5 Eczema Mistakes You're Probably Making

Sep 12

7 min read

Updated: Sep 29

中文摘要在文末

I want to be careful with the tone of this one, because "mistakes you're making" is a phrase that sounds like I'm about to scold you, and I'm not.

Almost everyone who comes into my clinic with badly-controlled eczema is trying hard. Often too hard, in the wrong direction. The mistakes below are not laziness — they're what happens when a frustrating condition meets an internet full of confident advice and a healthcare experience that gave you six minutes and a tube of cream.

So read these as a list of traps, not accusations. I've fallen into a couple myself, and I'm the doctor.

1. Chasing miracle creams

There is an entire industry built on the desperation of people with skin conditions. It's on Facebook, TikTok, Shopee, and in your relatives' WhatsApp groups. Before-and-after photos. Someone who "tried everything and finally found this." Usually a testimonial from someone whose skin was never that bad to begin with.

Two problems.

The first is money and time. Months spent cycling through products, none of which are treating the actual inflammation, while the skin quietly gets worse and the scratching becomes a habit that's hard to break even after the skin improves.

The second is more serious. A meaningful proportion of these unlabelled "natural" or "herbal" creams have been found to contain undeclared steroids — often potent ones. That's why they work so dramatically at first, and it's why people get so attached to them. But you're now applying an unknown-strength steroid, to an unspecified body part, with no end date and nobody supervising. That is precisely the scenario that causes the skin thinning everyone is so afraid of.

The irony is heavy. The person who refuses my prescription because they're scared of steroids often ends up on a much stronger steroid, used far more dangerously, because it came in a jar with a flower on it.

What to do instead: bring me the jar. I genuinely mean this and I'm not going to lecture you. If your skin got dramatically better on something unlabelled and then worse when you stopped, that's a clinically useful piece of information and it changes how I'd manage you.

2. Buying steroid cream over the counter and using it everywhere

This one's so common it's almost the default.

Someone gets a flare, goes to a pharmacy, comes out with a steroid cream. It works. Good. So the tube goes into the drawer and becomes the household eczema cream — used on the face, used in the groin, used on the child, used on the feet, used for a year, used for anything itchy.

The issue is potency versus site. Steroid creams come in strength classes, and the appropriate strength depends almost entirely on where it's going. Eyelid skin is very thin. Palms and soles are very thick. A cream that's dangerously strong for a face can be completely useless on a thickened palm — I know that one personally, since my own eczema is on my fingers.

So the single tube gets used at the wrong strength in most of the places it's applied. Too strong for the delicate sites, where it causes real problems over time. Too weak for the tough sites, where it fails and convinces you steroids don't work.

What to do instead: get told which cream goes where and for how long. That's a two-minute conversation that saves a year of confusion. And if you're about to use something on a body part your doctor didn't mention, ask first.

3. Using it for two days and stopping

If I could only fix one item on this list, it would be this one.

The pattern: flare starts, you apply the steroid, by day two it looks much better, and you stop — partly because it looks fine, mostly because you're nervous about the medicine. Three or four days later it's back. Two more days of cream. Stop again. Round and round for months.

Here's what's actually happening. The visible redness settles well before the underlying inflammation does. When you stop at day two, you're stopping when the surface looks calm and the process underneath is still active. So it returns, every time, and you conclude the treatment is weak.

Look at the totals, too. Six months of that cycle uses considerably more steroid, spread over a much longer period, than the one proper week-long course would have. The cautious approach ended up being the higher-exposure one.

What to do instead: finish the course you were given. For mild eczema that's usually around a week, sometimes with a taper afterwards; moderate cases need a stepped regime over longer. And if the plan frightens you, say so in the room rather than quietly running your own shortened version of it at home.

4. Doctor shopping

Two weeks with me, no miracle, off to the next clinic. Two weeks there, then the next. I've had patients arrive having seen five doctors in four months, with five different partial treatment plans in a plastic bag.

I understand the impulse completely. You're itchy, you're not sleeping, and progress feels too slow.

