Walking into a dermatologist’s office with eczema for the first time can feel overwhelming — especially if you’ve spent months or years trying over-the-counter creams without consistent relief. Understanding how a dermatologist approaches eczema diagnosis and treatment can help you get the most from your consultation and feel more confident about your care.
Here’s an inside look at how our dermatologists at the Baner and Aundh clinics in Pune assess and treat eczema patients.
Step 1: Proper Diagnosis and Severity Grading
Not all itchy, red skin is eczema. Dermatologists distinguish between atopic dermatitis, contact dermatitis, seborrhoeic dermatitis, and other inflammatory skin conditions before prescribing treatment. A thorough history — including family history of atopy, allergy testing where relevant, and assessment of your triggers, lifestyle, and previous treatments — guides the diagnosis. Severity is graded (mild, moderate, severe) using validated tools like the EASI or SCORAD index, which determines the treatment approach.
Step 2: Prescription Topical Therapy
For mild-to-moderate eczema, topical treatments remain the cornerstone. Corticosteroids are prescribed in the correct potency for each body area — lower potency for the face and skin folds, higher potency for the trunk and limbs. The ‘step-up, step-down’ approach is used: starting with what’s needed to control the flare, then stepping down to the least potent agent that maintains clear skin. Newer non-steroidal topical agents like tapinarof and ruxolitinib cream are proving effective alternatives for patients who are steroid-averse or have sensitive-zone involvement.
Step 3: Barrier Repair as the Foundation
Dermatologists universally emphasise that moisturisation is not optional — it is part of the treatment protocol. A prescription-grade or dermatologist-recommended emollient is chosen based on the patient’s skin type, severity, and climate. In Pune’s hot, humid summers, lighter emulsions may be preferred, while richer ointments are recommended during dry winter months. Patients are educated on the ‘soak and seal’ method: bathe in lukewarm water, pat (don’t rub) dry, apply topical medication, and immediately apply emollient on top.
Step 4: Allergy and Patch Testing
For patients whose eczema does not respond adequately to standard treatment, or whose flares seem linked to specific environments or products, patch testing is recommended. This involves applying a panel of common allergens to the back and reading results at 48 and 96 hours. Identifying contact allergens — such as nickel, fragrances, preservatives, or rubber compounds — allows patients to make targeted lifestyle changes that significantly reduce their flare burden.
Step 5: Systemic and Biologic Therapy for Severe Cases
For patients with moderate-to-severe eczema that has not responded to topical treatments, dermatologists may recommend systemic therapy. Traditional options include cyclosporine, methotrexate, and oral corticosteroids (for short-term flare control). The most significant advance in recent years is dupilumab — a biologic injection that specifically targets the inflammatory pathways responsible for eczema. Dupilumab has shown remarkable efficacy in clinical trials, with many patients achieving near-complete clearance. It is now available in India and is transforming severe eczema management at specialist clinics in Pune.
Follow-Up and Long-Term Management
Eczema is a chronic condition that requires ongoing management, not just treatment of individual flares. Dermatologists schedule regular follow-ups to assess treatment response, adjust therapy, and counsel patients on evolving triggers. Many patients benefit from a written ‘action plan’ that tells them exactly what to do when a flare starts — which medication to apply, for how long, and when to call the clinic. This proactive approach dramatically reduces hospitalisation, antibiotic use, and the psychological burden of living with unpredictable flares.