Managing an eczema flare

About this guide

Even with the best daily skincare routine, most people with eczema will have flares from time to time — periods when the skin becomes red, intensely itchy, and inflamed. Flares are not a sign that you’ve done something wrong. They’re part of how this condition behaves.

This guide is the second of three:

1. Everyday skincare for eczema — the daily routine (still important during a flare)
2. Managing an eczema flare (you are here) — the tools for bringing a flare under control
3. Children with eczema — and when to call us — age-specific tips and urgent red flags

Read this alongside guide 1. During a flare, your daily moisturising routine doesn’t stop — it becomes more important, not less, and the flare treatments below are added on top.

Spotting a flare early

Flares rarely arrive without warning. Catching one early usually means treating a smaller patch with less treatment.

Early signs include:

• Skin feels itchier than usual
• Small patches of redness (or darker, violet, or grey patches in Asian skin) returning to your usual “trouble spots”
• Dryness worsening despite your normal moisturising
• Disturbed sleep from night-time itching

If you recognise these, don’t wait. Starting flare treatment early — sometimes within the same day — usually brings it under control faster than waiting until the skin is cracked, weepy, or infected.

Your moisturiser when you’re flaring

During a flare, daily moisturising becomes more important, not less — your everyday routine continues alongside any flare treatment. A few adjustments help:

• If your usual moisturiser stings on inflamed skin, switch to something plainer. Some moisturisers that work well on calm skin — particularly those containing urea, fragrance, strong humectants, or active ingredients — can sting when your skin is broken or inflamed. A ceramide-based cream without added actives, or a plain oil-based ointment (even pure petrolatum / Vaseline), is usually better tolerated during a flare.
• Urea-containing moisturisers should be paused during a flare — keep them for calm, maintenance periods.
• Apply more frequently — several times a day, not just twice, while the skin is inflamed.
• For the itch specifically, a moisturiser with 1–3% menthol (available over the counter in pharmacies) can provide short cooling relief. Menthol works on the skin’s cold receptors to distract from the itch signal. It is an adjunct, not a replacement for your regular emollient — use in addition to, not instead of, your usual moisturiser. A small number of people are sensitive to menthol itself; if it worsens the skin, stop and switch back.

If you’re not sure whether your current moisturiser is helping or hurting during a flare, please bring the product with you to the consultation — we’ll have a look and suggest alternatives if needed.

Topical corticosteroids — the first-line treatment

Topical corticosteroids (TCS) remain the first-line anti-inflammatory treatment for eczema flares, and for most mild and moderate flares they are very effective.

Your doctor will choose the right strength of steroid for the area of your body and the severity of your flare. In general:

• Thin-skinned areas — face, neck, eyelids, groin, and the soft skin in the folds of the arms and knees — need gentler, low-potency steroids for short durations
• Body skin (arms, legs, trunk) — can tolerate moderate- or higher-potency steroids during flares
• Very severe flares may need higher-potency steroids for a limited period

The dose and frequency are set by your doctor at the consultation. If you’re unsure, please ask before starting a tube from a previous prescription on a new patch of skin.

How much to apply — the fingertip unit

A fingertip unit (FTU) is the standard way to dose topical steroids.

• One FTU = the amount of cream squeezed from a standard tube onto the fingertip, from the tip of the adult index finger to the first crease
• One FTU covers roughly two adult palms of skin (including fingers)

Your doctor will tell you how many FTUs per application for each affected area. Using too little is one of the most common reasons a flare doesn’t settle; using too much (or too strong) carries the risks we discuss in the safety section below.

When to stop — and “proactive therapy” for frequent flares

For occasional flares, a typical course is daily application until the area is clear, then stopping — your daily moisturiser continues throughout.

If you are having frequent flares (two or three a month) on the same patches of skin, there is an approach called proactive therapy worth discussing: after a flare has been brought under control, applying a topical steroid (or a calcineurin inhibitor — see below) to those known trouble-spots twice a week as maintenance. This keeps the subclinical inflammation from building back into a full flare, and over time it reduces the total amount of steroid you use compared to waiting for each flare and treating reactively.

