What are Eczema and Dermatitis?
Eczema and dermatitis are general terms for conditions where the skin becomes inflamed, presenting various symptoms such as itching, redness, blisters, and peeling. While both are broadly referred to as "eczema," their causes and treatments are entirely different, making accurate diagnosis the first step in treatment.
If left untreated or if steroids are stopped on one's own initiative, the condition can become chronic, prolonging the treatment period. Since our clinic has both internal medicine and dermatology departments, we provide a comprehensive diagnosis, considering the patient's overall health.
Even if they look similar, the treatments are completely different
Atopic dermatitis, contact dermatitis, seborrheic dermatitis, nummular eczema, and pompholyx, for example, may look similar, but their causes and treatments differ. Self-diagnosing and using over-the-counter medications can sometimes worsen the condition.
Main Types of Eczema and Dermatitis
Atopic Dermatitis
| Item | Content |
|---|---|
| Characteristics | Symmetrical, often on flexor surfaces, chronic course (6 months or more) |
| Background | Impaired barrier function + overactive immune response |
| Common Sites | Inner elbows, behind the knees, neck, face |
| Treatment | Moisturizing + topical steroids, tacrolimus, JAK inhibitor topical (Corectim), PDE4 inhibitor topical (Moizerto), biologics for severe cases (e.g., Dupixent) |
Contact Dermatitis
| Item | Content |
|---|---|
| Characteristics | Occurs only where the causative substance touched, clearly demarcated |
| Causes | Metals, cosmetics, hair dye, plants, detergents, rubber, bandages |
| Types | Irritant (anyone can develop) / Allergic (sensitization required) |
| Treatment | Removal of causative substance + topical steroids, patch test for refractory cases |
Seborrheic Dermatitis
- Areas with many sebaceous glands (scalp, eyebrows, sides of nose, chest, back)
- Redness and yellowish, flaky scales
- Involvement of a commensal fungus called Malassezia
- Worsened by stress and fatigue
- Treatment: Antifungal topical agents (ketoconazole) + mild steroids
Nummular Eczema
- Coin-shaped (several cm in diameter) eczema with intense itching
- Especially common on the lower limbs, often in individuals with dry skin
- Treatment: Moisturizing + topical steroids, tends to become chronic
Asteatotic Eczema (Dry Skin)
- Reduced skin barrier due to aging and dryness
- Common on lower legs and waist, worsens in winter
- Peeling skin that looks like powder
- Treatment: Mainly moisturizers + steroids if itching is severe
Pompholyx / Dyshidrotic Eczema
- Small blisters on the palms, sides of fingers, and soles of feet
- Worsens in spring to summer, stress-related
- Treatment: Topical steroids + moisturizing, aluminum topical for refractory cases
Psoriasis
- Red skin lesions with thick, silvery scales
- Common on the scalp, elbows, knees, and lower back
- May be accompanied by nail deformities and arthritis
- Treatment: Topical vitamin D3, steroids, phototherapy, biologics for severe cases (referral to specialist institution)
Distinguishing Eczema and Dermatitis
| Characteristic | Suspected Condition |
|---|---|
| Severe itching, symmetrical, flexor surfaces | Atopic Dermatitis |
| Clearly demarcated, only on touched areas | Contact Dermatitis |
| Scalp, sides of nose, yellow scales | Seborrheic Dermatitis |
| Coin-shaped eczema, lower limbs | Nummular Eczema |
| Blisters on hands and feet | Pompholyx |
| Thick, silvery scales | Psoriasis |
| Annular redness, central clearing | Tinea (KOH test required) |
| Nighttime itching, linear lesions between fingers | Scabies |
| Wheals, disappear within 24 hours | Urticaria |
Correct Use of Topical Steroids
5 Ranks of Strength
| Rank | Example | Main Uses |
|---|---|---|
| I. Strongest | Dermovate | Palms, soles of feet, stubborn eczema |
| II. Very Strong | Antebate, Myzer | Severe eczema on trunk and limbs |
| III. Strong | Rinderon V, Boala | General eczema on trunk and limbs |
| IV. Moderate | Rocoid, Almeta | Face, children, delicate areas |
| V. Weak | Kindavate | Infants, very mild symptoms |
Use the appropriate amount with FTU (Fingertip Unit)
The amount of cream squeezed from a tube from the tip of the index finger to the first crease (approx. 0.5g) is a guideline for covering an area the size of two adult palms. Applying a "thin layer" is not effective. If the necessary amount is not applied, healing will be slow, and as a result, the usage period will be prolonged.
Side Effects of Steroids and Their Reality
- Local side effects: Skin atrophy, telangiectasia, acne induction, hypopigmentation (with long-term use)
- Systemic side effects: Rarely occur with typical topical doses
- Weaker ranks are used for the face and genitals due to increased susceptibility to side effects
- The frequency and severity of side effects differ significantly from oral steroids
The misconception that "steroids are scary"
When used correctly, topical steroids are very safe and effective medications. The rule is to "use a stronger one quickly to treat it in a short period if it worsens." Hesitating and using it halfway out of fear can lead to prolonged use, which is a paradox.
