More Than Skin Deep and Why Eczema Keeps Coming Back, and What the Steroid Cream Never Addresses
- Jun 8
- 8 min read
Stephen Roigard is a registered naturopath, clinical nutritionist, and corporate wellness consultant with over 25 years of experience integrating science-based functional medicine and holistic health to support individuals, professionals, and teams in achieving sustainable well-being.
Most people who live with eczema know the cycle intimately. A flare appears. A steroid cream is applied. Within days, the redness fades, the itch quietens, and the skin calms. Relief arrives, along with the quiet assumption that the problem has been dealt with. Then, weeks or months later, the flare returns, often in the same place and often a little more stubborn than before. The cream comes out again, and the cycle repeats.
If this pattern feels familiar, you are not doing anything wrong, and neither is your doctor necessarily. You have simply been handed a tool designed to do one thing extremely well while being told, implicitly, that it does something else entirely.
What the cream actually does
Topical corticosteroids work by suppressing the local immune and inflammatory response in the skin. They are, by design, an off-switch for the visible symptom. Applied to an active flare, they reduce the cascade of inflammatory signaling that produces redness, swelling, and the maddening urge to scratch. For acute relief, they are effective, and there are situations where calming a severe flare quickly is the right and humane thing to do.
What they do not do is address why the flare occurred in the first place. This is not a controversial statement, even within conventional dermatology. The prevailing medical model openly describes eczema, or atopic dermatitis, as a chronic, relapsing condition to be controlled, not resolved. The language itself is honest about the goal: management, not cure. The difficulty is that “controlled” and “cured” can look identical from the outside, and that is where a great deal of confusion begins.
The uncomfortable question: What does “it worked” really mean?
Here is a question worth sitting with. When eczema improves over time on conventional treatment, what actually did the healing?
The honest answer from long-term research is uncomfortable for the suppression model. Eczema is an episodic condition that fluctuates, and in a meaningful proportion of people, settles on its own timeline as the underlying drivers shift, whether through immune maturation, a change in environment, or the removal of an unrecognized trigger. Older reviews suggested that half to two-thirds of individuals improve over a decade of follow-up, yet the definition of “clearance” varied so wildly between studies, from around one in ten to over nine in ten, that the figure tells us more about measurement than about treatment.
Crucially, none of that improvement can be cleanly attributed to the cream. The steroid manages the readout on the surface while the disease runs its own course underneath. When the underlying drivers happen to settle, it looks in hindsight as though the treatment cured it. When they do not, the flare returns the moment suppression is withdrawn. The withdrawal data make this plain: relapse after stopping treatment is common and often arrives within weeks to months because nothing causal was ever changed.
In other words, for many people, the body resolves the condition on its own timeline if and when it is able to, largely in parallel with the suppression rather than because of it. To be fair to the other side of the argument, there is a reasonable case that calming severe inflammation early can help some people by breaking the itch-scratch-barrier-damage cycle. But that is a long way from the idea that a cream heals eczema, and it is not what most long-term users are experiencing.
The cost of suppressing without resolving
Relying on suppression as a long-term strategy is not without consequence. Prolonged or potent topical corticosteroid use is associated with thinning of the skin, known as atrophy, and with the increasingly recognized, if still debated, phenomenon of topical steroid withdrawal, in which stopping the cream after extended use triggers an intense rebound of burning, red, weeping skin that can extend well beyond the originally affected areas. There is also tachyphylaxis, the tendency for the same strength to yield diminishing returns over time, nudging people towards stronger preparations and a deepening dependence on the very thing meant to be temporary.
This is the eczema equivalent of a pattern observed with reflux and acid-suppressing medication: a drug approved for short-term use quietly becomes a long-term fixture, the underlying cause is never investigated, and the person is left managing a symptom indefinitely while the root issue continues unchecked.
The same logic applies to the newer and more sophisticated treatments now entering the picture for moderate-to-severe eczema. Biologic injections such as dupilumab work by blocking specific immune messengers, interleukin-4 and interleukin-13, that drive the inflammatory response, while newer oral Janus kinase (JAK) inhibitors interrupt a different internal signaling pathway. These are clever, targeted drugs, and for severe, treatment-resistant cases, they can offer relief where little else has.
But it is worth being clear-eyed about what they are: more precise forms of suppression. They switch off specific immune signals rather than addressing why those signals are being generated, and when the medication is stopped, the condition commonly returns, as withdrawal data confirm. The oral JAK inhibitors also carry significant safety warnings that warrant careful discussion with a prescriber. None of this makes them wrong for the right person at the right time; it simply means the fundamental question remains unanswered: what is driving the immune system to behave this way in the first place?
Eczema as a whole-body conversation
The reframe that changes everything is this: the skin is not the problem; the skin is the messenger.
From an integrative perspective, eczema is a surface expression of an internal imbalance, and the most consistent and well-evidenced driver is the gut-skin axis. The health of the intestinal lining, the diversity of the microbiome, and the integrity of the gut barrier are in constant dialogue with the immune system, which ultimately determines whether the skin is calm or inflamed.