Proactive therapy is something your doctor will plan with you after you’ve had a few flares. It’s reviewed every 3 to 6 months and stopped once you’ve been flare-free for a while.

Topical calcineurin inhibitors — the steroid-sparing option

Topical calcineurin inhibitors (TCIs) — pimecrolimus (Elidel) and tacrolimus (Protopic) — are non-steroidal anti-inflammatory creams that work particularly well for:

• Face, eyelids, neck, and skin folds — areas where long-term or repeated steroid use would be a concern
• Patients who prefer a non-steroid option
• Proactive therapy, in place of or alongside a topical steroid

They can cause a transient burning or stinging in the first few days, which usually settles with continued use. The older FDA “black-box” warning about theoretical cancer risk has not been borne out by long-term human studies, and these are now routinely used by dermatologists worldwide. Age limits: pimecrolimus from 3 months of age; tacrolimus 0.03% from age 2 and tacrolimus 0.1% from age 16.

If your flare is on your face, around your eyes, or keeps coming back in the same sensitive spot, ask us about TCIs. They’re often underused in primary care and are a very useful tool.

Wet wrap therapy

For severe flares — typically on the limbs, with intense itching and scratching at night, not responding well to your usual topical treatments — wet wrap therapy (WWT) can be a useful short-term escalation. It amplifies the effect of your moisturiser (and any topical steroid applied with it) by holding hydration against the skin, while the outer dry layer protects against scratching overnight.

How to do it

The basic technique is a three-layer approach:

1. Skin preparation — take a short lukewarm bath or shower, and gently pat the skin dry. The skin should be slightly damp, not wet.
2. Apply your flare treatment first — topical corticosteroid (if prescribed), then wait a few minutes, then a generous layer of moisturiser on top. Or, if no steroid is being used, a thick layer of moisturiser only.
3. Inner layer — damp cotton. Soak a soft cotton garment (a long-sleeved cotton top, cotton pyjamas, cotton tubular bandage, or cut-up cotton gauze) in warm water and wring it out well — it should be damp, not dripping. Put this on over the area you’re treating.
4. Outer layer — dry cotton. Put a second, dry layer of cotton clothing on top of the damp inner layer to hold it in place and prevent chilling.
5. Leave on for 1–2 hours up to overnight. Most people start with a few hours and build up to overnight once they know how the skin tolerates it.
6. Remove, re-moisturise, and put on dry clothes. The skin should feel softer and calmer. You typically continue wet wraps nightly for 3–5 days, then reassess — they’re a short-term tool, not a long-term routine.

When not to do it

Wet wraps are not appropriate in these situations — if any of these apply, please come in before starting:

• Weeping, oozing, or infected skin — wraps can trap bacteria against inflamed skin and worsen infection
• Honey-coloured crusting, pus, fever, or other signs that eczema herpeticum or a bacterial skin infection might be present
• Very young infants — we recommend clinic supervision for the first wraps in under-2s, and never on large surface areas in infants
• Over a topical calcineurin inhibitor (pimecrolimus, tacrolimus) or a topical PDE4 inhibitor without specific advice — the safety of occlusion of these agents hasn’t been fully established
• If the person can’t tolerate the wrap (too cold, too uncomfortable) — it’s not worth persevering; try again another day

Things to watch for

• Chilling — especially in children, make sure the room isn’t cold and there’s a warm outer layer
• Skin softening or pruning — normal if mild, but if the skin is breaking down or developing small spots (folliculitis), stop and come in
• Worsening itch or burning during the wrap — remove and reassess

First time is best done with clinic guidance. The technique sounds simple, but the details (how damp is damp, what garments to use, whether a steroid under occlusion is right for you) make the difference between a helpful escalation and an ineffective one. Please discuss at a consultation before starting, especially for children.

