While eczema cannot be cured, most cases can be controlled by:
Making lifestyle modifications to prevent flare-ups
Seeing a dermatologist for treatment
Using medication as prescribed
This approach tends to prevent inflammation and itching and keeps eczema from getting worse. Dermatologists recommend that treatment be sought at the onset of signs and symptoms. When therapy begins early, it often reduces severity and duration.
Effective treatment requires a correct diagnosis; however, it is not always easy to distinguish one type of eczema from another or from similar skin conditions. Dermatologists have the medical training and experience needed to determine if eczema is present — and if present, which type. To diagnose eczema, dermatologists examine the skin and ask about:
When the skin condition first appeared
Signs and symptoms, such as long-term pruritus (itching) or recurring dermatitis (inflammation of the skin)
Certain circumstances that may aggravate the condition, such as excessively dry air or emotional stress
Family medical history, including questions about close blood relatives who have asthma, hay fever, or eczema
Personal medical history
In some cases, a skin biopsy may be performed to rule out other causes.
Allergies are more common in individuals with atopic dermatitis, and allergy testing may be considered when a patient has:
Significant indications of allergies, such as gastrointestinal symptoms (e.g., nausea, vomiting, or diarrhea and colic in infants) or hives
Been poorly responsive or unresponsive to treatment
If a food allergy is suspected, testing for allergic reactions to eggs, milk, peanuts, soy, wheat, fish, and tree nuts (e.g., walnuts, cashews) are usually performed as these foods are responsible for 85% of all food allergies. A positive allergy test does not confirm the food allergy. A suspected food allergy must be subjected to a "challenge." A challenge is conducted by having the patient eat the suspected food and observing the patient for a reaction. Even a challenge does not guarantee that the food is the trigger because: 1) another trigger may be present and causing the reaction or 2) the patient's reaction may be delayed. Consequently, allergy testing has limited value. However, it is useful for eliminating foods that cause immediate and severe reactions or welts.
Dermatologists may use a “patch test” to determine if the patient has allergic contact dermatitis, a type of eczema that develops when the person has an allergic reaction to a substance that contacts the skin. The reaction generally occurs a few hours after the substance contacts the skin and settles down within a few days if the substance does not contact the skin again. A patch test exposes the patient's skin to minute amounts of substances that may have caused the reaction. When the test is positive, the dermatologist must determine if the chemical caused the dermatitis and if so, if it is the primary cause or an aggravating factor. Further testing may be necessary.
Once eczema is diagnosed, a treatment plan will be made based on:
Type and severity of the eczema present
Age, health, and medical history (including presence of other conditions)
History of previous treatment
The primary goal of treatment is to relieve discomfort by controlling the signs and symptoms. Since eczema is usually dry and itchy, most treatment plans involve applying lotions, creams, or ointments to keep the skin as moist as possible. The treatment plan also may require lifestyle modifications and using medication as directed.
A topical (applied to the skin) medication may be prescribed to help relieve itching and inflammation. Another way to treat the itch is with a non-sedating antihistamine . If itching is severe, a sedative antihistamine may be recommended. Skin infections caused by bacteria , such as staphylococcus aureus (staph) or streptococcal (strep), are treated with an antibiotic . Some antibiotics are applied to the skin; others come in pill or liquid form. An antiviral is prescribed to treat an infection caused by a virus. The antiviral medication may come in topical, pill, or liquid form. It also may be given as a shot. An infection caused by a fungus is treated with an antifungal medication.
Certain types of severe eczema may be treated with phototherapy . Stronger systemic medications , such as corticosteroids and cyclosporine , may be prescribed to treat severe eczema that has been unresponsive to treatment.
Since so many factors affect why a person develops eczema, a treatment plan that works for one person may not effectively control eczema in another person. Sometimes it takes a bit of detective work to find an effective treatment plan.