Objective To explore the effect of loratadine tablets combined with 1% hydrocortisone acetate cream on eczema severity in patients with chronic eczema. Methods A total of 100 patients with chronic eczema admitted to Pingluo County Maternal and Child Health Hospital from January 2023 to January 2026 were selected, and they were divided into the control group and the observation group according to different treatment regimens, with 50 patients in each group. The control group was treated with loratadine tablets, and the observation group was treated with 1% hydrocortisone acetate cream on the basis of the control group. The treatment effect, eczema severity, serum inflammatory indicators and quality of life were compared between the two groups. Results The total effective rate of treatment in the observation group was 96.00%, which was higher than 84.00% in the control group (P <0.05). After treatment, the scores of lesion area and clinical manifestation in the observation group were lower than those in the control group (P <0.05). After treatment, the serum levels of CRP and IL-4 in the observation group were lower than those in the control group, while the IL-10 level was higher than that in the control group (P <0.05). After treatment, the score of Dermatology Life Quality Index in the observation group was lower than that in the control group (P <0.05). Conclusion The application of loratadine tablets combined with 1% hydrocortisone acetate cream in the treatment of chronic eczema can improve clinical efficacy, reduce the severity of skin lesions and inflammatory response, and improve patients' quality of life.