If you’ve been battling eczema and are concerned about the side effects of prolonged topical steroid use, you’re not alone. The global prevalence of atopic dermatitis is surging, and millions of patients find themselves trapped in a cycle of applying increasingly potent corticosteroids just to maintain a baseline level of comfort. Many people eventually experience diminishing returns, skin thinning, or the devastating reality of topical steroid withdrawal (TSW), leading them to ask: “What can I use instead of steroids for eczema?” Fortunately, a massive paradigm shift in modern dermatology has occurred over the last decade. Clinical science and natural barrier-care protocols now offer a multitude of highly powerful, targeted, steroid-sparing options designed to calm inflammation at the cellular level and repair your skin barrier. From advanced biologic injections and targeted synthetic creams to medical-grade emollients, there are now 7 highly effective alternatives to help you manage and overcome atopic dermatitis flare-ups safely without relying on traditional hydrocortisone or high-potency corticosteroids.

Understanding the Need for Steroid Alternatives

For over half a century, topical corticosteroids have served as the undisputed first-line pharmacological defense in treating atopic dermatitis and various subsets of eczema. These synthetic hormones are indisputably effective at broadly suppressing local immune responses, thereby swiftly reducing the acute erythema (redness), edema (swelling), and severe pruritus (itching) associated with inflammatory flare-ups. However, dermatologists and immunological researchers increasingly emphasize the vital importance of identifying and utilizing effective non-steroidal eczema treatment modalities. This shift is primarily driven by the escalating awareness of the severe, cumulative adverse physiological effects associated with the long-term, uninterrupted application of high-potency steroid creams.

The Risks of Prolonged Topical Steroids

While generally safe when utilized intermittently, in short durations, and strictly under careful medical supervision, the chronic application of topical steroids can precipitate a host of severe dermatological and systemic complications. One of the most documented and frequent localized side effects is skin atrophy, commonly referred to as skin thinning. Corticosteroids biochemically inhibit the synthesis of collagen and elastin within the dermal matrix. Over time, the epidermis loses its vital structural integrity, rendering it paper-thin, fragile, and highly susceptible to tearing, spontaneous bruising, and delayed wound healing. Prolonged exposure can also induce permanent telangiectasia (the appearance of visible, spider-like enlarged blood vessels on the skin’s surface), irreversible stretch marks (striae), and profound changes in localized skin pigmentation.

Furthermore, the risks extend beyond the surface of the skin. The systemic absorption of potent topical steroids—especially when applied over extensive body surface areas, under occlusion, or on highly permeable regions like the face, neck, and flexural folds—can occasionally suppress the hypothalamic-pituitary-adrenal (HPA) axis. This suppression can lead to secondary adrenal insufficiency, a serious medical condition where the body ceases to produce its own natural cortisol. Because of these well-documented risks, modern dermatological guidelines heavily emphasize the strategic use of steroid-sparing agents whenever clinically feasible to maintain long-term disease remission without the cumulative toxicity of traditional corticosteroids.

What is Topical Steroid Withdrawal (TSW)?

Another increasingly recognized and significant clinical concern driving patients to desperately seek out what they can use instead of steroids for eczema is the agonizing condition known as topical steroid withdrawal (TSW). Sometimes documented in medical literature as topical steroid addiction (TSA) or red skin syndrome, TSW is an iatrogenic (medically induced) condition that occurs when an individual abruptly ceases or significantly reduces the use of moderate-to-high potency topical steroids after prolonged, continuous application.

The clinical presentation of TSW can be catastrophically more severe than the original eczema the steroids were prescribed to treat. Symptoms classically include widespread, burning erythema that spreads beyond the original areas of eczema, intense and deep bone-level neuropathic itching, massive skin flaking or shedding (often described as “snowing”), oozing serous exudate from the skin, thermoregulation dysfunction (severe chills and sweats), and severe edema. The recovery trajectory for TSW is notoriously non-linear and can span many months to several years. To mitigate the profound risk of developing this debilitating syndrome, medical professionals strongly advise against the abrupt cessation of long-term steroids without strict medical guidance, advocating instead for a carefully tapered approach heavily supplemented by the integration of robust non-steroidal alternatives.

