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Why Eczema Treatments Fail

Medically Reviewed by Sabrina Felson, MD on March 06, 2022

Eczema treatment doesn’t always work the way you hope it will. Sometimes creams don’t provide enough relief for those itchy, scaly patches on your skin. Steroid creams and ointments of different levels of strength are the mainstay of eczema treatment. But they don’t always work; learn why. You may also learn that your skin won’t heal for reasons that have nothing to do with your medication. Some of them may surprise you.

Within a week of treatment your eczema should be improving. If not, let your doctor know. You may benefit from something as simple as a change in medication. No eczema treatment works for everyone. It may take trial and error to find one that works for you.

You May Be Misdiagnosed

You have the symptoms of eczema. Your doctor diagnosed you with eczema. Clearly, you have eczema, right?

Maybe not.

Several other skin conditions cause similar symptoms. It’s possible you have one of these, by itself or in addition to eczema. There’s no definitive lab test for eczema. To diagnose it, your doctor will look at your symptoms and medical history.

Eczema is most often confused with fungal or tinea infections. But while steroid creams and ointments are the first line of treatment for eczema, they can make fungal infections worse. Psoriasis is another skin rash that can be confused with eczema. Sometimes the only way to tell these conditions apart is to take a scraping of the rash and look at it under a microscope.

Your Dermatitis Needs a Stronger Steroid or Different Medication

People often use the terms "eczema" and "dermatitis" to mean the same thing. When someone says they have "eczema," usually what they mean is they have atopic dermatitis. It is the most common subtype of eczema. Experts believe atopic dermatitis results from a combination of genes and environmental triggers that overstimulate the immune system.

Eczema is an umbrella term that covers seven specific types:

All of these types of eczema inflame your skin. They cause some common symptoms:

  • Dryness
  • Itching
  • Scaly patches
  • Rashes
  • Blisters

While they do have a lot in common, these different forms of eczema require different potency (strength) steroid creams and different potency of ointments. For instance, dyshidrotic eczema, which usually affects the hands, requires higher dose steroids to go away.

Basic Skin Hygiene for Eczema

Remember, drugs are only part of an eczema treatment plan. Follow these basic steps to keep your skin healthy:

  • Don’t take steaming hot showers -- hot water dries out the skin
  • Keep your showers to 10 minutes or less
  • Use a loofah with a liquid cleanser
  • Put on moisturizer within 5 minutes of bathing
  • Use an unscented skin cream with a neutral pH. There are many on the market that are made for people with eczema.
  • Pat your skin dry -- don’t rub
  • Wear gloves when you do chores that expose you to skin irritants

Stay Away From Triggers

Find out what your common triggers are and stay away from them as much as possible. There are many substances in your environment that may make your symptoms worse. Some are known triggers. You may also have triggers you’ve never even thought about. Here’s a partial list of some of the most common ones, indoors or outside:

  • Dust mites
  • Dry air
  • Heat
  • Humidity
  • Pet dander
  • Sudden temperature changes
  • Tobacco smoke
  • Wind or cold (causing dry skin that cracks and may bleed)
  • Mold
  • Pollen
  • Pollution (measured by the Air Quality Index)
  • Stress
  • Food allergies

Stay Away From Skin Irritants

Sometimes the problem is that you need to identify and remove an irritant in order for the inflammatory rash to go away. Here are some examples:

  • Medicated skin creams or oral retinoid medication
  • Bleach
  • Metals like nickel that are commonly found in jewelry
  • Soaps, detergents, and fabric softeners
  • Foods that have a lot of acid, such as tomatoes, pineapples, or citrus fruits

Obstacles to Following Your Treatment Plan

Eczema treatments can effectively get this skin disease under control -- if you follow them as your doctor prescribes. But that can be challenging.

Did you take your medications as you were supposed to? Have you been able to avoid your triggers? Don’t worry if your answer is “no.” Just be honest about what you found challenging at your next appointment. These are just some of the reasons people may not be able to follow their doctor’s recommendations:

  • Frustration with how well or fast the medication works
  • Inconvenience
  • Fear of side effects
  • Forgetfulness
  • Financial burden
  • Dislike of prescription medication
  • Confusion about how to use the medications
  • Not understanding how the medications work
  • Not understanding what might happen if you don’t treat the rash

It may feel awkward to tell your doctor you haven’t followed up on your treatment plan. But it’s an important conversation to have so that you can work together on ways to overcome the barriers, even if they’re financial. Also, your doctor will not want to prescribe stronger medications when the current medication hasn’t had a fair chance to work.

Your Eczema Is Tough to Treat

In some cases, for different reasons, eczema is hard to drive into remission. A few obstacles to successful treatment:

  • Skin infections. You may need to address a secondary infection in order to get your eczema under control. Staphylococcus aureus, a type of bacteria that causes staph infections, makes a toxin that worsens eczema. Infection with herpes simplex virus, which causes cold sores, can trigger eczema flares.
  • Food sensitivities. A food sensitivity may trigger flares in infants and children. This happens less often in adults. Your dermatologist can help you better understand the role of food triggers, if you or your child have any, and decide what steps to take next.
  • Topical medications can sting. Some people are highly sensitive to topical treatments for eczema. Ingredients in creams and ointments may cause stinging, burning, and other skin discomfort, sometimes for a few days.
  • Creams and ointments aren’t always practical. Depending on where on your body your flare is happening, it can be hard to apply your treatment without help. Or you may have to choose between slathering on cream and getting dressed for work. And if you have young children, there may be a battle of wills if they don’t like the sensation of a cream or ointment on their skin.

Lifestyle Tips to Help Your Treatment Work

If your eczema treatment doesn’t seem to work, you can double down on common-sense lifestyle strategies to help reduce the impact of this disease. For example, keep your skin moisturized, keep your fingernails short so you won’t damage your skin when you scratch, and use gel packs or cool compresses to cool inflamed skin patches.

Most important: call your dermatologist about your discomfort. Once you get to the root of the problem, you can get on a better path to healing your skin. You may need a different treatment or new strategies to make your current treatment work better for you.

Show Sources

SOURCES:

Expert Review of Clinical Immunology: “When topical therapy of atopic dermatitis fails: a guide for the clinician.”

Journal of Clinical Medicine: “Diagnosis of Atopic Dermatitis: Mimics, Overlaps, and Complications.”

DermNet NZ: “Irritant Contact Dermatitis,” “Allergic Contact Dermatitis,” “Dermographism,” “Nummular Dermatitis,” “Dermatitis.”

National Eczema Association: “What is Eczema?” “Atopic Dermatitis,” ''These Are the 7 Types of Eczema and Here’s How to Tell Which One(s) You Have.”

Advances in Experimental Medicine and Biology: “Adherence in Atopic Dermatitis.”

American Academy of Dermatology: “How Can I Find Indoor Eczema Triggers?” “How Can I Find Eczema Triggers Outdoors?” “Stress: Is It A Common Eczema Trigger?” “Will Swimming in a Pool Trigger My Child’s Eczema?”

The Journal of Allergy and Clinical Immunology: In Practice: “Management of Difficult-to-Treat Atopic Dermatitis.”

American Academy of Allergy Asthma and Immunology: “Skin Care Tips for Individuals with Atopic Dermatitis.”

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