Eczema - Treatment Guide

Understanding Eczema Basics

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)	A	Steroid only	Betamethasone valerate 0.05 %	Cream	Thin layer 1 × /day	10 days, then stop
	B	Steroid + Non-steroid	Betameth. valerate 0.05 % → Protopic 0.1 %	Cream → Oint.	Steroid 1 × /day × 10 d → Protopic 2 × /day	Protopic up to 12 weeks or until clear
	C	Non-steroid (Protopic)	Protopic 0.1 %	Ointment	Thin layer 2 × /day	Until clear, max 12 weeks
Trunk • Arms • Legs	A	Steroid only	Betamethasone valerate 0.05 %	Ointment	Thin layer 1 × /day	10 days, then stop
	B	Steroid + Non-steroid	Betameth. valerate 0.05 % → Protopic 0.1 %	Oint. → Oint.	Steroid 1 × /day × 10 d → Protopic 2 × /day	Protopic up to 12 weeks or until clear
	C	Non-steroid (Protopic)	Protopic 0.1 %	Ointment	Thin layer 2 × /day	Until clear, max 12 weeks
Palms & Soles (thick-skin only)	A	Steroid only	Betamethasone dipropionate 0.05 %	Ointment	Thin layer 1 × /day + cotton gloves/socks nights 1-3	10 days, then stop
	B	Steroid + Non-steroid	Betameth. dipropionate 0.05 % → Protopic 0.1 %	Oint. → Oint.	Steroid 1 × /day × 10 d → Protopic 2 × /day	Protopic up to 12 weeks or until clear
	C	Non-steroid (Protopic)	Protopic 0.1 %	Ointment	Thin layer 2 × /day	Until clear, max 12 weeks
Scalp (hair-bearing)	A	Steroid only	Mometasone 0.1 %	Lotion	Apply to itchy areas 1 × /day	10 days, then stop
	B	Steroid + Non-steroid	Mometasone 0.1 % → Protopic 0.1 %	Lotion → Oint.	Steroid 1 × /day × 10 d → Protopic 2 × /day	Protopic up to 12 weeks or until clear
	C	Non-steroid (Eucrisa)	Eucrisa 2 % (new)	Ointment	Massage along part lines 2 × /day	Until clear, max 52 weeks
	D	Non-steroid (Protopic)	Protopic 0.1 %	Ointment	Dab part lines 2 × /day	Until clear, max 12 weeks

Flare Treatment Plan

What should I do when my eczema flares up suddenly?

You need to act fast with a 2-step plan:

1. 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)

2. 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:

1. Use lukewarm water—not hot

2. Pat skin gently (don’t rub dry)

3. 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.

Calcineurin Inhibitors (Tacrolimus & Pimecrolimus)

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.