1. Topical Calcineurin Inhibitors (TCIs)

When patients and physicians search for a direct, immediate prescription substitute for topical corticosteroids, Topical Calcineurin Inhibitors (TCIs) are typically the very first line of defense explored. Introduced to the market in the early 2000s, TCIs represented a monumental breakthrough in non-steroidal dermatological therapeutics, offering potent localized anti-inflammatory effects entirely devoid of the risk of cutaneous atrophy (skin thinning) and HPA-axis suppression.

How Tacrolimus and Pimecrolimus Work

There are two primary TCIs currently available by prescription in dermatological practice: tacrolimus (marketed heavily as Protopic, available in 0.03% and 0.1% ointment strengths) and pimecrolimus (marketed as Elidel, available as a 1% cream). Both of these pharmacological agents function by precisely modulating the local immune system at the cellular level. Specifically, they penetrate the skin and bind to a cytoplasmic protein called macrophilin-12. This complex then inhibits calcineurin, a calcium-dependent phosphatase enzyme that is absolutely essential for the activation of T-cells. By blocking calcineurin, the drug prevents the dephosphorylation of the nuclear factor of activated T-cells (NFAT), completely shutting down the transcription and subsequent release of inflammatory cytokines like interleukins (IL-2, IL-4, IL-5) that aggressively drive the eczema inflammatory cascade.

According to extensive clinical research regarding Topical Calcineurin Inhibitors, these specialized medications effectively short-circuit the cellular signaling pathways that inevitably lead to severe itching, vasodilation, and epidermal hyperproliferation. Unlike topical steroids, which exert a broad, non-specific, and somewhat blunt immunosuppressive effect on all skin cells including fibroblasts, TCIs are surgically targeted. They fundamentally do not inhibit collagen synthesis. Therefore, they physically cannot cause skin atrophy, irreversible stretch marks, or the permanent vascular changes associated with long-term corticosteroid application.

Best Uses for Sensitive Skin Areas

Because TCIs are clinically proven not to thin the skin, they possess an exceptionally high value for treating eczema on highly sensitive, thin-skinned areas of the body where continuous steroid use is strictly contraindicated. These highly vulnerable anatomical areas include the face, eyelids, perioral region (around the mouth), neck, axillae (armpits), and groin. Dermatologists frequently prescribe pimecrolimus (Elidel) cream for mild to moderate eczema flare-ups on the face due to its lighter vehicle, while the more potent tacrolimus (Protopic) ointment is heavily utilized for moderate to severe flares on thicker skin surfaces or highly stubborn facial plaques.

It is vital for patients to be educated on a very common, albeit transient, initial side effect: a significant percentage of patients experience a noticeable burning, stinging, or warming sensation at the application site during the first few days of TCI therapy. This is a well-documented localized neurological reaction resulting from the release of substance P from nerve endings. This sensation typically subsides completely within a week as the epidermal barrier heals and the baseline inflammation decreases. Many dermatologists now utilize TCIs not just reactively, but as “proactive therapy”—instructing patients to apply the ointment to historical hot-spots twice a week to maintain remission and prevent future flare-ups entirely without steroids.

2. PDE4 Inhibitors (Crisaborole)

Another major leap forward in the realm of specialized, non-steroidal eczema management is the relatively recent development of topical phosphodiesterase 4 (PDE4) inhibitors. The vanguard and primary drug in this specific class is crisaborole, aggressively marketed under the brand name Eucrisa.

Reducing Inflammation Without Steroids

Crisaborole is an innovative, boron-based non-steroidal topical ointment explicitly formulated to penetrate the stratum corneum and inhibit the action of PDE4, an intracellular enzyme found to be hyperactive in the circulating immune cells of individuals diagnosed with atopic dermatitis. In a healthy cellular environment, cyclic adenosine monophosphate (cAMP) regulates inflammation. When the PDE4 enzyme is overactive in an eczema patient, it rapidly degrades cAMP. This degradation triggers a massive overproduction of pro-inflammatory cytokines while simultaneously suppressing the production of anti-inflammatory cytokines, driving the chronic, visible inflammation characteristic of an eczema flare.

By effectively inhibiting the PDE4 enzyme, crisaborole facilitates a rise in intracellular cAMP levels. This rise helps to quickly restore balance to the immune signaling pathways, thereby significantly reducing the clinical redness, intense itching, and structural breakdown of the skin barrier. The FDA approved Eucrisa in late 2016 specifically as a targeted steroid-free option for mild to moderate atopic dermatitis, establishing it as a highly critical tool for patients deeply invested in avoiding corticosteroid side effects and TSW.

