Eczema flare-ups can be unpredictable, and sometimes people experience new or increased symptoms of eczema without a clear cause or trigger. Whether you’re newly diagnosed or have had eczema for years, it’s a good idea to establish an action plan with your dermatologist or treating physician. For instance, if an eczema flare-up seems to be worsening after one week, despite your efforts to control it, it may be time for another visit or an escalation of your usual treatment plan.

Here are five signs that your eczema treatment isn’t working, along with a list of next steps to get your management plan back on track. Keep in mind that each treatment might work for you at one time but not the next. Eczema care depends heavily on the weather, stress, trigger exposures, and illness, so even if a therapy worked before, that doesn’t necessarily mean it always will. And vice versa — a treatment that didn’t work in the past may be worth another try.

1. Increased Eczema Symptoms

Perhaps the most obvious sign that your eczema treatment isn’t working is a gradual worsening or sudden flare-up of eczema symptoms. Increased itching is often the first sign of an eczema flare. Dry skin, a common symptom of eczema, usually leads to itching, flaking, and tightness. Dryness and itchy skin can prompt an irresistible urge to scratch — and itchiness can lead to bigger issues, like scarring and skin discoloration from excessive scratching. You may develop discolored patches of skin, bumps and rashes, or areas of leathery and thickened skin. Individuals with darker pigmentation may experience a loss of pigment, or lightened areas, where flares occur.

2. Eczema in New Places

The areas of skin most affected usually depend on the type of eczema you have and your age. For example, adults with asteatotic eczema are most likely to develop symptoms on the shins, thighs, arms, stomach, or back. Infants are more likely to have eczema on the face and in skin folds, such as the backs of the knees.

However, when eczema treatment isn’t working, you may notice symptoms in new places. It’s important to discuss any skin changes with your health care provider, especially when you see symptoms in areas that weren’t a concern in the past. Early treatment for eczema in a different spot can help you get flare-ups under control to prevent weeping (oozing) skin, scarring, and more severe symptoms. Additionally, taking adequate care of all your skin can help prevent flares in new places.

3. Changes in Your Mental Health

A chronic condition like atopic dermatitis or eczema can affect every area of life, including decisions regarding education, a career, and relationships. In one study, more than 10 percent of people with moderate to severe atopic dermatitis showed signs of depression. Of those with severe eczema, the majority (88 percent) reported feeling less capable of tackling life’s challenges.

Sometimes the most significant sign that eczema treatment has stopped working is a change in your mood, mental health, or perceived quality of life. Making the connection between your emotional state and your skin can help alert you that your mental health may need some attention. Consider what’s causing you to feel differently, and seek solutions for your emotional well-being as well as your eczema symptoms. Consider meeting with a therapist to learn coping strategies and reframe your mindset more positively.

4. Insomnia or Sleep Issues

Several members of MyEczemaTeam have noticed a relationship between poor sleep and their eczema symptoms. For some, intense itching keeps them up at night. For others, lack of sleep makes symptoms worse the next day. Poor sleep and eczema flare-ups can feel like a difficult cycle to break. If your eczema treatment stops working, you may have trouble sleeping because of nighttime itching or anxiety about your eczema symptoms.

Some members have shared tips, such as this one: “I use moisturizer after my Rx cream with cotton gloves. That’s pretty much the only time I don’t itch.”

Another said, “After more than five years of night itching, I have a prescription to keep me asleep. It is so awesome to get decent rest. Ask your doctor. Mine is a low-dose prescription so I don’t have grogginess.”

Others have found relief by taking allergy medicine before bed or using antihistamine creams. It’s also possible that getting treated for an unrelated sleep disorder (like sleep apnea) could help improve your sleep quality and keep eczema symptoms at bay.

5. Effects on Your Social Behavior

Have you been avoiding social situations because of your skin? Many people with eczema feel self-conscious about eczema outbreaks. This can lead to isolation or unwillingness to put yourself out there and be around other people. It’s a common — and unfortunate — misconception that eczema is contagious, so some people with eczema worry about what others think when they see symptoms of this skin condition.