Itch and sleep

Itching that disrupts sleep is one of the hardest parts of a flare.

The first step is always to treat the inflammation itself with your topical treatments — the itch will follow. Cool compresses, cool showers (not cold), and gently pressing or rubbing rather than scratching can help bridge the first day or two.

Oral antihistamines don’t treat eczema itch very well — most eczema itch is driven by non-histamine pathways, which is why the standard antihistamines for hay fever or hives are disappointing here. However, a short course of a sedating antihistamine at bedtime (first-generation, such as hydroxyzine or chlorpheniramine) can help break the scratch-and-wake cycle during a severe flare, mainly by helping you sleep. This is not for routine daily use — longer-term use carries drowsiness, dry mouth and skin, and fall-risk concerns, especially in older patients. Your doctor will prescribe a short, time-limited course if it’s appropriate for you.

Concerns about steroids

Many patients are uncomfortable with topical steroids. Concerns are understandable, and we’d rather discuss them than have you under-treat the flare and end up worse.

A few things worth knowing:

• Topical steroids are not the same as oral steroids. The amount absorbed into the body is very much lower, and the side-effect profile is very different.
• The risks (skin thinning, visible blood vessels, stretch marks) are mainly associated with high-potency steroids used long-term on thin-skinned areas, not with appropriately-chosen treatments for a flare.
• Under-treating a flare is its own risk — poorly-controlled eczema means more scratching, more damage, and more chance of skin infection.
• Proactive therapy (as above) actually reduces your total steroid exposure over time compared to repeated reactive courses.

If you’ve been told to avoid steroids entirely by friends, online, or on social media, please bring that up at a consultation. We’d rather address it directly than have you leave the clinic with a prescription you’re not going to fill.

A note on “triple-combination” creams

Some patients come to us with creams containing three ingredients in one — typically a topical steroid, an antibiotic, and an antifungal. These products have their place in specific situations, but they’re not our preferred choice for routine eczema care: the steroid component is often higher-potency than needed, and in most eczema flares you don’t need the antibiotic or antifungal component as well.

If you have one at home and it’s working for you, that’s fine — continue using it as directed. But if your eczema isn’t settling with it, please come in. A flare that isn’t responding to a triple-combination cream usually needs a review — and sometimes further tests — rather than more of the same.

Topical steroid withdrawal

A concern some patients raise — often after reading about it online or on social media — is topical steroid withdrawal (TSW), sometimes called “red skin syndrome.” This is a recognised condition described after prolonged use of medium- or high-potency topical steroids followed by abrupt cessation, most often on the face or in skin folds. It typically presents with a burning or stinging sensation, widespread redness (sometimes extending beyond where the steroid was being applied), and may be mistaken for a bad eczema flare.

A few things worth being clear about:

• TSW is real but uncommon when topical steroids are used appropriately — right potency for the site, right duration, and weaned off rather than stopped abruptly after long-term regimens.
• Most rebound symptoms after stopping a steroid are actually the eczema flaring, not TSW. Telling the two apart can be difficult, which is part of why this is a topic best worked through with your doctor rather than by stopping treatment on your own.
• Proactive therapy (using topical steroids or calcineurin inhibitors twice weekly on flare-prone areas) reduces the total steroid exposure over time, which is one of the best ways to reduce the risk of ever getting to this point.
• Don’t abruptly stop long-term topical steroids on your own. If you’ve been using a moderate-to-strong topical steroid daily for an extended period and want to step off, please come in so we can plan a gradual step-down — usually by switching to a weaker agent, spacing out applications, or bridging with a calcineurin inhibitor.

If you think you may be having TSW symptoms — especially a burning sensation or redness that spreads beyond your usual eczema pattern — please come in for assessment. We’d rather diagnose and support you through this together than have you cycle through self-treatment strategies alone.