Who Can Use Eucrisa?

Eucrisa is approved for use in a very broad demographic, including adults and pediatric patients as young as 3 months old, which serves as a powerful testament to its robust systemic safety profile when compared to the hazards of high-potency steroids. It is typically prescribed to be applied twice daily to all affected cutaneous areas. Similar to the experience with TCIs, the most frequently reported adverse event is transient application-site pain, frequently described as severe stinging or burning upon application to open excoriations. Dermatologists often advise keeping the ointment refrigerated to numb the application area, or using it in tandem with a heavy ceramide barrier cream. For patients dealing with chronic, low-grade localized eczema who require a consistent maintenance therapy that completely circumvents the adrenal suppression risks of steroids, Eucrisa presents a scientifically validated, highly viable alternative.

3. JAK Inhibitors (Topical and Oral)

Janus kinase (JAK) inhibitors represent the absolute cutting edge of modern dermatological immunology. They function by physically blocking highly specific intracellular signaling pathways that transmit messages from the cell receptor to the nucleus—messages that are directly responsible for the severe systemic inflammation and the maddening, sleep-depriving itch of atopic dermatitis. They provide highly precise, targeted relief and have rapidly emerged as incredibly powerful tools for patients entirely unresponsive to older, traditional treatments.

Targeted Relief with Opzelura

Ruxolitinib cream, marketed as Opzelura, is a highly potent topical JAK inhibitor recently granted approval for the short-term and non-continuous chronic treatment of mild to moderate atopic dermatitis in non-immunocompromised patients. By aggressively inhibiting the JAK1 and JAK2 signaling pathways, Opzelura rapidly neutralizes the downstream effects of multiple cytokines—most notably Interleukin-31 (IL-31), which is widely known in dermatology as “the itch cytokine.”

Clinical trial data overwhelmingly demonstrates that topical JAK inhibitors can provide profound, almost immediate relief from severe pruritus, frequently within a matter of days. This speed of action often drastically outperforms traditional non-steroidal creams and rivals the speed of mid-potency steroids. Because its mechanism of action is non-steroidal, Opzelura can be safely deployed on highly sensitive areas like the face, eyelids, and neck without generating the risk of skin atrophy or initiating topical steroid withdrawal. However, because of its potent, localized immune-modulating capabilities, its administration is carefully monitored, and prescribing guidelines strictly limit the maximum body surface area to which it should be applied to prevent excess systemic absorption.

Oral Options for Severe Cases

For individuals suffering from atopic dermatitis that covers a vast surface area of the body, or for those whose disease is clinically categorized as severe and recalcitrant, localized topical applications (whether they be steroidal or non-steroidal) are simply insufficient. In these severe clinical scenarios, oral JAK inhibitors, such as upadacitinib (Rinvoq) and abrocitinib (Cibinqo), are frequently utilized. These potent systemic medications work internally, disseminating throughout the body to comprehensively block the hyperactive immune signals driving the total-body systemic inflammation.

Oral JAK inhibitors are incredibly and notoriously effective, frequently clearing vast tracts of inflamed skin and halting the systemic itch cycle with remarkable speed. They serve as a vital, highly modern systemic alternative to traditional oral corticosteroids (like oral prednisone), which carry notoriously severe long-term systemic risks, including induced osteoporosis, rapid weight gain, hypertension, diabetes, and adrenal failure. Medical professionals at leading institutions like the Mayo Clinic carefully evaluate severe patients for these advanced therapies when standard topical protocols completely fail, heavily monitoring patients via routine blood work to ensure safety.

4. Biologic Therapies

Biologic medications, or simply biologics, are highly complex, genetically engineered proteins derived from human DNA genes. Unlike older systemic immunosuppressants (like methotrexate or cyclosporine) which broadly and bluntly suppress the entire human immune system, biologics are meticulously designed to target only one specific, microscopic component of the immune system. For patients with severe eczema, biologics have utterly revolutionized the global standard of care, offering profound, long-lasting clinical relief without the widespread toxicity associated with traditional oral steroids.

