Atopic Dermatitis: When Treatments Cause the Same Symptoms as the Disease
Laura Chrobok 28.09.2026
With agonising itching and scaly, red and inflamed skin, atopic dermatitis can significantly impair quality of life. Conventional medicine primarily treats the symptoms. And it often does so with very expensive medicines that can have considerable side effects which are disturbingly similar to typical symptoms of atopic dermatitis.
We explain what atopic dermatitis is and why conventional medical treatments of atopic dermatitis should not be trusted “blindly”.
Atopic Dermatitis — Many Possible Causes, Many Possible Symptoms
Atopic dermatitis, also known as atopic eczema or endogenous eczema, is a chronic inflammatory skin disease. The term “eczema” refers to inflammatory changes in the skin that may involve redness, itching and scaling, for example. The condition particularly often begins in childhood, but it can also affect adults and significantly impair quality of life at any age (Weidinger et al., 2018).
There is no single cause of atopic dermatitis. Genetic factors, an impaired skin barrier and misdirected immune responses may underlie the condition. In particular, the interaction between a disrupted skin barrier and immune-mediated inflammation is an important part of our current understanding of how the disease develops (Guttman-Yassky et al., 2017; Weidinger et al., 2018).
Conventional Medicine Treats Symptoms — Not Causes
Relieving the symptoms of atopic dermatitis without eliminating the causes can certainly be lucrative. After all, people who are chronically — and therefore permanently — ill may also need (sometimes very expensive) medicines on a permanent basis.
Some of these medicines can have side effects resembling symptoms that occur during an atopic dermatitis flare-up anyway: skin irritation, itching or redness.
This is one of the “medical scandals” surrounding atopic dermatitis. After all, who wants to undergo a treatment that can cause the very symptoms it is actually intended to combat?
Another issue is that so-called basic therapies — emulsions and creams designed to improve skin hydration and support the skin barrier — are not always covered by Germany’s statutory health insurance funds. “Basic therapies” — in other words, what could be described as fundamental necessities in the event of illness — which the insurance does not cover … (Gemeinsamer Bundesausschuss, 2008).
In more severe cases, considerably more elaborate “systemic therapies” may be used. Some of these can not “only” incur considerable costs, but may also be associated with sometimes significant side effects:
Topical Corticosteroids Can Damage the Skin
(Topical: applied externally to a specific area of the body, directly to the skin or mucous membrane.)
Topical corticosteroids — usually simply referred to as cortisone creams — have been among the most important medicines for inflammatory atopic dermatitis flare-ups for decades. Their anti-inflammatory effect is the reason for their therapeutic benefit.
At the same time, particularly long-term, high-potency or improper use can cause adverse effects. These include skin atrophy, i.e. thinning of the skin, which can make it more sensitive and vulnerable to injury (Barnes et al., 2015).
Other possible local adverse effects include skin irritation and changes in pigmentation. Improper use on the face can also lead to steroid-related skin problems (Hengge et al., 2006).
This creates a remarkable contrast: the medicine is intended to treat inflamed and irritated skin, yet it can itself cause skin problems. Correct and time-limited use is crucial for tolerability (Barnes et al., 2015).
Topical Calcineurin Inhibitors Can Cause Burning and Itching
Other treatment options include topical calcineurin inhibitors such as tacrolimus and pimecrolimus.
They can provide an alternative to topical corticosteroids and do not cause the skin atrophy typical of corticosteroids. However, they are not free from adverse effects. In particular, burning and itching can occur at the treated area of skin.
A systematic review and meta-analysis confirms the efficacy of topical calcineurin inhibitors, while also documenting local side effects such as burning and itching (El-Batawy et al., 2009).
Antihistamines Provide Only Limited Help for Atopic Dermatitis
Antihistamines are used, among other things, to relieve itching. However, their benefits in atopic dermatitis are limited. Overall, there is no consistent evidence supporting oral H1 antihistamines as a useful adjunctive treatment for eczema. At most, a slight improvement in itching has been found for individual active substances (Matterne et al., 2019).
Older H1 antihistamines in particular can also have a sedative effect. Tiredness and drowsiness are therefore possible side effects (Simon & Simons, 2008).
Systemic Immunosuppressants Suppress More Than Just the Symptoms
In more severe forms of atopic dermatitis, systemic immunosuppressants or immunomodulators may be used.
Unlike creams applied externally, they do not act specifically on individual areas of skin, but on the immune system. However, the immune system is not only involved in inflammatory reactions; it also performs essential protective functions in the body. Systemic interventions in its activity must therefore be carefully weighed in terms of benefits and potential risks and medically monitored.
Furthermore, suppressing the symptoms does not — of course — mean that atopic dermatitis has been cured. Symptoms may return after treatment is discontinued.
(Weidinger et al., 2018).
Biologics Enable Targeted but Costly Treatment
More modern treatment options for atopic dermatitis include so-called biologics. These are biotechnologically produced proteins that specifically influence certain signalling pathways in the immune system (Weidinger et al., 2018).
One well-known example is dupilumab.
The development and production of such active substances is complex. Accordingly, treatment costs can also be considerable.
