I’m a dermatologist – how to break the incessant itch-scratch cycle of eczema

• Dermatologist warns misinformation about steroid creams is stopping eczema sufferers getting relief
• Millions affected: one in 10 adults in the UK live with eczema
• Common fears debunked: steroid creams aren’t addictive and they won’t all thin skin
• Important guidance reveals simple, practical ways to break the “itch-scratch cycle” and improve daily life.

Widespread misconceptions about the treatment of eczema may be preventing sufferers from getting the relief they need, warns a leading dermatologist.

“Eczema sufferers often fail to see improvement in symptoms because they’ve been given, or have found and followed, inaccurate advice about steroid creams,” says Sophia Brown, dermatology lead nurse at Vita Health Group, who has over 15 years’ experience treating clients.

“If you’re an eczema sufferer, it’s crucial you’re equipped with the right information to ensure you can get the relief you need, as quickly as possible.”

To help people living with eczema achieve the relief they desperately want, Brown’s cleared up three of the most common myths about the condition:

Myth 1: All steroid creams will thin my skin

“One of the most persistent myths we hear from patients is that steroid creams thin the skin,” says Brown.

“This often instils fear in patients and can cause them not to apply a high enough dose of cream, or to not apply it often enough. Whilst it is true that using a very strong steroid cream for an extended period of time could cause the skin to thin, this is not the case for most corticosteroid creams – such as hydrocortisone cream – when used appropriately.

“When used as correctly prescribed – typically in short bursts – the risk of side effects is very minimal.”

Myth 2: The only way to treat my eczema is with a steroid cream

“While steroid creams are a cornerstone of eczema treatment, they are not the only option,” explains Brown.

“There’s no one-size-fits-all approach to eczema treatment and effective management can involve a combination of therapies including emollients, moisturisers, lifestyle changes, and sometimes medications. A holistic approach to eczema treatment can help to address all aspects of the condition.”

Myth 3: I can get addicted to steroid creams

“The myth that people can become addicted to steroid creams stems from misunderstandings about how these medications work,” says Brown.

“Steroid creams do not cause addiction. However, improper use of steroid creams can lead to a phenomenon called tachyphylaxis, where the skin becomes less responsive to treatment over time. This is why steroid creams should be used under medical supervision and as part of a broader treatment strategy.”

Eczema may be more common than you think

Eczema is a widespread skin condition, affecting a significant portion of the population. According to the National Eczema Society, approximately one-in-five children and one-in-ten adults in the UK are affected by atopic eczema at some point in their lives. This translates to up to 15 million people dealing with eczema across various age groups.

Eczema can have a significant impact on someone’s quality of life – according to a survey conducted by the National Eczema Society, nearly half of people report that eczema affects their daily lives and one-in-three feel embarrassed or self-conscious about their skin condition.

Two facts about eczema to understand for healthier skin

Brown says, “It’s important we trust in the long-standing treatments – such as the use of corticosteroid creams – for the treatment of eczema. When applied correctly, they can significantly reduce skin irritation, swelling and itching experienced by eczema sufferers.”

Brown explains that there are two fundamental points that can help patients to better understand eczema treatment:

1/ Proper application: the fingertip unit (FTU)

Proper application of corticosteroid creams is vital for effectiveness. Unless instructed otherwise by a doctor or trained medical professional, it’s important to follow the directions on the patient leaflet that comes with the medicine. Sometimes, the amount of medicine you’re advised to use will be given in fingertip units (FTU).

One FTU—a line of cream from the tip of an adult’s index finger to the first crease—should cover an area of skin the size of two adult palms. This means that, if you were to treat an area as large as a leg, this might require applying more than one FTU. This will ensure the right dosage and maximises the treatment’s efficacy. Misapplication or under-application can hinder treatment progress and delay relief.

2/ Gradual adjustment: the “steroid ladder”

The “steroid ladder” is a tool that can be used to help gradually reduce the strength of a topical steroid. The idea behind the “steroid ladder” is to start with a potent steroid (a steroid that sits at the top of the ladder) and gradually move down to a weaker one as the condition of the patient improves.

This approach minimises potential side effects, ensures that the treatment is scaled back appropriately as the condition improves and helps to find the lowest effective dose for the patient. Steroid creams that sit at the top of the ladder are up to 600 times more potent as hydrocortisone (the lowest potency which sits at the bottom of the ladder).

How to break the itch-scratch cycle

Managing eczema effectively often involves a holistic approach. Brown has shared five tips to help break the frustrating itch/scratch cycle:

1/ Emollients: Emollients are moisturising treatments applied directly to the skin to reduce water loss. They can reduce dryness, soothe the skin, lower the number of flare-ups you have and help to reduce the urge to scratch. Talk to a pharmacist for advice on which emollient might be best for you and how best to apply it.

2/ Prevent night-time scratching: Consider using techniques like wearing soft gloves to bed to prevent scratching in your sleep

3/ Look at mental wellbeing: Eczema can have a big impact on mental wellbeing – and vice versa. Incorporating stress-reduction practices into your daily routine, such as mindfulness or yoga, can be beneficial. Talking therapies may also help you to manage eczema flare-ups.

4/ Avoid triggers: It can help to establish what might be triggering your eczema (although it’s important to acknowledge that there may not be an obvious trigger). Sometimes eczema can be activated by certain fabrics or tight clothing, heat or the cold, and soaps and detergents – particularly those with added fragrances.

5/ Seek professional advice: If you have mild eczema, a pharmacist can help you with advice on emollients. If you have moderate or severe eczema, it’s important to talk to a GP or seek the help of a dermatologist. A dermatologist will do a thorough review of existing treatment to ensure you’re using enough of the right things and at the right times, and can develop a specialised treatment plan to help you manage symptoms.

Brown says, “Eczema management is a multi-faceted approach that requires patience and proper guidance. By debunking myths and providing accurate information, we can help those affected achieve better skin health and overall wellbeing.”

About Vita Health Group

Vita Health Group, part of Spire Healthcare, is a leading private UK healthcare provider dedicated to making people better. The organisation provides integrated physical and mental health services to employers/ insurers, the NHS and private patients. In partnership with the NHS, Vita Health Group offers easy access to dermatology services across the UK. Vita Health Group has over 30 years experience delivering best-in-class physical and mental health services, with unique expertise in holistic, person-centred care.

Sophia Brown, lead dermatology consultant nurse, Vita Health Group

Sophia Brown is a dermatology consultant nurse at Vita Health Group, a UK healthcare provider working in partnership with the NHS to deliver community-based dermatology services. With over 15 years of experience across acute and community settings, Sophia is a highly motivated and compassionate leader in dermatology with an MSc in Independent Prescribing (INP). Passionate about aesthetics and cosmetic dermatology, Sophia is also a committed advocate for skin diversity and equity in the treatment of darker skin tones.

Vita Health Group NHS Dermatology

Vita Health Group works in partnership with the NHS to provide dermatology services to support local residents in various districts throughout the UK.

It offers treatment at a number of locations and has a team of highly trained and experienced professionals who are committed to excellence in clinical standards and customer service. Vita Health Group’s approach allows it to understand individual needs and create specialised treatment plans. Its team are experts in diagnosing and treating skin conditions and provide patients with easy to understand and helpful advice.

Find out more at: www.vitahealthgroup.co.uk/nhs-services/nhs-dermatology