Without treatment, eczema symptoms may become chronic, or you may develop other complications such as mental health issues and sleeping difficulties.

Eczema is a term for a group of inflammatory skin conditions that cause dryness, itchiness, and damage. More than 31 million people in the United States experience some form of eczema. It most often develops during early childhood but can happen at any point from infancy to adulthood.

Various treatment options are available for eczema. These may include:

  • moisturizers
  • medicated lotions, creams, and ointments
  • oral medications
  • injectable therapies

Without treatment, eczema symptoms can become recurrent or chronic and may lead to other bothersome complications.

This article answers some common questions about what could happen if eczema is left untreated and important things to know about eczema treatment.

The natural course of eczema depends on a variety of factors, including the cause of eczema and its management. Many people who develop eczema as a young child will outgrow symptoms, but it may persist for others.

A 2016 analysis of 45 studies involving more than 110,00 people with childhood atopic dermatitis — the most common form of eczema — found that about 80% had resolution of symptoms within 8 years of diagnosis. Less than 5% had persistent symptoms 20 years after diagnosis.

Studies suggest that long-term persistence of eczema is more common in people with more severe symptoms and those who have an onset of symptoms after 2 years of age.

If left untreated, eczema symptoms can worsen and may lead to other complications affecting the skin and other parts of the body.

One of the most common complications of eczema is skin infections. Bacterial infections — from the pathogenic bacterium Staphylococcus aureus — are especially common, but viral infections can also occur. People with eczema who experience infections with the herpes simplex virus can develop a serious and potentially fatal secondary skin condition known as eczema herpeticum, which causes itchy, painful blisters.

Other possible complications of untreated eczema include:

  • sleeping difficulties
  • anxiety, depression, and reduced self-esteem
  • eye disorders
  • growth issues

Eczema is a result of inflammation in the skin. Inflammation refers to the mechanisms the immune system uses to help fight off infections. In small amounts, inflammation can be helpful and serves to keep the body healthy. However, when these inflammatory mechanisms are unable to “shut off,” they can cause damage to other cells and tissues in the body.

In eczema, long-term inflammation can disrupt the integrity of the skin barrier, leading to dryness and cracking in the skin. These defects can allow bacterial, viral, and fungal pathogens to enter the skin tissues and cause infections.

Inflammation and skin damage are also responsible for the itchiness and pain that many people experience with eczema and can lead to scratching that further damages the skin tissue. This is known as the itch-scratch cycle.

In many people with eczema, inflammation is not contained to the skin and may be more widespread throughout the body. This is known as systemic inflammation. Systemic inflammation is especially common in atopic dermatitis and can lead to various other health concerns related to heart health, autoimmunity, and mental health.

The progression of eczema varies from person to person. Some individuals may only experience mild symptoms that resolve on their own with a skin care regimen and over-the-counter (OTC) topical therapies.

Others may have more persistent disease that worsens over time. According to a survey of more than 1,500 people with eczema conducted by five leading organizations in eczema research:

  • 48% indicated that their eczema symptoms had worsened since the diagnosis
  • 64% said that more or different areas of the body were now affected
  • 49% reported that eczema flares occurred more frequently than when diagnosed

Progression of eczema depends on several factors, including age of onset, underlying causes of disease, and management of disease flares.

Many people with mild eczema can effectively manage their symptoms with OTC treatment or by avoiding chemicals, allergens, or other factors that trigger symptoms. Nonprescription treatment of eczema typically involves:

  • daily, or more frequent, use of moisturizer
  • daily baths with a soap-free cleanser
  • low dose steroid cream — some formulas may require a prescription

If these steps are not effective, more support may be necessary to manage symptoms, including the use of prescription medications. Doctors typically recommend treatment escalation for people who have worsening symptoms, either due to more frequent or more severe flare-ups or whose flares are difficult to manage.

Signs of worsening symptoms may include:

  • more intense itchiness, pain, or flaking
  • deepening of skin discolorations — red on light skin and purple, brown, or gray on darker skin
  • oozing or crusting of skin
  • involvement of new areas of the body
  • symptoms that affect sleep or mental health

People with eczema who are experiencing bothersome symptoms even after taking steps to manage it should discuss with their healthcare team if more treatment may be necessary to help relieve their symptoms.

Prescription treatments for eczema include:

  • topical calcineurin inhibitors
  • biologics
  • Janus kinase (JAK) inhibitors
  • oral immunosuppressants

Eczema is a common inflammatory skin condition that affects many people. Symptoms often develop in childhood but can occur at any age. Many cases of eczema resolve by adolescence, but it may persist for some people. Untreated eczema can lead to a variety of complications, such as other skin issues, mental health concerns, and sleep difficulties.

Various treatment options are available for eczema, including topical, oral, and injectable medications. If OTC care options are ineffective, a healthcare professional can help determine if prescription treatment is necessary to relieve symptoms.