Severe refractory eczema

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Severe refractory eczema

Also known as Severe eczema

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$Severe refractory eczema$

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Summary

Severe eczema is a skin condition that can affect both children and adults.
It’s more common in women, and affects more people living in cities than in rural areas.
There’s no cure for it, but treatments can reduce its severity and itchiness.

Severe refractory eczema: essential info
Causes and symptoms
What are my options?
FAQ

Reviewed on October 10, 2023. by

Dr Alexandra Cristina Cowell

Writer & Clinical Content Reviewer

Next review due on October 10, 2026

Last updated on October 09, 2023

Find the severe refractory eczema treatment that’s best for you.

We’ve got a range of options, and our clinicians can help you find the one that’s best for your body and your budget.

Fexofenadine

Fexofenadine hydrochloride

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An antihistamine that can help relieve eczema symptoms. Take one a day to alleviate itching.

Starting from £34.95

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Loratadine

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Daily antihistamine that can ease urges to scratch itchy skin. Relieves a range of other allergy symptoms.

Starting from £24.95

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Fifty:50

White soft paraffin, Liquid paraffin

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Soothing and moisturising treatment for very dry skin. Free from additives or preservatives.

Starting from £34.95

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Montelukast

Montelukast sodium

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A leukotriene inhibitor that relieves symptoms like itching, redness and inflammation.

Starting from £25.95

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Medrone

Methylprednisolone

Potent oral steroid to reduce the severity of eczema symptoms. Highly effective short-term treatment.

Not available

Prednisolone

Out of stock

Corticosteroid that helps reduce inflammation. The dose can be lowered once your symptoms improve.

Starting from £39.95

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What is severe refractory eczema?

Severe refractory eczema (aka severe atopic dermatitis) is a skin condition characterised by severe inflammation, redness and irritation. The term ‘refractory’ means it’s resistant to treatment. Severe refractory eczema is long-term (chronic), making it challenging to live with and affecting the quality of your life.^[1] Although there’s no cure for it, that doesn’t mean it can’t be managed and maintained. Some medications can help reduce the severity and itchiness it causes.

How common is severe refractory eczema?

Atopic dermatitis (AD) is a common condition worldwide, but can be more or less common depending on which country you’re in. In the UK, for example, 12.3% of children are thought to be affected with eczema, compared with 34% in Sweden.^[2] The differences in statistics among countries might be because of the different ways eczema is diagnosed, differing climates and other risk factors. Nonetheless, the trends across countries generally show a similar pattern, with eczema being more commonly seen in children under the age of 17 than in adults.

The prevalence (commonness) of AD also varies between genders, environmental living conditions and recreational drug usage. It’s more common in females than males, though it’s not known why. Additionally, people living in urban cities are more likely to have eczema than rural dwellers. This could be because of increased air pollution in urban areas, however, most studies were conducted by participants living in urban regions, so the statistics in rural areas could be underreported.^[3]

Determining the prevalence of severe eczema is hard, as it’s a long-term condition and most studies don’t report the time the participants developed eczema, in childhood or adulthood.^[2] However, one study shows that around 0.6%-1.1% of adolescents and children are expected to have symptoms of severe eczema.^[4]

How is severe refractory eczema different from other types?

Severe refractory eczema is a more severe form of one of the seven types of eczema.^[5] Most patients will have one type, but in some cases, some may have a combination of two or more. The types include:

Atopic dermatitis (AD), also known simply as eczema, is the most common type. It causes inflammation, redness and itchy skin. It’s not associated with a specific age range or linked to a specific risk factor. If AD is chronic and severe, it will be termed severe AD (or severe refractory eczema).
Contact dermatitis, also known as allergic dermatitis, is caused by environmental triggers and irritants such as soap, detergents and raw vegetation.
Discoid eczema is a long-term condition that causes your skin to be itchy and swollen. It can appear as a single patch or be present in multiple patches. These patches may be crusty and oozing with liquid. On light skin, it’s generally pink or red, and on darker skin, it’s brown. It often needs treatment as it can take several months to clear up.
Dyshidrotic eczema mainly affects the hands and feet. It can be very itchy and has no visible appearance at the start. But, as it worsens, blisters filled with clear liquid appear, which can become infected if popped.
Nummular dermatitis is often on the arms and legs. Small round lesions, about the size of a coin, form on the body, which can be red and itchy.^[6]
Seborrhoeic dermatitis mainly affects your scalp. It’s an inflammatory skin condition that’s characterised by flaking skin on oily areas of the body, like the scalp and face.
Stasis dermatitis is associated with skin discolouration on the legs, possibly caused by poor blood flow. It can be mistaken for varicose veins as they look similar.