Around that central axis sit a number of individual, modifiable drivers that I assess in clinical practice:
Food triggers and sensitivities, commonly involving dairy, gluten, eggs, and soy, which can perpetuate immune activation in susceptible people
Histamine intolerance and reduced diamine oxidase activity, which can amplify itch and reactivity
Micronutrient status, particularly zinc, vitamin D, and the balance of essential fatty acids, which directly influence both barrier function and the inflammatory tone of the skin
Stress and the HPA axis, which is not a vague footnote but a measurable physiological input into skin inflammation
The composition of both the skin and gut microbiomes, which shapes how reactive the barrier becomes
Even the barrier defect that conventional medicine emphasizes, including the filaggrin-related changes that reduce the skin's ability to hold moisture and keep irritants out, is far more responsive to nutritional and lifestyle support than the language of fixed genetics tends to suggest.
The triggers closest to home: Water and washing
Not every driver is internal. Some of the most overlooked triggers are the things in daily contact with the skin, and in my clinical experience, two stand out repeatedly: the water people shower in and the products they use to wash their clothes.
Most municipal water supplies are chlorinated to keep them free of microbes. Chlorine does that job well, and that is precisely the problem for sensitive skin. The same antimicrobial action that disinfects the water also strips the skin's protective oils, disrupts the barrier, and disturbs the delicate community of microbes that live on healthy skin. For some people, a daily hot shower in chlorinated water is a constant, low-grade irritant that quietly undermines every other effort to calm the skin. I have worked with clients whose eczema clearly tracked with showering in town-supplied water and who improved markedly once that exposure was addressed, whether through a quality shower filter designed to remove chlorine, shorter and cooler showers, or applying a barrier moisturizer immediately afterward while the skin is still damp.
Laundry products are the second culprit and arguably the more insidious one, because clothing and bedding are in contact with the skin around the clock. Residual surfactants, enzymes, optical brighteners, and fragrances left in the fabric after washing are a well-recognized source of contact irritation. What surprises many people is that a “sensitive” or “eco” label on the bottle is no guarantee of a non-reactive formulation. I have seen clients continue to flare even while using popular, well-marketed products, including eco-labeled sensitive laundry liquids, only for the eczema to settle once they switched to a truly minimal, natural alternative. The marketing language and the actual irritant profile of a product are not always the same thing. Where laundry appears to be a factor, I generally suggest moving to a truly simple, low-surfactant product, running an extra rinse cycle to clear residue, and observing the skin's response over a few weeks.
These are simple, low-cost changes, and for the right person, they can be the difference between chasing flares and removing the causes.
A different goal: Resolution, not indefinite control
When the question shifts from “how do we suppress this flare” to “why is this person's system producing flares,” the entire approach changes. Rather than applying an off-switch to the surface, the work becomes identifying and removing the specific triggers, restoring the integrity and diversity of the gut, replenishing the nutrients the skin depends on to repair its own barrier, removing the daily irritants that keep the skin provoked, and supporting the nervous system that quietly governs inflammation. In my practice, this follows a staged framework: clearing what is driving the imbalance, restoring beneficial microbial balance, nourishing the system, and repairing the barrier from both the inside and the outside.
This is slower than a cream. It asks more of the person. But it works with the body's own capacity to heal rather than overriding the signal it is trying to send, and the aim is something the suppression model never even sets out to measure: durable resolution and resilience, rather than a lifetime of management.
Where to from here
If you have been caught in the steroid cream cycle for years, applying, calming, relapsing, and applying again, it is worth knowing that this is not the only path available to you. The fact that suppression has not resolved your eczema is not a personal failing, and it is not evidence that your eczema is simply incurable. It may be evidence that the actual drivers have never been investigated.
The body knows how to heal. Our role is to provide the conditions in which it can do that work, and for the skin, those conditions almost always begin elsewhere.
If this resonates, and you sense that something deeper is driving your symptoms but have not yet found the answers, I would welcome the opportunity to explore whether we are the right fit to work together. You can learn more about my approach and book a consultation at stephenroigard.com.
A note on your current treatment: it is not within my scope of practice to advise you to cease any prescribed or pharmacy medication, including topical corticosteroids. If you have been using a steroid cream regularly and wish to reduce it, please do so with appropriate guidance, as stopping abruptly after prolonged use can provoke a significant rebound. This article is for educational purposes only and does not constitute medical advice.
Read more from Stephen Roigard
Stephen Roigard, Integrative Corporate Wellness Consultant
Stephen Roigard is a seasoned health expert specialising in integrative and functional medicine. With over 25 years of experience as a registered naturopath, clinical nutritionist, medical herbalist, and health coach, he empowers individuals and corporate teams to tackle stress, low energy, chronic illness, and mental well-being from the root cause. Stephen also brings expertise as a personal trainer and yoga, dance, and martial arts instructor. His corporate wellness work combines science‑backed strategies and behavioural coaching to transform workplace health culture. Passionate about achieving long‑term results, he helps professionals thrive physically, mentally, and emotionally.
References:
The Long-Term Course of Atopic Dermatitis (Abuabara et al., Clinics in Dermatology, 2018)
Evaluating the Longitudinal Course of Atopic Dermatitis (Chovatiya & Silverberg, American Journal of Clinical Dermatology, 2023)
Recurrence and Influencing Factors of Moderate-to-severe Atopic Dermatitis After Dupilumab Withdrawal (Frontiers in Immunology, 2025)
Topical Corticosteroid Withdrawal (Dermnet NZ, 2025)
