Why does my eczema flare up despite regular treatment?

Question

Hello doctor,

I have had severe eczema since early childhood with intensely itchy, inflamed patches on hands, arms, inner elbows, behind knees, neck, and face, but it has dramatically worsened over the past three years. The itching is absolutely unbearable and uncontrollable, especially at night, causing me to scratch until the skin breaks, bleeds, oozes clear fluid, and forms thick crusts that frequently become infected, requiring multiple antibiotic courses. The affected skin is extremely dry, thickened, leathery, and darkly pigmented from chronic inflammation, and sometimes cracks and bleeds with movement.

I have tried countless treatments, including high-potency topical steroids (causing skin thinning), Tacrolimus, Pimecrolimus, oral antihistamines, bleach baths, wet wraps, and narrowband ultraviolet B (UVB) phototherapy, with only partial temporary improvement. The constant severe itching, poor sleep, visible lesions, pain, and infections are profoundly impacting mental health, work, social life, and intimate relationships.

What causes severe atopic dermatitis?
Why did mine worsen in adulthood?
What are biologic options (Dupilumab)?
What about Janus kinase (JAK) inhibitors (Upadacitinib, Abrocitinib)?
How do they work?
What are the side effects and infection risks?
How quickly do they work?
Will I need them forever?
Can atopic dermatitis be cured, and are there food triggers?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I would like you to know that eczema is a chronic inflammatory condition. This condition is due to changes in the immune system and generally has triggers. These triggers may flare up the lesions, as in your case. The triggers could be improper sleep schedule, stress, unhealthy sedentary lifestyle, alcohol, lack of exercise, or hormonal imbalance. First, you need to identify your triggers and correct those.

Yes, topical steroids, if used for a long time, will cause skin darkening, thinning, and pigmentation. And they will help only for a brief period of time. Biologics are available and are being widely used for eczema. These are indicated in moderate to severe cases. These are antibody medications prepared to target eczema lesions. These are better than steroid injectables and do not affect or suppress the immune system, and are therefore well tolerated.

You can go for Dupilumab, which is best used for people whose disease is not well controlled with topical agents. These are given as subcutaneous injections. Before any treatment, always consult your primary treating physician. Atopic dermatitis is the commonest type of eczema, and yes, it can be due to certain food triggers as well, like soy, peanuts, certain dairy products, etc. Follow up for any further queries.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.