Topical steroids are a mainstay treatment for eczema, and severe episodes are sometimes treated with oral steroids.

Meanwhile stress is a known trigger for exacerbating eczema. During physiological stress, large amounts of endogenous steroid cortisol are released.

Why would exogenous steroids and endogenous steroids have opposite effects on eczema?

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    Because your first question is a great question at its root, to meet site guidelines I have changed the question to remove all personally related info. – DoctorWhom Oct 9 at 21:29

Exogenous topical steroids are mainly used for maintenance. They are very effective for long term use and does not have significant systemic side effect. Meanwhile oral steroids were used to treat severe acute flares with the risk of its side effects.

Stress has several pathways to trigger eczema/dermatitis and not only cortisol (endogenous steroid, stress hormone).

  1. upregulation of neuropeptide mediators in the brain, endocrine organs, and peripheral nervous system directly affect immune and resident cells in the skin

  2. Increased mast cells and mast cell-nerve fiber contacts

  3. sensory nerves release neuromediators that regulate inflammatory and immune responses, as well as barrier function.

In summary, several underlying mechanisms results to the effects of stress towards eczema and cortisol is released by the body to help and combat some of eczema's inflammatory response. We treat eczema with steroids to help our endogenous steroid reduce inflammation.

Source: Psychoneuroimmunology of Psychological Stress and Atopic Dermatitis: Pathophysiologic and Therapeutic Updates Andrea L. SUÁREZ, Jamison D. FERAMISCO, [...], and Martin STEINHOFF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704139/

P.s. Eczema is a poorly understood disease with no definite treatment, all we have for now is symptomatic relief

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    There are a lot of assertions in here that need much more backup. For some I'd say they are 'not even wrong' [Systemic Side-Effects of Topical Corticosteroids ](dx.doi.org/10.4103%2F0019-5154.139874) or Side-effects of topical steroids: A long overdue revisit (PMC4228634) come to mind as saying just the opposite of this answer. Unless edited, this results in a -1. – LangLangC Nov 18 at 14:09
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    In view of the comment above, you need to either edit the question or respond and explain why your answer is correct. Incorrect answers will generally be deleted. – Carey Gregory Nov 18 at 22:41
  • @LangLangC well I'm fully aware that there is a risk for systemic side effect on children when I answered this question and intentionally omitted that part because that paragraph was just meant to set a background to the topic. The OPs question was "Why would exogenous steroids and endogenous steroids have opposite effects on eczema?" I showed the explanation and the short answer is "No because exogenous and endogenous doesn't have the opposite effect, they work just the same and they work in tandem". – kit Nov 19 at 17:38
  • I do not say that this answer is without any value or potential. Your core seems to meet my goals. I do say that I consider eg the assertion "Exogenous topical steroids are mainly used for maintenance" is widely overgeneralised and IMO borderline misuse or beyond that threshold in too many cases. "Generally most of the TC, regardless of the potency, should not be used for more than 2–4 weeks duration at a stretch." An edit addressing that would calm my mind & is more needed IMHO than a comment, unless that comment would convince me otherwise. – LangLangC Nov 19 at 18:40
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    Thinning of skin is one adverse side effect from long term topical corticosteroid use. I think adjusting how you phrase that part would improve the answer. – DoctorWhom Nov 20 at 6:18

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