With atopic dermatitis, also known as eczema, you might go years on the same medication, experiencing minimal flares and sometimes none at all. Then suddenly you’re dealing with itching, redness, rash, and other symptoms even though you take your medication as directed.
“In some cases, you could have more intense symptoms when you’re transitioning to a new medication, but there are also situations where a drug you’ve used for a while isn’t managing your condition as effectively as it once did,” says Tanya Evans, MD, a dermatologist and the medical director of the skin cancer program at MemorialCare Saddleback Medical Center in Laguna Hills, California. “This might be from an external issue, such as exposure to a trigger, but it can happen that you simply need a different medication from that point forward.”
How can you know whether you have to make a medication switch or just change your everyday skin routine? Or both? By asking your dermatologist, Dr. Evans suggests. Here are five key questions for kicking off that discussion.
1. What Are the Signs My Current Medication and Lifestyle Habits Aren’t Working?
The first step in talking about eczema treatment is communicating the severity of your current symptoms, when they started, and how they’re affecting you, says Amy Huang, MD, a dermatologist at Medical Offices of Manhattan in New York City.
“Someone with eczema will need to reevaluate their treatment if they are experiencing more frequent or intense eczema flares,” she says. Because of that, tracking how often symptoms happen is helpful, as well as what type of issue you’re having. Jot down any new or worsening challenges such as:
- Dry, cracked skin
- Itching
- Rash with raised bumps
- Crusting or oozing
- Thickened skin
- Sleep disruption due to itching
- Depression or anxiety
It’s useful to note where itchy red spots appear, adds Dr. Huang. For example, you may notice that more skin is involved than in the past.
2. What Are My Options for Switching Treatments?
Treatment for eczema can vary widely, from over-the-counter topical creams that reduce inflammation to immunosuppressant medications for long-term management of severe eczema. Treatment could also include injected medications like biologics, which target specific proteins in the immune system, or light therapy that can improve the appearance of your skin.
“Keep in mind that if you’re switching medications, it might not be from one drug to another,” says Evans. “Your doctor may suggest combining treatments in a different way, such as using the same medication but adding a topical vitamin D ointment, or changing your dosage schedule, or adding light therapy. You might switch medications but also go through all your potential lifestyle factors as well, like reducing environmental triggers by getting an air purifier or removing carpet that might contain dust mites.”
In other words, a “medication switch” is often more of a deep dive, she says. Your health provider will look at all the possible reasons why symptoms are coming up, beyond the medication you’re taking.
3. Could Other Medications I Take Be Making My Symptoms Worse?
Before you decide that you need to switch your eczema treatment, you need to consider all your medications. In some cases, symptoms may flare as a result of a drug that’s unrelated to your atopic dermatitis.
For example, a study in JAMA Dermatology found that use of blood pressure medications was associated with a 29 percent increase in the rate of eczema diagnosis among older adults. Other research has linked worsened eczema symptoms to medications including statins and even some antidepressants.
Additionally, many drugs can cause a rash or very dry skin that could be mistaken for eczema. That includes certain antibiotics, gout medication, and NSAIDs. Let your dermatologist know if you’ve begun taking any new medications.
4. How Soon After Switching Will I Feel Better?
Although the symptoms of a flare can be miserable, a treatment change likely won’t provide overnight relief. It’s important to understand the timeframe for a new medication to start working, says Huang.
“People will know if the treatment is working if they experience resolution or lessening of symptoms,” she explains. “However, that can sometimes take two to four weeks to occur.”
Because of this, a related question might be: When should I contact you again if symptoms aren’t improving? Write that answer down on your calendar so you know when to follow up.
5. How Long Will I Be on This Treatment?
When you’re getting ready to start a new medication, it’s helpful to understand whether you’ll be taking a drug for maintenance or to address symptoms, says Evans. For example, your dermatologist might suggest topical steroids to dampen inflammation and resolve a flare, but that medication is not meant to be taken long-term.
“If there is a significant flare, we might use steroids for two to three weeks and then switch to another medication that doesn’t have steroids,” she says. “That’s because there’s a risk with topical steroid use when it’s extended, that your skin can become thinner and more fragile. So we tend to limit its use just for calming down flare symptoms.”
That means you may go through several medication switches before you’re on a treatment routine that’s designed for eczema management. Knowing the timeframe for each medication and how it’s supposed to work can help you understand whether you’re on track in reducing eczema effects.
In general, it’s helpful to write down questions like these in advance and bring them to your appointment, Evans suggests. That way, you can get your concerns addressed and make the most of the conversation with your dermatologist.
The Takeaway
- Even if you’ve been using the same atopic dermatitis treatment for years, you may need to make a change if you’re experiencing symptoms more often and for a longer duration.
- Write a list of questions for your next dermatology appointment so you can get your concerns about switching treatment addressed.
- When discussing a switch, be sure to mention other medications you may have started taking; some drugs related to blood pressure, heart health, and depression can worsen eczema symptoms.
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