Steroid Cream Isn't Working for My Eczema — What Should I Do?
Topical steroids remain one of the most effective treatments for eczema. When they seem not to work, the problem is usually how they are being used, or something else that is keeping the eczema active – not that steroids "don't work for you".
Common reasons steroid cream seems to fail
The strength is too low. Steroids range from mild (such as hydrocortisone) to very potent. A mild steroid on thick, long-standing eczema may barely make a difference.
Not enough is applied. Doctors measure steroid cream in "fingertip units". One fingertip unit – a line of cream from the tip of an adult finger to the first crease – covers an area about the size of two adult palms. Many people use far less.
It is not used for long enough. Stopping after two or three days, as soon as the itch eases, often leaves inflammation behind.
Bacteria are driving the flare. When Staphylococcus aureus levels on the skin are high, inflammation can persist despite steroid treatment. Treating the bacteria alongside the inflammation can make a significant difference.
The skin barrier is not being repaired. Steroids calm inflammation but do not restore the barrier. Moisturisers are needed every day, in generous amounts.
It may not be eczema, or not only eczema. Fungal infection, contact allergy (including, rarely, allergy to the cream itself) and psoriasis can all look similar.
Is it "steroid resistance"?
True resistance to topical steroids is uncommon. When people describe their cream "stopping working", it is more often a sign of under-treatment, infection or ongoing triggers.
A note on topical steroid withdrawal
Some people worry about topical steroid withdrawal (TSW), a reaction reported after long-term, frequent use of potent steroids, particularly on the face and genitals. It appears to be rare. Used correctly and under medical supervision, steroids are safe and effective, but this is a real concern for some patients and worth discussing with your doctor.
What to do next
Do not simply keep applying the same cream in the same way.
Ask for a review of the strength, amount and duration of treatment.
Ask whether bacteria on the skin could be contributing.
Keep moisturising generously every day.
At eczema-doc, many of our patients come to us after years of creams that "never quite worked". We review your history and photographs, and create an individualised treatment plan that addresses inflammation, bacteria and the skin barrier together.
Find out more about our approach when topical steroids stop working.
Book a video consultation to review your treatment.
This article is for general information and does not replace individual medical advice.