But eczema treatment needs a bit of runway. There's an initial control phase, then a maintenance phase, and the maintenance phase is where the long-term result actually gets made. If you leave at week two, every time, you're collecting first steps forever and never reaching step two with anybody. You also lose the accumulated knowledge — after a couple of visits I know your triggers, what your skin did on which cream, whether your flares follow your work schedule. That context is worth a lot, and it gets thrown away with every switch.

What to do instead: pick a doctor you're reasonably comfortable with and give the plan a fair run. If it isn't working, come back and tell them it isn't working, rather than silently leaving. Genuinely — a patient telling me "doctor, this didn't work" is useful. It narrows things down. It's not a complaint and I won't take it personally.

And if you should be seen by someone else, I'll say so. If your eczema is severe and resistant to everything I've tried, I'll refer you on for phototherapy or specialist input rather than keeping you coming back to me out of pride. I'm a GP with a strong interest in skin, not a dermatologist, and I'd rather be honest about where that line is.

5. Overwashing

Malaysians are clean people. In this heat, two or three showers a day is completely normal and I'm not going to argue with it.

But there's a version of it that quietly destroys skin barriers: long showers, hot water, soap over the entire body, twice or three times daily, often with an antibacterial or "medicated" wash chosen specifically because it feels like the responsible thing to do for a skin problem. Those washes are frequently the most stripping products on the shelf.

Then, on top of freshly stripped skin, the moisturiser goes on — and people wonder why it doesn't hold.

There's usually a scrubbing element too. When skin itches, scrubbing it in the shower feels wonderful. It's basically scratching with social permission. And it damages the barrier the same way scratching does.

What to do instead: my rule is clean enough, not too clean. Cooler water, shorter showers, a non-soap cleanser, soap only in the places that actually need it — the rest of you is getting clean from the water alone. Pat dry rather than rub. Moisturise while the skin is still slightly damp, generously, and don't skip it on the good days.

The one underneath all five

If there's a common thread, it's this: eczema is managed, not cured, and almost every mistake on this list comes from not fully accepting that.

Miracle creams are a search for a cure. Stopping at day two is treating it like an infection that's now finished. Doctor shopping is looking for the person who has the cure. Overwashing is trying to clean off something that isn't dirt.

Once it clicks that this is a long-term barrier problem you manage rather than a one-off illness you defeat, the correct behaviour becomes obvious. Treat flares properly and completely. Moisturise permanently. Reduce your triggers. Accept that there will be an occasional bad week.

I've had eczema since my twenties. These days I flare maybe once every year or two, and when I do, I know what to do and it settles within about a week. That's not because I found a miracle. It's because I stopped looking for one.

Klinik Dr Tan (Skin & Acne), Lot 27, Ground Floor, Block D, Lintas Square, Kota Kinabalu. WhatsApp 017-234 7328. Appointments preferred — bring the creams, all of them.

简要说明

我是陈医生，亚庇 Lintas Square 的 Klinik Dr Tan（皮肤与暗疮）。我是对皮肤有专长的普通科医生，不是皮肤专科医生。

五个最常见的错误：

追求「神奇药膏」。网上、社交媒体卖的无标示「天然」药膏，不少被验出含有未标示的强效类固醇。讽刺的是：因为怕类固醇而不用医生处方的人，往往在不知情下用了更强的类固醇，而且没有疗程限制。请把那罐药膏带来给我看，我不会骂你。
在药房买类固醇药膏，全身通用。药膏强度要配合部位。眼皮皮肤很薄，手掌脚底很厚。一支药膏用在所有地方——在薄的部位太强，在厚的部位又无效。
用两天就停。表面的红退了，底下的发炎还没好。停药→复发→再擦两天→再停，半年下来皮肤一直发炎，累计用量反而更多。请把疗程做完。
频繁换医生。治疗湿疹需要时间：先控制，再维持。每两周换一次医生，等于永远停在第一步。如果治疗没效，请回来告诉医生，这是有用的资讯，不是投诉。若真的顽固难治，我会转介光疗或专科。
洗太多太用力。热水、长时间、全身打肥皂、一天两三次，还用「抗菌」洗剂——这会把本来就不好的皮肤屏障洗掉。原则是干净就好，不要过度干净：水温低一点、时间短一点、用温和无皂洗剂、只在需要的部位用肥皂、擦干用轻拍、趁微湿时涂保湿。