American Academy of Dermatology issues new guidelines for resistant eczema

The American Academy of Dermatology (AAD) has released its first formal guidelines for adults with atopic dermatitis (AD) that does not respond to standard treatments. The guidance suggests that persistent, treatment-resistant symptoms may indicate a misdiagnosis rather than a need for stronger medication. Potential conditions that can mimic eczema include psoriasis, allergic or irritant contact dermatitis, food allergies, asthma, allergic rhinitis, hives, and in rare instances, skin lymphoma.

Additionally, managing inflammatory skin conditions like eczema can lead to secondary complications such as milia—tiny, keratin-filled bumps. This often occurs when chronic inflammation weakens the skin barrier or when the long-term use of topical steroids affects skin-cell turnover. The use of heavy occlusive ingredients, such as petroleum jelly, can also contribute to milia formation, particularly in melanin-rich skin which may require more moisture but is prone to trapped keratin.