A health-economic study published in 2018 specifically analysed the costs and health benefits of dupilumab for moderate-to-severe atopic dermatitis. In the US model examined, dupilumab was associated with additional health benefits, but also with considerable additional costs compared with usual treatment (Zimmermann et al., 2018).
Atopic Dermatitis and Conventional Medicine: Treating Without Curing
People affected by atopic dermatitis may depend on treatments for years or even permanently, while some of the medicines used can themselves cause precisely the symptoms they are intended to treat, such as skin irritation, burning or itching.
This principle becomes particularly critical with long-term, systemic and costly treatments. Merely suppressing inflammatory reactions does not necessarily eliminate the factors that contribute to the disease. Symptoms may return after treatment is discontinued. Responsible treatment of atopic dermatitis should therefore not be limited to keeping symptoms under control with medication. It should carefully weigh the benefits, risks and costs of each treatment while also looking beyond symptom management alone. We will explore how alternative medicine approaches this in our next article.
FAQ — Frequently Asked Questions About Atopic Dermatitis
1. How is human skin structured — and how is it affected by atopic dermatitis?
Our skin essentially consists of three layers: the epidermis, dermis and subcutaneous tissue. In atopic dermatitis, the outermost barrier of the epidermis is particularly important. Among other things, it is designed to prevent excessive moisture loss and stop irritating or allergenic substances from penetrating unhindered.
In atopic dermatitis, this skin barrier is often impaired. The skin loses moisture more easily and reacts more sensitively to external influences. At the same time, inflammatory immune reactions occur. The skin barrier and immune system influence one another — atopic dermatitis is therefore more than simply “dry skin” (Weidinger et al., 2018).
2. Which factors can trigger or worsen an atopic dermatitis flare-up?
This varies greatly from person to person. Possible triggers include mechanical or chemical skin irritation, allergens, heavy sweating, certain climatic conditions, infections or psychological stress. Skincare products or certain clothing materials may also play a role in some people (Werfel et al., 2024).
However, the crucial point is that a possible trigger is not automatically the cause of atopic dermatitis. Rather, it may contribute to an existing predisposition becoming apparent or to an existing inflammatory process becoming more severe. It therefore makes more sense to observe individual patterns than to indiscriminately avoid as many supposed triggers as possible.
3. Can certain foods make atopic dermatitis worse?
Yes, food allergies can be relevant to the course of the disease in some people. However, this does not mean that people with atopic dermatitis should generally avoid certain foods. The current German S3 guideline explicitly advises against general diets, such as routinely avoiding cow’s milk or gluten, as a treatment for atopic dermatitis. An elimination diet, by contrast, is recommended when a clinically relevant food allergy has been diagnostically confirmed (Werfel et al., 2024).
This is particularly important in children: unnecessary elimination diets can lead to an inadequate supply of nutrients. If there is reasonable suspicion that a particular food triggers or worsens symptoms, targeted allergy testing should therefore be carried out first (Werfel et al., 2009).
Further information — also on many other topics — can be found on our blog. You can also find our “Medizinskandale” book series and the “Codex Humanus”, the fifth volume of which was recently published, in our online shop. We look forward to your visit.
Sources:
· Weidinger, S. et al. (2018): “Atopic Dermatitis,” Nature Reviews Disease Primers.
· Guttman-Yassky, E. et al. (2017): “Atopic Dermatitis: Pathogenesis,” Seminars in Cutaneous Medicine and Surgery.
· Gemeinsamer Bundesausschuss (2008): “Tragende Gründe zum Beschluss über die Neufassung der Arzneimittel-Richtlinie,” Gemeinsamer Bundesausschuss.
· Barnes, L. et al. (2015): “Topical Corticosteroid-Induced Skin Atrophy: A Comprehensive Review,” Drug Safety.
· Hengge, U. R. et al. (2006): “Adverse Effects of Topical Glucocorticosteroids,” Journal of the American Academy of Dermatology.
· El-Batawy, M. M. Y. et al. (2009): “Topical Calcineurin Inhibitors in Atopic Dermatitis: A Systematic Review and Meta-Analysis,” Journal of Dermatological Science.
· Matterne, U. et al. (2019): “Oral H1 Antihistamines as ‘Add-On’ Therapy to Topical Treatment for Eczema,” Cochrane Database of Systematic Reviews.
· Simon, F. E. R. & Simons, K. J. (2008): “H1 Antihistamines: Current Status and Future Directions,” World Allergy Organization Journal.
· Zimmermann, M. et al. (2018): “Economic Evaluation of Dupilumab for Moderate-to-Severe Atopic Dermatitis: A Cost-Utility Analysis,” Journal of Drugs in Dermatology.
· Werfel, T. et al. (2024): “S3-Leitlinie Atopische Dermatitis: Teil 1 – Allgemeine Aspekte, topische und nichtmedikamentöse Therapien, besondere Patientengruppen,” JDDG: Journal der Deutschen Dermatologischen Gesellschaft.
· Werfel, T. et al. (2009): “Approach to Suspected Food Allergy in Atopic Dermatitis. Guideline of the Task Force on Food Allergy of the German Society of Allergology and Clinical Immunology (DGAKI) and the Medical Association of German Allergologists (ADA) and the German Society of Pediatric Allergology (GPA),” Journal der Deutschen Dermatologischen Gesellschaft.
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