It’s important to have your eczema diagnosed by its type and severity, as this can affect your treatment options. It can also be beneficial to help determine the cause of your symptoms to prevent future flare-ups.

Treated trusted sources:

National Institutes of Health. 2023. Atopic Dermatitis.
Hadi, H. A., et al. (2021).The Epidemiology and Global Burden of Atopic Dermatitis: A Narrative Review. Life, 11(9).
Maspero, Jorge et al. Epidemiology of adult patients with atopic dermatitis in AWARE 1: A second international survey. World Allergy Organization Journal, Volume 16, Issue 3.
Langan, S. M., Mulick, A. R., et al. (2023). Trends in eczema prevalence in children and adolescents: A Global Asthma Network Phase I Study. Clinical & Experimental Allergy, 53(3), 337-352. Trends in eczema prevalence in children and adolescents: A Global Asthma Network Phase I Study. Clinical & Experimental Allergy, 53(3), 337-352.
National eczema association. 2023. An Overview of the Different Types of Eczema.
Robinson CA, Love LW, Farci F. 2023. Nummular Dermatitis.

This page was written by The Treated Content Team.

This page was medically reviewed by Dr Alexandra Cristina Cowell on October 10, 2023. Next review due on October 10, 2026.

How we source info.

When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.

What causes severe refractory eczema?

The exact cause of AD is unknown, but it’s thought to start because of a problem with your skin barrier. There are many layers to your skin, and the outermost one is called the corneal layer. When this layer gets damaged by an inflammatory response in your skin, it can cause eczema.

Filaggrin is a significant component in your skin’s formation. It’s needed to balance your skin’s pH and retain moisture. A deficiency of this protein causes your skin to lose a lot of moisture and reduces its protection from irritants and allergens, which can lead to eczema. Mutations and genetics can lead to a decreased production of filaggrin.^[1]

Another potential cause could be changes to the balance of ceramides within the skin. Ceramides are lipids (fats) that play a crucial role in maintaining moisture, repairing damaged skin, and preventing inflammation. As a result, an imbalance of ceramides can lead to eczema.^[2]

Furthermore, around 30-40% of people with eczema have some kind of allergy. This means the immune system reacts to allergens, such as milk, eggs or pollen, and causes inflammation.^[3]

Eczema is a multifactorial disease with no one cause. A combination of allergies, mutations and genetics play a part in the development of it.

What symptoms does severe refractory eczema cause?

There are many different types of eczema, each with varying symptoms. Most people with eczema have itchy skin, which ranges from mild to severe itching. Other symptoms of eczema include:

Dryness
Inflamed skin
Discoloured skin
Rough and scaly skin
Oozing or crusting
Swelling

The symptoms of severe AD are a lot worse. Frequent itching can lead to bleeding, infection and further irritation. This can affect daily activities such as washing your hands, cooking and sleeping. It can affect some people’s mental health and self-esteem too.

Can severe refractory eczema lead to other problems?

Severe AD is associated with other diseases and disorders. Damages to the skin barrier make it easy for bacteria like S. aureus to enter. The bacteria can then cause infections like boils, impetigo (an infection that causes sores and blisters on the skin), and cellulitis, an infection in the deep layers of the skin, which can be life-threatening if left untreated.

Additionally, sleep problems are common with AD. This can be caused by several factors, including the ‘itch-scratch cycle’ (inflammation causes itchiness, which leads to scratching, which causes further inflammation) and your circadian rhythm, which can induce itching at night. As a result, this lack of sleep can negatively impact your quality of life and increase your risk of cardiovascular diseases.^[4]

Treated trusted sources:

InformedHealth.org 2013. Eczema: Overview. Institute for Quality and Efficiency in Health Care (IQWiG); Cologne, Germany.
Hadi, H. A., et al. (2021). The Epidemiology and Global Burden of Atopic Dermatitis: A Narrative Review. Life, 11(9).
InformedHealth.org 2013. Eczema: Overview. Institute for Quality and Efficiency in Health Care (IQWiG); Cologne, Germany.
Silverberg, J. I. (2018). Associations between atopic dermatitis and other disorders.

