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Consider these research findings: Biofilm formation: Bacterial biofilms can form in chronic nummular lesions, contributing to treatment resistance [3] Altered drug penetration: The thick, scaly (hyperkeratotic) nature of chronic lesions can reduce the absorption of topical medications [13] Neurogenic inflammation: The density of nerve fibers containing Substance P, a neuropeptide involved in inflammation and itching, is significantly increased in nummular eczema lesions [14] Most frustrating is the rebound phenomenon that can occur after discontinuing topical steroids, which can lead to a dependency cycle [15]

10.1016/j.cmet.2005.05.004 Cell Metab