What can I do if eczema creams aren't working?

Dear Helplessly Itchy, 

Eczema is a form of dermatitis that weakens the protective barrier of your skin, making you more sensitive to outside elements. Unfortunately, this often leads to a cycle of itching and scratching, which irritates the skin and leads to more itching. There are a variety of ways that you can ameliorate the symptoms—many of which you have mentioned trying. Identifying what triggers these flare ups could ultimately be what helps inform treatment options. Narrowing down the options can help you focus your side effects research on that specific product. Read on for some prevention and treatment strategies. 

While “eczema” is often used as an umbrella term, there are several types of this condition. It’s worth mentioning that you can have more than one form of eczema at the same time. Since each person’s eczema can have different triggers, treatment can vary depending on what exactly it is that irritates your skin. 

While you can’t change your genetics, you might be able to make emotional and environmental changes that can lead to some relief. 

• Applying emollients (also known as moisturizers) several times a day, especially right after a shower or bath can help to lock in moisture. Additionally, using mild soaps and cleansing products, and avoiding clothing that may irritate your skin are all recommended strategies in the battle against eczema. 
• Short, warm baths also seem to be more effective in reducing symptoms as they are less stressful on the skin than longer, hot baths. 
• Using humidifiers and drinking plenty of water will ensure that you stay hydrated from the inside out.  
  When it comes to emotional triggers, finding healthy ways to manage stress and anxiety can be helpful in preventing flare-ups.  

It also seems like you’ve kept regular dermatology visits to explore possible options for treatment. Managing eczema usually involves a good deal of trial and error, and every approach will affect each patient differently so kudos to you for keeping it up! 

Corticosteroid creams or ointments applied topically are commonly recommended to treat eczema. Similar to the ones you’ve mentioned, they vary widely in strength and often have varying side effects. One possible side effect of topical steroid use is skin atrophy (where the skin gets thin and fragile). This can result from regular use of stronger creams, especially on the face. However, this would be unusual with hydrocortisone. The other possible problem with long-term use is ineffectiveness. This can be avoided by using simple emollients for a week or more, after which the corticosteroid cream may again become effective. 

While eczema cannot be cured, symptoms can often be reduced or kept at bay through other forms of treatment besides the creams that you’ve tried. Some examples include: 

• Coconut oil. Some studies have shown coconut oil to effectively ease mild to moderate eczema symptoms. 
• Elimination diets. Cutting out foods that commonly trigger eczema (such as nuts, tomatoes, eggs, milk, and cereals) can potentially reduce symptoms. However, this should not be done without the support of a health care professional such as a dermatologist or a dietitian who can help to guide you through this practice. 
• Sedating antihistamines or antibiotics. These medications can help reduce itchiness and help you fall asleep at night. Your dermatologist or a primary care provider can provide additional guidance on these medications. 
• Bandaging the affected skin. This protects the affected skin from the elements. 
• Phototherapy. This form of treatment involves exposure to ultraviolet radiation in gradually increasing intervals. 
• Coal tar and UVB radiation. This combination, also known as “Goeckerman therapy”, is often used to treat patients with psoriasis and might be helpful in treating people with severe forms of eczema. 

In addition to these remedies, there are some forms of alternative and complementary medicine that some have used to treat eczema such as acupuncture and certain herbs. However, these approaches have either limited or conflicting evidence when it comes to their efficacy in reducing symptoms. 

If you are able, consider visiting a primary care provider if you’re concerned about the costs of frequently seeing a dermatologist. These professionals can often assist with mild-to-moderate forms of eczema. Additionally, since stress can make eczema work, you may also consider signing up for a stress reduction course or talking with a mental health professional about making an individualized plan to cope with stress. Ultimately, being able to identify what triggers your eczema and making the appropriate environmental, emotional, or product level changes will set you on the right track for fewer flare-ups. 

Here’s to less itching and more smiling!