This page was written by The Treated Content Team.

This page was medically reviewed by Dr Alexandra Cristina Cowell on October 10, 2023. Next review due on October 10, 2026.

How we source info.

How is severe refractory eczema treated?

There’s no cure for severe eczema, however, treatments can help prevent flare-ups, restore and maintain your skin barrier and stop itching. Treatments for eczema are categorised into non-pharmacological and pharmacological treatments.

Non pharmacological methods are typically used to reduce the severity of your symptoms. Treatments in this category include emollients to help restore and retain moisture. Creams and lotions that contain glycerol and soy sterols help lubricate and soften the skin, whereas ingredients like petroleum and mineral oil help to retain moisture.^[1] Moisturising in combination with a bath can help repair your skin barrier. Although bathing for a long time can cause dryness, immediately applying a moisturiser afterwards helps create a barrier which retains water and prevents bacteria from entering your skin.^[2]

Pharmacological options include corticosteroids, which are often the first-line treatment for severe eczema. Topical steroids help to reduce inflammation and suppress your immune system. Wet wrap therapy (WWT) can also be used in conjunction with topical treatment. WWT involves wrapping gauze or bandages that have been treated with steroids around the affected area. This allows for better absorption, decreases itching and provides a physical barrier to protect the skin.^[1] If the topical steroids don’t work, oral steroids or topical calcineurin inhibitors (TCI) might be prescribed. TCIs treat eczema by altering your immune system to reduce inflammation.

And if these options don’t work, then Dupilumab and phototherapy are the next options. Dupilumab is an immune cell’s antibody, which inhibits the signalling of pro-inflammatory molecules. This reduces inflammation in eczema.^[3] However, not everyone with eczema is eligible to take Dupilumab as it’s only prescribed for severe eczema and is used as a last resort. Phototherapy, also known as light therapy, is using different wavelengths of light to treat eczema. Light of certain wavelengths like UVA and UVB rays, can help reduce inflammation and swelling. However, the process can be time consuming as it requires several sessions in a clinic.^[4]

What medications are there for severe refractory eczema?

There’s a range of treatments for severe refractory eczema, including ointments, oral steroids and antihistamines.

Fifty:50 Ointment contains only two ingredients: 50% Liquid Paraffin and 50% White Soft Paraffin BP (hence the name). It has a thick texture that helps create a barrier to keep moisture and water in and keep allergens and irritants out.

Oral steroids include prednisolone and methylprednisolone. They help reduce swelling and suppress your immune system to prevent flare-ups and reduce itching. Studies show they are faster acting and have an immediate effect on eczema, but can’t be prescribed regularly because of the side effects.^[5]

Antihistamines are usually used in combination with steroids and other treatments, and they include Fexofenadine, Loratadine and Cetirizine. All three are effective treatments, commonly used for allergies, but can also help reduce itchiness in eczema. This is good as it can help stop the itch-scratch cycle and prevent further damage to your skin barrier.

Does severe refractory eczema always need treatment?

For the most part, yes. Severe refractory eczema is a long-term condition and is considered incurable, so without treatment, the symptoms can worsen.^[6] Severe eczema can cause extreme dryness, inflammation, and irritation, and may even result in oozing liquid and other infections that can impact your quality of life. Treatments can help improve symptoms associated with severe eczema.

After getting diagnosed with severe eczema, our clinician will help create a personalised treatment plan for you. This could include a range of medicines and creams, some of which are formulated specially for you.

Treated trusted sources:

Brar KK, Nicol NH, Boguniewicz M. 2019. Strategies for Successful Management of Severe Atopic Dermatitis. J Allergy Clin Immunol Pract. 2019 Jan;7(1):1-16.
Johnson, B. B., et al. 2019.Treatment-resistant atopic dermatitis: Challenges and solutions. Clinical, Cosmetic and Investigational Dermatology, 12, 181-192.
Gade A, Ghani H, Rubenstein R. Dupilumab
InformedHealth.org 2013. Eczema: Light therapy and oral medications. Institute for Quality and Efficiency in Health Care (IQWiG); Cologne, Germany.
National institution for health care and excellence (NICE). 2023. Eczema – atopic. Prescribing information – Oral corticosteroids.
American academy of dermatology association (AAD). 2023. Can Anything Relieve Severe Atopic Dermatitis?

