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Derm
Eczema
General eczema evaluation including atopic features and trigger management.
Atopic featuresmoisturizationtriggersreferrals
Overview
Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition characterized by dry, itchy, and inflamed skin. It's the most common chronic skin condition in children but can affect people of all ages.
symptoms
- Dry, sensitive skin
- Intense itching (pruritus)
- Red, inflamed patches
- Rough, scaly, or leathery skin
- Oozing or crusting (during flare-ups)
- Darkened patches of skin
- Small, raised bumps that may leak fluid when scratched
atopic Features
- Personal or family history of atopy (asthma, allergic rhinitis, food allergies)
- Elevated IgE levels
- Positive allergy testing
- Associated with other allergic conditions
- Often begins in childhood
common Triggers
- Dry skin
- Irritants (soaps, detergents, fragrances, wool)
- Allergens (dust mites, pet dander, pollen, mold)
- Food allergies (especially in children)
- Stress and emotional factors
- Temperature changes
- Sweating
- Infections (bacterial, viral, fungal)
evaluation
history
- Onset and duration of symptoms
- Family history of atopy
- Associated allergic conditions
- Trigger identification
- Impact on quality of life
- Previous treatments and responses
physical
Assessment of skin lesions, distribution, severity, and signs of infection
testing
- Allergy testing (skin prick or serum IgE) if allergic triggers are suspected
- Patch testing if contact dermatitis is suspected
- Consider food allergy evaluation in children with moderate to severe eczema
treatment
moisturization
- Daily use of fragrance-free moisturizers
- Apply immediately after bathing to lock in moisture
- Use thick creams or ointments rather than lotions
- Moisturize multiple times per day as needed
- Choose products with ceramides or hyaluronic acid
topical Therapy
- Topical corticosteroids - mainstay for flare-ups (use appropriate strength)
- Topical calcineurin inhibitors (tacrolimus, pimecrolimus) - for sensitive areas
- Topical phosphodiesterase-4 inhibitor (crisaborole) - non-steroidal option
- Wet wrap therapy for severe cases
trigger Management
- Identify and avoid known triggers
- Use gentle, fragrance-free skin care products
- Wear soft, breathable fabrics (cotton)
- Keep nails short to prevent scratching
- Use cool compresses for itching
- Manage stress and anxiety
systemic
- Oral antihistamines for itching (especially at night)
- Oral corticosteroids - short courses for severe flares only
- Dupilumab (Dupixent) - biologic for moderate to severe atopic dermatitis
- Other biologics or immunosuppressants in severe cases
prevention
- Maintain consistent moisturization routine
- Avoid known triggers
- Use gentle, fragrance-free products
- Take shorter, lukewarm showers
- Pat skin dry instead of rubbing
- Wear protective clothing in harsh weather
- Manage stress and get adequate sleep
referral
- Refer to dermatologist for severe or refractory cases
- Consider referral for patch testing if contact dermatitis is suspected
- Refer to allergist for comprehensive allergy evaluation if triggers are unclear
- Consider referral for biologic therapy evaluation in severe cases
prognosis
Eczema is a chronic condition that can be managed effectively with proper treatment and trigger avoidance. Many children outgrow eczema, while others may have it persist into adulthood. With appropriate management, most patients can achieve good control and quality of life.
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