If you have eczema, also known as atopic dermatitis, you likely understand the frustration of living with red, itchy, and dry skin.
According to the Cleveland Clinic, eczema affects about 15 million Americans. It can occur in anyone, but it’s most commonly seen in young children. Some people develop eczema in their youth and then outgrow the condition as they become older.
The severity of eczema varies from person to person. Some people have mild eczema and only deal with minor dryness or itchiness. But eczema can also be severe — and even stop responding to treatment.
The exact cause of eczema is unknown and, unfortunately, there’s no cure. This doesn’t mean you have to live with severe flare-ups, though. Eczema might be tricky to control, but relief is available.
Here’s what you can do when one eczema treatment stops working.
There isn’t one single treatment that can reduce your eczema symptoms. Rather, numerous therapies can calm your dry, itchy skin.
It’s important to note, though, that a therapy that works for one person may not work for another. So, you may have to experiment with different treatments until you find one that works for you.
If you’re not seeing results from a treatment, there’s no need to stay on it. Given the multitude of options to reduce skin inflammation, you don’t have to continue an ineffective treatment.
Initially, you might use over-the-counter (OTC) topical eczema steroid creams that contain hydrocortisone. These creams can control itching and reduce redness and swelling.
If your eczema worsens and OTC treatments stop working, it’s time to consider other options. Eczema is an inflammatory disease, and steroids have an anti-inflammatory effect on the body. These steroids can include prescription-strength steroid creams, or your doctor may also suggest an oral steroid like prednisone.
A newer FDA-approved steroid-free prescription ointment for those older than 2 years old is crisaborole, which reduces redness and swelling of the skin, as well as prevents new redness and swelling.
Other nonsteroidal topical treatments include topical immunomodulators (TIMS), like tacrolimus (Protopic) or pimecrolimus (Elidel). Also known as topical calcineurin inhibitors, they work by changing the body’s immune response to allergens. They have fewer side effects than steroids.
These medications can get your eczema under control and reduce the frequency of flares.
If your severe eczema doesn’t respond to these therapies, your doctor may recommend a newer class of drugs called biologics.
These medications alter the body’s immune response and target the source of inflammation. Dupilumab (Dupixent) is the first biologic approved for adults who have moderate to severe eczema. It’s an injection that can be used alone or with a topical steroid cream.
Some people may experience side effects from prescription steroids, nonsteroidals, or biologics. Redness, swelling, and soreness can occur at the injection site with biologics. Side effects of oral steroids include headaches, dizziness, trouble sleeping, and weight gain. Side effects from crisaborole and TIMS are stinging and burning at the application site.
If you experience severe side effects from medications or they’ve stopped working, your doctor may recommend another option. Phototherapy, or light therapy, may be able to help with your symptoms.
Exposing your skin to ultraviolet (UV) light waves can improve eczema symptoms in some people. This type of therapy uses narrowband UV (UVB) lights, which reduce itchiness and inflammation.
Light therapy is helpful for both widespread and localized eczema. It’s estimated that about 70 percent of people see improvement in their skin after phototherapy.
Side effects of light therapy include sunburn, premature skin aging, and melanoma.
Since eczema is a common skin condition, you might see your family doctor for a prescription cream. But even if your doctor has experience treating this skin condition, they may not have experience treating severe eczema.
If you’re under the care of a family doctor, but your eczema stops responding to treatment, it might be time to see a specialist. Ask your primary doctor to recommend a dermatologist who specializes in eczema.
Eczema can also mimic other skin conditions. A dermatologist can confirm an eczema diagnosis given by your primary care doctor, as well as rule out other possible skin conditions like rosacea or psoriasis.
It’s also helpful to practice good skin care at home. The more self-care measures you take, the better your skin may respond to treatment.
Avoid hot showers as they can dry out your skin. Take warm showers or baths instead. Apply lotion or body oil after showers, baths, and swimming.
Apply moisturizer to your skin at least twice a day. If you can prevent dryness, your skin may become less irritated and itchy.
What you apply to your skin can also worsen eczema. Avoid strong or harsh perfumes and soaps. Use a humidifier to keep your skin moist, and avoid any fabrics that cause a rash or itchiness.
If possible, avoid scratching your skin to prevent redness. To control itching, use an anti-itch cream along with a topical or oral steroid.
You can also combine alternative therapy with traditional therapy to bring severe eczema under control.
One example of this is acupuncture. Acupuncture is an alternative practice from traditional Chinese medicine. It’s used to treat a variety of conditions, including skin conditions like eczema, acne, and psoriasis.
This therapy involves the insertion of fine needles into different points in the body. It promotes healing by stimulating the release of endorphins.
More research is needed to determine if acupuncture can help reduce eczema symptoms. If you decide to try acupuncture, it’s important to continue your traditional treatments as well.
Although there’s currently no cure for eczema, different treatments can help control this condition and reduce skin inflammation. If your current therapy isn’t working, discuss alternatives with your doctor.
With a new medication, complementary therapy, and self-care measures, you can improve the health of your skin and put redness and itchiness behind you.