If you notice yourself becoming more hesitant about social situations, maybe it’s time to reconsider whether your eczema treatment is working. Ineffective eczema treatment shouldn’t discourage you from opportunities to be with others.

What To Do if Your Treatment Stops Working

A flare-up doesn’t necessarily signal that your current treatment isn’t right for you. Sometimes eczema outbreaks result from exposure to environmental triggers, including weather changes, or other issues, like a skin infection. If you’re under stress or recently tried a different cosmetic or cleaning product, you may need to address the trigger rather than switch treatments.

Here are some next steps to take if your eczema treatment doesn’t seem to work anymore.

Be Diligent About Skin Care

If you’ve been lax about bathing, moisturizing, and self-care, you may experience an eczema flare-up. Often, applying a thick emollient three or four times a day can make the difference between the rest of your action plan helping — or falling apart.

Try Topical Steroids

Topical steroid ointments (prescription or over-the-counter) can be used alongside your usual eczema treatment to provide temporary relief from an eczema flare-up. Your dermatologist or primary care physician can help you determine the right dosage and duration for treatment. If you’re already using a topical steroid and it isn’t helping, contact your physician to reevaluate your treatment plan.

Ask About Clinical Trials

Researchers are always exploring new and more targeted eczema therapies. The National Eczema Association has several resources about participating in a clinical trial if you want to learn more about what these studies entail.

Consider Your Triggers

Could some new factor — such as a different detergent or cleanser or perhaps a food allergy — be causing your flare-up? If the weather will be changing soon or you’re starting to feel ill or stressed, double down on your action plan to help prevent a worsening flare.

Evaluate Your Sleep Habits

If lack of sleep contributes to your eczema symptoms, tell your doctor, and ask about a sleep study to find out if you need treatment for an underlying sleep disorder. You could also try these sleep hygiene tips to help improve your sleep quality.

Take a Mental Health Day

Try stepping back and giving yourself permission to take a break if stress is a trigger for you. Read about ways to manage your stress and help prevent eczema triggers.

Meet With a Specialist

Sometimes, a second opinion from another dermatologist or health care provider (like a dietitian, a therapist, or an allergist) can offer a different perspective and helpful medical advice.

Reach Out for Support

Connecting with others online or in person can help you cope with the ups and downs of life with a chronic condition.

Talk to Your Employer

You have no obligation to tell co-workers about your eczema. However, if your boss or human resources department knows about your condition, they might help you find temporary solutions to make life easier during a flare-up. Perhaps you can work from home or change your schedule to avoid a stressful rush hour.

Try a New Cream or Moisturizer

Changing your at-home skin care regimen may help ease eczema symptoms. Evidence shows that using emollients at least twice daily and immediately after bathing or hand-washing is key. Thick creams or emollients are preferred, but many people find them greasy. Lotions offer an alternative but may need to be used more often because they can be less effective. Look for these ingredients in moisturizers:

• Glycyrrhetinic acid — A natural anti-inflammatory
• Urea — A humectant (an ingredient that helps skin retain moisture)
• Glycerol — Another humectant

For some people with eczema, moisturizers containing oats might help prevent flares and the need for prescription creams.

Use Home Remedies With Caution

There are many home remedies for eczema, but few have been proved effective. It’s generally best to avoid introducing too many changes to your skin care routine during a flare-up.

Talk With Others Who Understand

MyEczemaTeam is the social network for people with eczema and their loved ones. Here, over 46,000 members from around the world come together to ask questions, offer support and advice, and connect with others who understand life with eczema.

How can you tell when your eczema treatment isn’t working? What symptoms are the first to go away or the most difficult to get rid of? What strategies do you use to control a flare-up? Share your experience in the comments below or start a discussion on your Activities page.

Call to Action

In the event that your eczema treatment stops working, which of these steps do you plan to take? Select the actions below that you would take, and see how many others on MyEczemaTeam are doing the same.