Evaluation and step-by-step treatment of inflammatory skin diseases (eczema, dermatitis) presenting with dryness, itching and rash. Triggers are identified and topical and systemic therapy are arranged.
Indication
- Diagnosis and follow-up of atopic dermatitis (chronic itchy eczema in atopic individuals)
- Contact dermatitis (rash from contact with allergens or irritants) — occupational or cosmetic-related
- Seborrheic dermatitis (oily scaling on the scalp, face and chest)
- Subtypes such as nummular eczema and dyshidrotic eczema (small blisters on fingers and toes)
- Chronic itching, sleep disturbance and persistent rashes affecting quality of life
- Eczema lesions with superinfection (oozing, crusting)
- Further evaluation in cases unresponsive to standard treatment or with frequent recurrences
Preparation
- Onset of complaints and suspected triggers (new cosmetic, detergent, jewelry, occupational exposure) should be noted
- A list of currently used creams, medications and natural products should be brought
- Previous dermatology reports, allergy test results and blood tests may be brought along
- If patch testing is planned, no topical corticosteroid should have been applied for the last week
- Scheduling the visit during an active phase of lesions is helpful for diagnosis
How it's performed
- The physician asks in detail about the distribution and shape of the rash and family history of atopy
- Skin examination is supported with a magnifier (dermatoscope); photographic documentation is performed if necessary
- If the diagnosis is uncertain, patch testing (contact allergen screening) or a small skin biopsy may be planned
- Treatment is staged according to severity: moisturizer, topical corticosteroid, calcineurin inhibitor, phototherapy or systemic therapy
- A list of trigger avoidance, a bathing-skin care routine and a written treatment plan are provided
- In moderate-to-severe cases, joint dermatology-allergy follow-up is planned
Post-procedure
- A follow-up visit 2-4 weeks after the initial evaluation to assess treatment response
- After the active phase, maintenance therapy 2 days per week (proactive approach) may be recommended
- The class, duration and application area of topical corticosteroids are followed carefully (risk of skin thinning)
- Blood test monitoring (usually every 1-3 months) in patients on systemic therapy
- Visit without waiting for an appointment in case of new rash, crusting or signs of infection such as fever
Risks
- Skin thinning (atrophy), prominent vessels (telangiectasia) and color changes due to long-term incorrect use of topical steroids
- Long-term use of high-potency (class 1-2) steroids on the face and skin folds is unsuitable
- Steroid-related acne-like rash and perioral dermatitis may develop
- Bacterial or viral superinfection (especially herpes — eczema herpeticum)
- Systemic treatments (cyclosporine, methotrexate, biologics) require monitoring of blood counts, liver/kidney function and infection
FAQ
Is eczema contagious?
No. Eczema is an inflammatory skin disease, not microbial, and is not transmitted by contact. However, if bacteria or viruses settle on top of it, that condition may be contagious.
Do corticosteroid creams thin the skin?
Low-to-moderate potency creams can be used safely under physician guidance for limited durations. Long-term, uncontrolled use of high-potency steroids or application to thin skin areas may cause atrophy. For this reason, treatment is given according to a plan.
Does eczema go away completely?
Atopic dermatitis is a chronic disease and may decrease with age in children, although the course differs in each individual. Treatment aims to control flares and preserve quality of life.
Which moisturizer should I use?
Fragrance-free products with few preservatives, containing ceramide or urea, are usually suitable. For a personalized recommendation, skin type and sensitivity should be evaluated.
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