Eczema and Atopic Dermatitis Management
Eczema Management provides specialist dermatological care combining optimal emollient therapy, topical anti-inflammatories, and advanced biologic treatments to achieve clear skin, break the itch-scratch cycle, and restore quality of life in patients with moderate to severe atopic dermatitis.
Overview
Atopic dermatitis affects 15 to 20% of children and 2 to 3% of adults. Management uses a stepwise approach from regular emollients as the irreplaceable foundation through topical corticosteroids, phototherapy, and systemic therapy. Dupilumab -- an IL-4/IL-13 biologic -- has transformed severe AD achieving EASI 75 response in over 70% of patients. JAK inhibitors abrocitinib and upadacitinib offer additional options for severe disease.
Treatment Stepladder
- Step 1 (Mild -- regular emollients, avoid triggers, mild TCS for flares)
- Step 2 (Moderate -- moderate-potency TCS or tacrolimus/pimecrolimus)
- Step 3 (Severe -- potent TCS, wet-wrap therapy, consider phototherapy)
- Step 4 (Severe refractory -- dupilumab, tralokinumab, abrocitinib, upadacitinib)
- Rescue therapy (short-course oral prednisolone for severe acute flares)
- Proactive therapy (twice-weekly maintenance TCS on previously affected areas)
- Allergen testing (for food allergy assessment in infants and suspected contact allergy)
- Eczema action plan (written flare guide for every patient)
Common Eczema Triggers
- Irritants (soaps, detergents, fragrance, rough fabrics, excessive heat)
- Aeroallergens (house dust mite, animal dander, grass and tree pollen)
- Food allergens in infants (milk, egg, wheat, soy, peanut)
- Staphylococcus aureus colonisation triggering and worsening flares
- Stress and psychological factors
- Hard water in the home
- Contact allergens identified by patch testing
- Hormonal factors -- cyclical perimenstrual flares
Eczema Symptoms Requiring Specialist Assessment
- Eczema not controlled by prescribed topical therapies and emollients
- Sleep disturbance most nights from itch affecting daily function
- Recurrent skin infections suggesting poor baseline control
- EASI score above 16 indicating severe disease
- Eczema affecting face, eyelids, or hands causing significant impairment
- Consideration for biologic or JAK inhibitor therapy
- Food allergy investigation in infants with severe eczema
- Failure of phototherapy or systemic immunosuppression
Key Benefits
Discover the advantages of choosing our eczema and atopic dermatitis management services.
Dupilumab achieves EASI 75 in over 70% of severe AD patients within 16 weeks
Correct liberal emollient technique provides the skin barrier restoration that prevents flares
Topical calcineurin inhibitors provide effective steroid-free facial eczema management
Early identification and treatment of skin infection prevents the most common flare trigger
Patch testing identifies contact allergen contributions that can be cured by avoidance alone
Clinical Features
The technology, techniques and clinical approach behind our eczema and atopic dermatitis management.
EASI and itch NRS scored at every appointment -- objective severity measures for treatment decisions
Emollient application technique corrected at every appointment
Calcineurin inhibitors used on face and flexures where long-term potent TCS is inappropriate
Dupilumab requires formal severity documentation confirming eligibility
Eczema herpeticum recognition and urgent antiviral treatment prevents potentially fatal complication
Preparation Instructions
Apply emollients at least twice daily within 3 minutes of bathing to lock in moisture -- this is the single most important daily intervention. Avoid known triggers consistently. Contact your dermatologist for any suspected skin infection as infected eczema requires prompt antibiotic treatment. Take dupilumab injections on schedule and attend all monitoring appointments.
The Procedure
Step-by-step guide to what you can expect during your eczema and atopic dermatitis management procedure.
EASI Score and Itch Assessment
The Eczema Area and Severity Index (EASI) scores eczema extent and severity in four body regions. Itch NRS and sleep disruption are recorded at every appointment providing objective severity measures for systemic therapy eligibility.
Emollient Technique and Quantity Review
Emollient application technique is assessed at every appointment -- most patients apply insufficient quantities (300 to 500g weekly minimum for adults). Correct liberal emollient application is the single most important daily intervention.
Topical Corticosteroid and Calcineurin Inhibitor Guidance
The appropriate TCS potency for the body site and severity is reviewed. Calcineurin inhibitors (tacrolimus pimecrolimus) are used for face and flexures where potent TCS should not be used long-term.
Dupilumab Eligibility Assessment
Dupilumab eligibility requires EASI above 16 SCORAD above 50 or DLQI above 10 plus failure of topical therapies and systemic immunosuppression. Pre-treatment blood tests and baseline photographs are taken.
Skin Infection Management
Staphylococcus aureus colonisation triggers flares. Bacterial impetiginisation requires systemic antibiotics. Eczema herpeticum requires urgent oral or IV aciclovir. Regular bleach baths reduce staphylococcal colonisation.
Allergen Avoidance and Trigger Identification
Patch testing is arranged for suspected contact allergy in chronic hand or facial eczema. House dust mite reduction measures benefit a subset of AD patients with confirmed mite sensitisation.
What to Expect
Your dermatologist calculates EASI score and DLQI to assess severity and quality of life impact. Topical treatment technique is reviewed -- many patients apply insufficient emollient quantities. Systemic therapy eligibility is assessed. Dupilumab or JAK inhibitor is initiated when criteria are met with pre-treatment infection screening.
Frequently Asked Questions
Common questions about eczema and atopic dermatitis management.
Related Services
Explore other services in our Dermatology department.
Psoriasis Management
Skin Lesion Assessment and Biopsy
Acne Vulgaris Management
Ready to Get Started?
Schedule your consultation today and take the first step towards better health.