Dupixent (Dupilumab) for Eczema

The most prominent, famous, and widely prescribed biologic utilized specifically for the treatment of eczema is dupilumab, marketed globally as Dupixent. Administered via a routine subcutaneous injection (typically every two weeks), dupilumab is a fully human monoclonal antibody. It specifically binds to the interleukin-4 (IL-4) receptor alpha subunit on the surface of cells. By chemically locking onto this receptor, it effectively blocks the signaling cascade of both interleukin-4 (IL-4) and interleukin-13 (IL-13). In the pathogenesis of eczema, these two specific cytokines are recognized as the primary drivers of the type 2 (Th2) inflammation that causes the disease.

Comprehensive clinical studies and peer-reviewed data published regarding Dupixent (dupilumab) consistently demonstrate that it significantly improves overall skin clearance, radically reduces the debilitating severity of itching, and greatly enhances the overall quality of life and sleep architecture for patients who had previously suffered for decades from recalcitrant, full-body eczema. Because Dupixent selectively targets the exact inflammatory pathway of atopic dermatitis rather than broadly suppressing the immune system, its long-term safety profile is highly favorable, avoiding the organ toxicity seen with older systemic drugs.

When are Biologics Recommended?

Biologics are strictly not considered first-line treatments for mild, highly localized, or easily manageable eczema. They are exclusively indicated for patients suffering from moderate-to-severe atopic dermatitis whose disease remains inadequately controlled despite the diligent use of optimized topical prescription therapies (including steroids, TCIs, or PDE4 inhibitors), or when those topical therapies are medically inadvisable due to prior adverse reactions like TSW. Biologics provide a continuous, systemic, utterly steroid-sparing mechanism to manage the disease at its deepest immunological root, making them a literal life-changing intervention for individuals dealing with crippling, full-body flare-ups.

5. Medical-Grade Emollients and Barrier Repair Creams

While advanced pharmacological interventions focus on manipulating the immune system to halt the inflammatory cascade, the fundamental physiological and structural defect in atopic dermatitis is a severely compromised epidermal barrier. Eczema-prone skin inherently lacks sufficient structural lipids, vital proteins (like filaggrin), and natural moisture-retaining factors. This defect allows essential cellular water to rapidly escape (a process known as transepidermal water loss, or TEWL) while simultaneously allowing environmental irritants, allergens, and bacteria to easily penetrate the skin. Therefore, the daily, aggressive application of medical-grade emollients remains an essential, totally non-steroidal foundational pillar of any comprehensive eczema management strategy.

The Role of Ceramides

Ceramides are highly complex lipid molecules naturally found in massive concentrations within the cell membranes of the stratum corneum (the uppermost layer of the skin). In the established “brick and mortar” model of the skin barrier, skin cells (corneocytes) are the bricks, and lipids (ceramides, cholesterol, and fatty acids) are the mortar holding everything tightly together. Clinical biopsies reveal that individuals with atopic dermatitis naturally exhibit a profound, genetic deficiency in ceramides.

Prescription and high-quality over-the-counter barrier repair creams formulated with a precise, scientifically optimized physiological ratio (often 3:1:1) of ceramides, cholesterol, and free fatty acids actively and physically rebuild this compromised barrier. Products containing these vital physiological lipids actively draw moisture into the dermal layers and seal it there. By continuously repairing the physical barrier integrity, patients experience drastically fewer flares and less allergen penetration, thereby naturally reducing their overall dependence on medical treatments and topical steroids. The consistent, daily application of thick, ceramide-rich moisturizers is universally recommended by the American Academy of Dermatology as the absolute baseline for preventing the relapse of atopic dermatitis.

Ointments vs. Lotions

When selecting a non-steroidal barrier repair product, the vehicle of the moisturizer matters immensely. Lotions contain a very high percentage of water mixed with alcohol and preservatives. While they feel cosmetically elegant, light, and spread easily, the water within them evaporates incredibly quickly, often drawing even more native moisture out of the already compromised eczema skin. Furthermore, the high water and alcohol content frequently causes severe stinging when applied to open fissures or cracked skin. Creams are significantly thicker, containing a much higher oil-to-water ratio, making them highly effective for routine daily maintenance.