Oral steroids — the short answer

Oral corticosteroids are not used routinely for eczema, even during flares. They work quickly but the eczema tends to rebound worse when the course ends, and repeated use carries real long-term risks. When they are prescribed, it’s as a short, tapered course under clinical supervision for a severe flare that isn’t settling with topical treatment, or as a short “bridging” course while a slower-acting treatment takes effect — not a reach-for-when-itchy option.

In children, we’re especially careful with oral steroids because of the effect on growth.

If a flare isn’t responding to topical treatment

This is a common situation, and it usually means it’s time to come in rather than to keep applying the same treatment hoping it eventually works.

At the consultation, we’ll try to understand why the topicals aren’t controlling things. Common reasons include:

• Secondary bacterial infection — a flare with honey-coloured crust, oozing, or rapid worsening is often infected and needs antibiotic treatment alongside the anti-inflammatory
• The wrong potency, frequency, or duration of topical steroid for the site and severity
• Application technique — too little, too infrequent, or not on the full affected area
• Moisturiser that’s stinging or irritating the inflamed skin
• An unrecognised trigger — new detergent, new pet exposure, other allergen, or stress
• A different diagnosis — occasionally what looks like eczema turns out to be something else

Depending on what we find, treatment might include a short course of oral corticosteroids together with oral antibiotics (if the skin is infected) — or a referral, usually to a private dermatologist for specialist skin-focused care, or in rare severe cases to the emergency department for inpatient management.

When to come back and see us

Most flares settle with a consistent flare-treatment plan and the right daily skincare. But there are situations where the plan needs adjusting, and coming in sooner rather than later will usually get you better results than staying on a regimen that isn’t working. Please book a consultation if:

• Your flare isn’t improving after about 2 weeks of the treatment we prescribed — review usually beats continuing the same regimen
• You’re flaring in the same patches of skin repeatedly — you may be a good candidate for proactive therapy (twice-weekly maintenance treatment) rather than repeated reactive courses
• Your moisturiser is stinging on inflamed skin or you’re not sure it’s still the right choice
• You’re experiencing side effects from your topical treatment — persistent burning or stinging, visible thinning of the skin, stretch marks, or unexplained changes
• You’re worried about long-term topical steroid use, or you think you might be experiencing the topical steroid withdrawal symptoms described above
• Sleep, school, or work are being significantly affected by the flare

Urgent — come in (or go to an emergency department) today

Separate from the situations above, a few signs need same-day attention rather than a routine appointment:

• Weeping skin, honey-coloured crusts, or yellow pus on an eczema patch — suggests a bacterial skin infection
• Fever, feeling generally unwell, or rapidly spreading redness in an eczema area
• Sudden appearance of many small, dome-shaped blisters or punched-out sores on the eczema skin — this may be eczema herpeticum, which is urgent

For the full list of red-flag signs across all ages — including more detail on eczema herpeticum in children — see the third guide: Children with eczema — and when to call us.

Get in touch

Joo Chiat — 172 Joo Chiat Road, #01-01, Singapore 427443 · Tel 6920 1952

Punggol — 658 Punggol East, #01-04, Singapore 820658 · Tel 6312 4589

Email — admin@ktmc.sg

References

• Agency for Care Effectiveness (ACE). Mild and moderate atopic dermatitis (eczema) — a journey from flare to care. ACE Clinical Guideline, Ministry of Health, Singapore. February 2026. ace-hta.gov.sg
• American Academy of Dermatology. Guidelines of care for the management of atopic dermatitis in adults with topical therapies. J Am Acad Dermatol, 2023. jaad.org
• British Association of Dermatologists, British Dermatological Nursing Group, and National Eczema Society. Joint position statement on topical steroid withdrawal (2024).
• Hawro T et al. Safety and antipruritic efficacy of a menthol-containing moisturizing cream. J Dermatol Treat. 2018. PubMed

This information is for general education only and is not a substitute for medical advice. Flare severity, treatment choice, and dosing must be individualised — please attend a consultation for assessment. v1.0 · April 2026 · Review due April 2028.