Skin problems health centre

Understanding eczema - diagnosis and treatment

How is eczema diagnosed?

To diagnose eczema, your GP will first talk to you about your symptoms and medical history. He or she will also ask about your family's history of rashes and other allergy-related medical conditions, such as asthma and hayfever. While there is no single test to effectively diagnose eczema, a good medical history combined with an examination of your skin is usually adequate.

What are the treatments for eczema?

Good skin care is a key component in controlling eczema. Proper care of the skin can often be enough in many milder cases.

In treating eczema, most doctors will start patients on basic therapies. A good moisturiser (in cream, lotion or ointment form) helps conserve the skin's natural moisture and should be applied immediately after showering or bathing and at least one other time each day. It is also a useful technique to apply them little and often and not vigorously rub them in. They should be applied following the line of the hairs on the skin.

Corticosteroid creams and ointments have been used for many years to treat eczema. Your GP may recommend application of over-the-counter hydrocortisone cream in mild cases but will often prescribe a stronger steroid cream when the eczema is more severe. When other measures fail, the doctor may prescribe oral corticosteroid medication; steroids should always be taken with caution and never without medical supervision. Antihistamines are sometimes used with moderate to severe flare ups. If strong topical steroids, oral steroids, antihistamines and loads of applications of emollients don’t work, a referral to a dermatologist may be needed.

Newer medicines called topical immunomodulators are available to help treat eczema. These medicines help control inflammation and reduce immune system reactions when applied to the skin. Examples include pimecrolimus and tacrolimus. These medicines are thought to be as effective as topical corticosteroids.

However, the National Institute for Health and Clinical Excellence (NICE) says that neither pimecrolimus nor tacrolimus are recommended for the treatment of mild atopic eczema or as first-line treatments for atopic eczema of any severity. NICE guidelines say that tacrolimus and pimecrolimus are only recommended as an option for the second-line treatment of eczema and only for people over the age of two.