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Eczema (cont.)

What Types of Doctors Treat Eczema?

Most eczema can be managed by primary-care physicians (family practice, pediatrics, or internal-medicine doctors). Dermatologists may be consulted when either the diagnosis is in doubt, patients are not responding to treatments that should be working, or higher-risk medications and long-term systemic medications may be needed to get adequate control of the disease.

When seeing a physician, it is important that they know of everything (prescription and over-the-counter drugs, and home remedies) that has been tried and which things helped and which did not. As it is normal for eczema to come and go depending upon many factors, a photo taken to show things at their best or worst may also be useful to the physician.

How Do Health-Care Professionals Diagnose Eczema?

A medical professional can usually identify the type of eczematous dermatitis by looking at the rash and asking questions about how it appeared. Samples of scale from the rash may need to be examined microscopically to search for a fungus (ringworm). Occasionally, a portion of skin may be removed (a biopsy) to be examined by a pathologist, but this will not distinguish atopic dermatitis from allergic contact dermatitis. A baby with what appears to be eczema of the palms and soles may have scabies, which may be confirmed with a skin scraping.

Psoriasis will lead to scaly skin but only rarely shows the weeping commonly seen with eczema. Psoriasis also doesn't itch much if at all, and eczema seldom involves the scalp while psoriasis and seborrheic dermatitis often do. While it is possible to have more than one chronic skin condition at a time, it would be unusual to have very active psoriasis and very active atopic dermatitis in the same patient at the same time.

On lighter skin, active eczema is usually red and can leave discoloration as it improves. On dark skin, there may be a mixture of light and dark color changes to the skin during and after a flare. Not enough color (hypopigmentation) is common, but total lack of color (depigmentation) should suggest other conditions, such as vitiligo or discoid lupus.

The three key elements in identifying atopic dermatitis are

  • characteristic appearance and distribution of a chronic rash;
  • severe itching; and
  • atopy, or a personal or family tendency toward asthma and hay fever.
Last Reviewed 11/20/2017
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