However, pure ointments (such as 100% petroleum jelly or specifically formulated occlusive healing ointments) remain the absolute gold standard for treating severe eczema and excessively dry, cracked skin. Ointments contain the highest possible ratio of oil, forming an impermeable, highly occlusive physical barrier over the epidermis that viciously traps internal moisture and entirely shields the vulnerable skin from external environmental irritants. When searching for a pure, non-steroidal mechanical intervention, transitioning completely from a watery lotion to a heavy, medical-grade ointment can frequently yield the most dramatic, immediate improvements in skin hydration and barrier strength.

6. Phototherapy (Light Therapy)

For patients suffering from highly widespread eczema that proves exceedingly difficult to manage with topical creams alone, and for whom potent systemic drugs or biologics may be either medically contraindicated or financially out of reach, phototherapy stands as a highly proven, highly effective, non-pharmacological, and entirely steroid-free alternative.

How UV Light Reduces Inflammation

Clinical phototherapy involves systematically exposing the patient’s affected skin to carefully calibrated, therapeutic wavelengths of ultraviolet (UV) light. In modern dermatology, the absolute gold standard for eczema is Narrowband UVB (NB-UVB), which utilizes a very specific wavelength of light (typically 311 to 313 nanometers). When this specific UVB light penetrates the epidermis, it exerts a profound, localized immunosuppressive effect. It induces apoptosis (programmed cellular death) in the hyperactive, inflammatory T-cells residing in the skin and drastically reduces the localized production of pro-inflammatory cytokines.

Furthermore, consistent NB-UVB phototherapy physically alters the skin structure by thickening the stratum corneum, effectively fortifying the barrier against irritants. It also promotes a significant increase in the local production of naturally occurring antibacterial peptides. This peptide increase helps dramatically to prevent the secondary bacterial skin infections (most notably Staphylococcus aureus) that so frequently complicate and exacerbate atopic dermatitis. Unlike topical steroids, which relentlessly thin the skin over time, phototherapy physically strengthens the barrier while simultaneously downregulating the localized immune response.

What to Expect During Treatment

Phototherapy is a rigorous medical procedure typically performed in a clinical dermatologist’s office, though highly regulated home-units are occasionally prescribed for severe, chronic cases. Patients undress and stand in a specialized light booth for a duration ranging from a few seconds to several minutes, generally 2 to 3 times per week. The dosage of the UV light is mathematically and precisely calibrated by the physician based on the patient’s specific Fitzpatrick skin type and the severity of their eczema, ensuring therapeutic efficacy while actively avoiding any risk of sunburn.

A standard induction course of phototherapy may last several months. While it unequivocally requires a significant logistical time commitment for repeated office visits, it boasts a robust, highly documented clinical track record of inducing prolonged, deep remission in moderate to severe eczema patients. It acts as a superb, systemic-level steroid-sparing modality with minimal systemic side effects when compared to oral immunosuppressants.

7. Natural and Home Remedies

In addition to advanced medical therapies and pharmaceuticals, several highly studied, evidence-based natural remedies can serve as exceptional adjuncts to a comprehensive, steroid-free eczema regimen. While these natural methods may not possess the sheer pharmacological power to single-handedly halt a severe, acute immune flare, they are highly effective at soothing neuropathic itch, deeply hydrating the skin, and significantly minimizing the frequency of disease exacerbations when used consistently.

Colloidal Oatmeal Baths

Colloidal oatmeal simply refers to whole oats that have been finely milled and processed so they can remain suspended in a liquid medium without settling. It is officially recognized and classified by the FDA as an over-the-counter skin protectant, possessing proven, clinical anti-inflammatory and antipruritic (anti-itch) properties. Colloidal oatmeal’s efficacy is largely attributed to avenanthramides, unique phenolic compounds found exclusively in oats that have been shown to directly inhibit the release of inflammatory cytokines and histamine within the epidermal layers.

Soaking in a lukewarm bath heavily infused with high-quality colloidal oatmeal for 15 to 20 minutes can significantly and rapidly reduce the intense, maddening itching and profound redness of an active eczema flare. Furthermore, the highly mucilaginous nature of the suspended oatmeal leaves a soothing, protective, and hydrating physical film over the compromised skin barrier upon exiting the bath, directly assisting in critical moisture retention without any need for synthetic pharmacological agents.

