Severe eczema treatment

The Management of Severe Eczema

For eczema that hasn't responded to the usual treatments, or that improves on steroids and then flares again as soon as you stop.

Severe eczema treatment when your current treatment isn’t working.

Severe eczema can affect almost every part of daily life.

It can cause persistent itching, disturbed sleep, painful skin, recurrent infections and repeated flare-ups.

If your eczema improves temporarily but keeps returning, or previous treatments haven't given you lasting control, an eczema-focused medical assessment may help.

At Eczema Doc, we specialise in assessing persistent and difficult-to-control eczema in adults and children.

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We can help you understand:

• Why your eczema may keep returning
• What treatments you've already tried
• Whether your current treatment is appropriate
• Whether a different treatment approach may be appropriate
• What ongoing treatment and review may involve

The cycle most people are stuck in

It usually runs like this. A flare starts, so you use the steroid cream you've been given. Within a few days the skin looks better. You stop, as instructed, because you've been warned about using it too long. Days later it's back, often worse. You go back to the cream.

Meanwhile you're applying emollients several times a day, changing your washing powder, cutting foods out, and the eczema is still there.

If that's your experience, the problem probably isn't that you're using the treatment wrongly. It's that one part of the problem is being treated while two others are left alone.

Why severe eczema keeps returning

Severe atopic eczema generally involves three things at once:

• Inflammation - the redness, heat and itch, which is what steroid creams address
• A damaged skin barrier - which lets moisture out and irritants in, which emollients address
• Bacterial overgrowth - usually Staphylococcus aureus, which commonly colonises eczematous skin and drives flares, and which typically isn't addressed at all

That third element is the one usually missed. Skin affected by atopic eczema carries far more Staphylococcus aureus than healthy skin. It needn't be a visible infection to be contributing.

Treat inflammation alone and the improvement is often short-lived, which is the pattern most people recognise.

A different approach

The Aron Regimen treats all three at once, using a single compounded preparation that combines a dilute topical steroid, a topical antibiotic and a large quantity of emollient. It's applied frequently at first, then reduced as the skin improves, with the strength adjusted at review.

What makes it work is less the prescription than the adjustment: reviews at two weeks and four weeks, with the preparation changed each time based on how your skin has actually responded.

Read more about how the Aron Regimen works

Is this right for you?

The regimen tends to suit people with:

• Moderate to severe atopic eczema
• Eczema that returns within days of stopping topical steroids
• Repeated skin infections or courses of oral antibiotics
• Eczema disturbing sleep or affecting work
• Widespread eczema rather than a single patch
• A long history of treatments that haven't held

It isn't right for everyone. Some conditions resemble eczema without being it, and some patients have reasons not to use these treatments. That's what the consultation is for.

About steroid concerns

If you're worried about topical steroids, you're right to think about it, and it's worth saying how this differs.

The steroid in the compound is heavily diluted, weaker than a typical prescribed tube, and mixed into a large volume of emollient. The aim is to reduce strength and frequency over the first weeks, so most patients use considerably less by the end of the first month than at the start.

If you've been through topical steroid withdrawal or are worried about it, raise it at the consultation. It deserves a proper discussion.

How treatment works

1. Online consultation, £180. By video from anywhere in the UK. Photographs of the affected skin are helpful, particularly at its worst.

2. Assessment. Your history, what's been tried, what's happening now, and whether this approach is appropriate for you.

3. Prescription. If appropriate, a preparation made up for you by a compounding pharmacy. Medication is paid for separately.

4. Reviews at two and four weeks, £100 each, then annually. This is where the treatment is tuned to you.

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Common questions

I've already seen a dermatologist. Is this different? This is a specific approach to treating the three drivers of severe eczema simultaneously, using a compounded preparation that isn't routinely prescribed on the NHS. Many patients arrive having already seen dermatology.

Can I continue under my NHS team? Yes. Tell them what you're using so everyone is working from the same information.

Do I need a GP referral? No. Book directly.

How soon might I see a change? Many patients notice improvement within the first two weeks. A short period of worsening at the start isn't unusual.

What if I've had topical steroid withdrawal? Raise it at the consultation. It affects how treatment is approached and it needs discussing properly.

How long will I need to use it? Most patients reduce substantially over the first month and settle into occasional use, stepping up briefly during flares.

What does it cost in total? £180 initial consultation, £100 per review, plus medication from the pharmacy separately.

What if it doesn't work for me? By four weeks it's usually clear. If it isn't working, that's said honestly and other options considered.

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*From our 2022–2026 outcomes audit of more than 1,500 new patients who completed a POEM score at each review. Not every patient returns a score at every review. A meaningful improvement means a fall of 4 or more POEM points. Individual results vary.

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