Tacrolimus Ointment and New Topical Medications
The options have expanded for areas where steroids are difficult to use, such as the face and neck, and for cases where steroid side effects are to be avoided.
| Medication | Characteristics |
|---|---|
| Tacrolimus ointment (Protopic) | Immunosuppressant, for facial eczema, can be used long-term |
| Delgocitinib ointment (Corectim) | JAK inhibitor, for atopic dermatitis in patients 2 years and older |
| Difamilast ointment (Moizerto) | PDE4 inhibitor, when steroid side effects are to be avoided |
New Treatments for Severe Atopic Dermatitis
For moderate to severe atopic dermatitis that does not improve with conventional topical treatments, the options for systemic therapy have significantly increased.
| Medication | Administration | Characteristics |
|---|---|---|
| Dupilumab (Dupixent) | Subcutaneous injection (every 2 weeks) | IL-4/13 inhibitor, 12 years and older |
| Tralokinumab (Adtralza) | Subcutaneous injection | IL-13 inhibitor |
| Upadacitinib (Rinvoq) | Oral (JAK inhibitor) | 12 years and older, potent |
| Baricitinib (Olumiant) | Oral (JAK inhibitor) | 15 years and older |
| Abrocitinib (Cibinqo) | Oral (JAK inhibitor) | 12 years and older |
※ These treatments are administered in collaboration with specialized institutions, managing indications and side effects.
Moisturizers (Basic Skin Care)
Moisturizing is the most important basic step in eczema treatment. Continuing to moisturize even after inflammation subsides can prevent recurrence.
| Moisturizer | Characteristics |
|---|---|
| Heparinoid (Hirudoid) | Moisturizing + circulation improvement, lotion/cream/ointment |
| Vaseline (Propeto, White Vaseline) | Oily, forms a barrier, less irritating |
| Urea cream (Keratinamin, etc.) | Keratolytic moisturizer, for cracks and hard heels |
| Commercially available ceramide-containing products | Barrier function repair, for those with atopic diathesis |
Correct Use of Moisturizers
- Apply within 3 minutes after bathing (golden time)
- At least twice a day (morning and night)
- Apply generously (don't skimp on moisturizer)
- Okay to layer after topical steroids (no need for time difference)
- Apply to the entire affected area, not just avoiding inflamed parts
- Keep nails short to prevent scratching
Consult us for these symptoms
- Eczema that does not improve for more than 2 weeks
- Worsening condition after using over-the-counter medications
- Widespread redness, blisters, erosion
- Severe itching that prevents sleep or interferes with work
- Eczema on the face and wanting to avoid over-the-counter medications
- Recurrent urticaria and itching
- Wanting to discuss treatment strategies for child's atopic dermatitis
- Concerns about how to use steroids
Examinations and Tests at Our Clinic
Medical Interview and Visual Inspection
- When and where did the symptoms first appear?
- Changes in living environment (new cosmetics, detergents, clothing, pets)
- Association with diet, stress, season
- Medical history and family history (atopy, asthma, hay fever)
- Medications and supplements currently being taken
Tests
- Blood tests (TARC = atopic dermatitis severity index, total IgE, eosinophils)
- Allergy tests (View39, specific IgE)
- KOH direct microscopy (exclusion of tinea)
- Bacterial culture (in case of secondary infection)
- Patch test (identification of causative agent for contact dermatitis: referral to specialized institution)
Daily Life Tips
Basic Skin Care
- Do not over-wash (bathe once a day, wash gently)
- Lukewarm (38-40℃) short baths
- Choose mild soaps and body washes
- Pat dry gently with a towel, do not rub
- Apply plenty of moisturizer immediately after bathing
- Keep nails short to prevent scratching
Clothing and Environment
- Skin-friendly materials such as cotton and silk
- Avoid direct contact with wool and synthetic fibers
- Avoid excessive use of fabric softener
- Maintain indoor humidity at 50-60%
- Keep clean (bedding, towels)
Lifestyle Habits
- Sufficient sleep (stress and immune regulation)
- Balanced diet
- Stress management
- Moderate alcohol and irritants
Features of Eczema and Dermatitis Treatment at Our Clinic
- Wide range of conditions covered, including atopic dermatitis, contact dermatitis, and seborrheic dermatitis
- Topical steroids are appropriately prescribed considering rank and body area
- Also handles new topical medications such as tacrolimus, delgocitinib, and difamilast
- Referral to institutions capable of treating severe atopic dermatitis with Dupixent and JAK inhibitors
- Identification of causative agents through allergy tests (View39, specific IgE)
- Selection of moisturizers and skin care guidance
- Internal medicine department allows for checking the involvement of systemic diseases
- No appointment necessary, same-day visits OK / Open daily from 9 AM to 9 PM / 1-minute walk from Jujo Station
Consult before it becomes chronic
Eczema is a condition that can be treated in a short period if appropriate treatment is started early. Don't give up with the thought "it will just recur," but aim for remission with correct treatment.