How we source info.

FAQ: Severe refractory eczema

Have something specific you want to know? Search our info below, or ask our experts a question if you can’t find what you’re looking for.

How is severe refractory eczema diagnosed?

Answer:

Eczema is usually diagnosed simply by looking at your affected skin. Your clinician may then diagnose the type of eczema you have and determine its severity.

Can dietary changes make severe refractory eczema better?

Answer:

Food allergies and dietary changes have been linked to symptom severity and flare ups for eczema.

Food allergies can increase inflammation and worsen eczema. The most common allergies for people with eczema include peanuts, cow's milk, eggs, soy and shellfish. Avoiding these foods can reduce flare-ups. A study found patients excluding dairy from their diet had reported improvement in their eczema symptoms. However, this might not be true for everyone. In most trials, the number of participants was small and, therefore, would not give a detailed picture of how effective exclusion diets are at improving eczema symptoms.^[1]

On the other hand, certain supplements and foods are thought to help with eczema. Patients adding fish oil or omega-3 to their diet, for example, reported a 35% improvement in their skin. This could be because of the high amount of polyunsaturated fatty acids (PUFA) in fish oils, which can modulate the production of signalling molecules called eicosanoids, which play a role in inflammation.^[1],^[2] So by regulating this pathway, omega-3 can help to reduce inflammation, resulting in the relief of eczema symptoms.

Is children's eczema different from adults?

Answer:

Atopic dermatitis is a common condition in both children and adults. However, the way it appears in each is often different. For both groups, it’s common to see symptoms in the creases of the knees, armpits, elbows and groin. And an increased risk of allergies and dryness.

Adults with eczema tend to have more symptoms associated with chronic atopic dermatitis. Hand eczema is also more common in adults, and emotional factors, like stress, play a bigger role in flare ups.^[3]

However, in children, crusty lesions are more common, as are seborrhoeic dermatitis-like symptoms (seborrhoeic dermatitis is a form of eczema that mainly affects the scalp, causing scaly patches and dandruff). Eczema is also commonly found near their hair follicles and under the eye fold.

Additionally, the way they’re both treated is slightly different. Adults can be prescribed stronger steroids and medications, which aren’t suitable for children.

Are there specific risk factors for severe refractory eczema?

Answer:

There are several risk factors for eczema, including:^[4]

Filaggrin protein deficiency - Filaggrin is an important protein found in the outermost layer of the skin, which helps maintain its pH and moisture levels. A mutation in the filaggrin gene decreases the amount of filaggrin produced, causing a deficiency. As a result, the skin barrier function is altered.

Climate - Environments with really hot or cold temperatures have a significant impact on eczema (children in Norway tend to get flare-ups in the winter months due to the extremely cold temperatures, for example). And research suggests it’s much less common where it’s more humid, such as in certain parts of Japan and America.

Air pollution - Studies have shown that AD is more common in urban areas than it is in rural areas. A reason for this could be airborne pollutants, like nitrogen dioxide and carbon monoxide, which promote oxidative stress and induce a proinflammatory response.^[5]This can alter your skin’s barrier function, leading to eczema.

Food allergies - Food allergies can trigger the immune response and cause inflammation. Common food allergens include milk, egg, soy and nuts.

Treated trusted sources:

Nosrati, A., et al. 2017. Dietary modifications in atopic dermatitis: Patient-reported outcomes. The Journal of dermatological treatment, 28(6), 523.
F. Sheppe, A. E., & Edelmann, M. J. (2021). Roles of Eicosanoids in Regulating Inflammation and Neutrophil Migration as an Innate Host Response to Bacterial Infections. Infection and Immunity, 89(8).
Ramírez-Marín, H. A., & Silverberg, J. I. (2022). Differences between pediatric and adult atopic dermatitis. Pediatric Dermatology, 39(3), 345-353.
Hadi, H. A., et al. (2021). The Epidemiology and Global Burden of Atopic Dermatitis: A Narrative Review. Life, 11(9).
Fadadu, R. P., 2023 Air Pollution and Atopic Dermatitis, from Molecular Mechanisms to Population-Level Evidence: A Review. International Journal of Environmental Research and Public Health, 20(3).

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