Virgin Coconut Oil

Cold-pressed, virgin coconut oil is widely recognized and frequently utilized in dermatological research for its unique, dual-action capabilities serving as both a powerful emollient and a mild, natural antimicrobial agent. It contains remarkably high levels of lauric acid, a medium-chain fatty acid that has demonstrated proven in-vitro and in-vivo efficacy against Staphylococcus aureus—the specific strain of bacteria most commonly responsible for aggressive colonization and subsequent secondary infections in highly vulnerable, eczema-prone skin.

Applying liberal amounts of raw, virgin coconut oil to slightly damp skin immediately after bathing helps aggressively lock in water, drastically increases skin surface lipid levels, and actively reduces the risk of secondary bacterial infections that act as massive triggers for eczema flares. In direct contrast to other natural oils (like olive oil, which studies suggest can actually disrupt the skin barrier by damaging the lipid structure), coconut oil physically fortifies the barrier. It remains a highly accessible, exceedingly safe, and entirely natural alternative to purely synthetic barrier creams and acts as a mild anti-inflammatory agent.

Frequently Asked Questions

Can you heal eczema without steroid creams?

Yes, many individuals successfully manage, control, and effectively heal their eczema flare-ups entirely without relying on corticosteroid creams. This is generally achieved through a rigorous, multi-faceted approach utilizing targeted steroid alternatives. This includes utilizing prescription non-steroidal options like topical calcineurin inhibitors (Protopic, Elidel) or PDE4 inhibitors (Eucrisa), paired with the extremely diligent daily application of heavy, ceramide-rich medical barrier creams. For highly severe cases, modern advanced systemic therapies or highly targeted biologics (like Dupixent) provide a powerful mechanism to clear the skin globally without any use of topical or oral steroids.

What is the best over-the-counter alternative to hydrocortisone?

The most effective over-the-counter (OTC) alternatives to hydrocortisone strictly focus on aggressive physical barrier repair and neurological itch relief. Highly effective, scientifically backed OTC options include ultra-thick occlusive ointments (like 100% pure white petrolatum), medical-grade ceramide-dominant restorative creams, and specific skin protectants containing high percentages of colloidal oatmeal for their natural anti-inflammatory avenanthramides. Additionally, OTC anti-itch lotions formulated with pramoxine hydrochloride are highly beneficial, as pramoxine acts as a local anesthetic, temporarily numbing the skin to interrupt the damaging scratch-itch cycle entirely without the use of steroids.

How long does topical steroid withdrawal last?

The timeline and total duration of topical steroid withdrawal (TSW) is notoriously highly variable and heavily depends on multiple physiological factors: the specific potency of the synthetic steroids used, the total length of continuous usage, the body surface area affected, and the individual patient’s unique metabolic and cellular response. Recovery is rarely linear and can unfortunately take anywhere from several grueling months to multiple years. During this protracted period, the skin must slowly and painstakingly rebuild its native cellular matrix, regulate its own vascular tone, and re-establish a functional lipid barrier. Managing TSW absolutely requires close, empathetic medical supervision and the heavy utilization of supportive, completely non-steroidal therapies to endure the severe withdrawal symptoms safely.

Are calcineurin inhibitors safer than steroids?

Yes, topical calcineurin inhibitors (TCIs) are widely considered significantly safer than topical steroids regarding long-term, proactive, and continuous use. This specific safety profile exists because TCIs fundamentally do not inhibit collagen production, meaning they physically cannot cause skin atrophy (thinning), irreversible stretch marks, or the permanent vascular changes (telangiectasia) universally associated with prolonged corticosteroid application. This vital distinction makes TCIs the absolute preferred, gold-standard choice for treating sensitive, thin-skinned anatomical areas like the face, eyelids, and neck. However, they carry their own specific clinical warnings and transient side effects (like application-site burning) and must always be used precisely as directed by a healthcare professional.

Is coconut oil good for eczema flare-ups?

Yes, cold-pressed virgin coconut oil is exceptionally beneficial for managing mild to moderate eczema flare-ups due to its superb physical emollient properties and its high natural concentration of lauric acid, which breaks down into monolaurin—a compound possessing potent natural antibacterial qualities. Eczema-prone skin is structurally compromised and highly susceptible to Staphylococcus aureus bacterial colonization, which physically drives further inflammation and flaring. High-quality coconut oil effectively helps to moisturize and seal the compromised stratum corneum while simultaneously mitigating the severe risk of bacterial overgrowth, making it a truly excellent, scientifically sound natural, steroid-free adjunctive therapy.