Eczema: Why Treatment Can Sometimes Make It Itchier

After applying medication and receiving an injection for eczema, it has instead become itchier?

Hello, doctor.
I often experience allergic reactions when using pain relief patches (though they usually aren't very itchy, just a rough texture when touched).
Recently, I developed an allergic rash on my neck that hasn't gone away (it feels rough to the touch but isn't painful or itchy).
I consulted a dermatologist who diagnosed it as eczema and prescribed an ointment.
I applied it once a day for two days and noticed a significant itching sensation (about 2-3 out of 10) when applying it, but it gradually subsided after a few hours.

This was my first visit to a dermatologist due to a drug rash, as the area couldn't undergo electrical therapy.
Feeling a bit strange, I visited another dermatologist who also diagnosed it as chronic eczema.
They administered two injections in the eczema area (about one centimeter in size).
Shortly after the injections, the area started to itch continuously.
The next day, I returned to the hospital to see a dermatologist and asked if itching was normal.
The doctor confirmed it was and prescribed an ointment (Nerifin) and an antihistamine (Dihydrocodeine).
I initially had no itching, but now I am experiencing itching all day, which feels like it has worsened.
It has been ongoing for two days, maintaining an itch level of about 3 out of 10, but this morning it felt itchier.
I applied the ointment, which reduced the itching.
I have a few questions for the doctor (as I am in a rural area and will take a few days to return for a follow-up):
1.
Is this a drug allergy, or is it a normal reaction to the treatment? (I have noticed occasional itching in areas not near the rash, such as my scalp.)
2.
Regarding medication, if I do not specifically scratch the rash, do I need to take the antihistamine? (I am unsure if it only relieves itching or has therapeutic effects as well.)
3.
I currently have two ointments: Nerifin and Betamethasone ointment (which I found out is quite potent).
Since the injections, I have only started applying Nerifin this morning (which has reduced itching by about 50%, but it wasn't itchy before).
4.
Lastly, can I continue using the ointment? I initially planned to see if the itching would stop on its own after the injections, but it seems to be getting worse.

mou, 30~39 year old female. Ask Date: 2023/10/20

Dr. Wu Yuxin reply Dermatology

I'm sorry, but without actually seeing your skin lesions, I cannot provide any medication recommendations.

Reply Date: 2023/10/20

More Info

Understanding eczema and its treatment can be quite complex, especially when it comes to the paradoxical experience of increased itchiness following treatment. Eczema, or atopic dermatitis, is a chronic inflammatory skin condition characterized by dry, itchy, and inflamed skin. The management of eczema often involves topical treatments, including corticosteroids, which can sometimes lead to temporary worsening of symptoms, including itchiness.

In your case, it seems that you have been experiencing a persistent rash on your neck diagnosed as chronic eczema. The treatment you received, including topical corticosteroids and injections, is commonly prescribed to reduce inflammation and alleviate symptoms. However, it is not uncommon for patients to experience increased itchiness after starting treatment. This can be attributed to several factors:
1. Initial Reaction to Treatment: When corticosteroids are applied to inflamed skin, they can initially cause a sensation of itchiness as the skin reacts to the medication. This is often a temporary response as the skin begins to heal.

2. Skin Barrier Function: Eczema is associated with a compromised skin barrier, which makes the skin more susceptible to irritants and allergens. Even with treatment, the skin may still react to environmental factors, leading to increased itchiness.

3. Medication Side Effects: Some topical treatments can cause irritation or allergic reactions, leading to increased itchiness. If you suspect that the medication is causing an adverse reaction, it is essential to discuss this with your healthcare provider.

4. Underlying Conditions: Sometimes, the itchiness may not be solely due to eczema but could be related to other skin conditions or systemic issues. If you are experiencing itchiness in areas not affected by the rash, it may warrant further investigation.

Regarding your specific questions:
1. Is this a drug allergy or a normal reaction?: The increased itchiness could be a normal reaction to the treatment rather than a drug allergy, especially if the itchiness subsides after a few hours. However, if the itchiness persists or worsens, it is crucial to consult with your dermatologist.

2. Do you need to take antihistamines if you are not scratching?: Antihistamines can help alleviate itching, but they are not a substitute for treating the underlying eczema. If you are not scratching and the itchiness is manageable, you may not need to take them. However, if the itchiness becomes bothersome, antihistamines can provide relief.

3. Can you continue using the ointments?: It is generally safe to continue using topical treatments like Nalisone (a corticosteroid) and Betamethasone ointment (which is a potent corticosteroid) as prescribed. However, it is essential to follow your doctor's instructions regarding the frequency and duration of use to avoid potential side effects, such as skin thinning.

4. Will the itching stop after the injections?: The injections you received are likely intended to reduce inflammation and may take some time to show effects. It is not uncommon for symptoms to fluctuate during treatment. If the itching persists or worsens, it is advisable to follow up with your healthcare provider for further evaluation and management.

In summary, while increased itchiness can be a frustrating aspect of eczema treatment, it is often a temporary response to therapy. It is essential to maintain open communication with your healthcare provider, especially if you notice any significant changes in your symptoms. They can help tailor your treatment plan to ensure optimal management of your eczema and associated symptoms.

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