days
Crisaborole (Eucrisa): ~111 days [New 2023]
Roflumilast (Zoryve): ~281 days [New 2025]
Fluticasone (Topical Steroid): 112 days
Always consult with your TeleTest physician to determine the best treatment plan for your eczema.
Pricing Comparison - Protopic/Elidel vs. Eucrisia/Roflumilast
How much do each of these drugs cost?
Updated May 2025 - Attached is a price survey from different pharmacies within Ontario.
(60 g tubes unless stated otherwise)
Medication
Costco
SDM
Rexall
Tacrolimus 0.1% (Protopic)
$244.01
$267.45
$268
Tacrolimus 0.03% (Protopic)
$228.40
$251.59
$261
Eucrisa 2% (Crisaborole)
$165.77
$186.23
$180
Roflumilast 0.3% cream (Zoryve)
$327.26
$354
$369
Roflumilast foam 0.3% (Zoryve)
$327.26
$354
$369
Roflumilast (Zoryve) - A New Non-Steroid Option - Released 2025
What is roflumilast, and how does it help eczema?
Roflumilast is a topical PDE-4 inhibitor that reduces inflammation in the skin by blocking the enzyme phosphodiesterase-4 (PDE4).
It's a steroid-free, once-daily cream that:
Is non-greasy and easy to apply
Is safe on sensitive areas like face and folds
Shows improvement in itch and lesion severity within days to 2 weeks in many patients
Is roflumilast approved for eczema in Canada?
Yes—but only one strength is authorized for eczema in Canada:
✔️ Zoryve 0.15 % cream
Approved by Health Canada on 17 March 2025
Indicated for mild-to-moderate eczema
For adults and children aged ≥ 6 years
It's used once daily
What about the 0.3 % cream or foam versions? Can I use those?
These are not approved for eczema in Canada, but are used for other conditions:
Formulation
Indication
Age
Approval Date
0.3 % cream
Plaque psoriasis
≥ 6 y
2023
0.3 % foam
Seborrheic dermatitis
≥ 9 y
Oct 2024
0.15 % cream
Eczema
≥ 6 y
Mar 2025
Note: All forms are once-daily and cosmetically elegant, but only the 0.15 % cream should be used for eczema.
How long can I use roflumilast? Is it safe long-term?
Yes. Studies support long-term, once-daily use:
No steroid-like side effects (e.g., skin thinning)
Well tolerated even in sensitive areas like face and neck
Most side effects are mild local stinging or burning, which improve over time
No systemic immune suppression noted in trials
You can use it continuously or as needed to prevent flares.
Is roflumilast (Zoryve) safe in pregnancy?
Roflumilast 0.15% cream (approved for eczema) and 0.3% cream/foam (for psoriasis/seborrheic dermatitis) are not recommended during pregnancy—here’s why:
There is very limited human safety data
Oral roflumilast (used for COPD) has been associated with fetal toxicity in animal studies
What to do:
✘ Avoid topical roflumilast if you're pregnant
Can I use roflumilast cream or foam while breastfeeding?
There’s no specific data yet on topical roflumilast and lactation, but general principles apply:
Likely minimal systemic absorption
No evidence it passes into breast milk
Given the lack of study data, we advise erring on the side of caution and not using this while breastfeeding
Tips
My cream stings when I apply it—is that normal?
Yes, especially with non-steroid treatments like Protopic (tacrolimus), Elidel (pimecrolimus), or Eucrisa (crisaborole):
Up to 50% of users report a stinging or burning sensation during the first 3–5 days
The feeling is temporary and usually improves as the skin barrier heals
Try applying a moisturizer 30 minutes before your medicated cream to buffer irritation
For very sensitive areas like the face or eyelids, chilling the tube in the fridge may help dull the stin
How can I tell if a cream will cause a reaction before using it?
Always do a patch test before starting a new prescription cream or over-the-counter product:
Apply a small amount to your jawline or inner elbow once daily for 2–3 days
If you see no major redness, swelling, or burning, it’s likely safe to proceed
If a rash develops, check with your provider before continuing—some people react to the base or preservatives, not the active drug itself
Should I keep any of my eczema medications in the fridge?
It’s optional, but helpful for some:
Tacrolimus (Protopic) and crisaborole (Eucrisa) can be stored in the fridge to reduce stinging
Cold ointments can provide a mild numbing effect
Don’t freeze them, and always check the label for temperature limits
How do I know if a cream is working or not?
Look for:
Itch reduction within 2–3 days
Visible redness and swelling reduction within 7 days
Full resolution may take 2–3 weeks, especially in thickened or chronic areas
If you’ve been using a cream as prescribed and there’s no improvement by day 10–14, talk to your TeleTest physician. It may be the wrong strength, or you may have an infection or incorrect diagnosis.
How long can I safely use these creams?
Here’s a general guide:
Steroid creams: safe in short bursts (5–14 days), with breaks; long-term use risks skin thinning
Tacrolimus/Pimecrolimus: safe for long-term use, especially on face, neck, and folds
Roflumilast or crisaborole: designed for ongoing daily use without steroid side effects
Always follow a step-down plan: intense daily use during flares, then taper to maintenance.
