Topical corticosteroid creams treat the inflammation of an eczema flare effectively - reducing redness, itch, and skin inflammation during the acute phase - but they do not address the allergen or trigger that caused the flare to occur. When eczema recurs repeatedly after the cream has cleared the flare, the question is what is causing the flares, not whether the cream is working. The most important addition to the management of recurrent eczema flares is trigger identification. The common triggers that allergy evaluation reveals are: food allergy, particularly to egg, milk, wheat, and tree nuts in children, and shellfish, tree nuts, and wheat in adults, where the food-eczema connection is often not recognised because the flare does not occur immediately after eating; environmental allergen contact, where house dust mite and cockroach sensitisation in Chennai's environment produces persistent skin inflammation that topical treatment controls only temporarily; and contact allergy to specific ingredients in skin care products, including preservatives, fragrances, and emulsifiers in topical preparations - including, sometimes, ingredients in the very products being used to manage the eczema. Patch testing identifies contact allergens. Skin prick testing and specific IgE identifies food and environmental allergens. The management plan after trigger identification is specific: remove the identified trigger from the diet or environment, optimise emollient use to restore the skin barrier that eczema disrupts, use topical anti-inflammatory treatment as needed, and treat any identified environmental sensitisation with appropriate avoidance measures. Identifying the trigger is the step that turns recurrent eczema into a controllable condition.
Written by Dr. Janani Marianne A, MS ENT, DNB ENT, Consultant ENT Surgeon and Allergy Disorders Specialist, Fellowship in Allergy, Asthma and Immunotherapy, Fellowship in Rhinology, Sri Hospitals, Tondiarpet and Royal Pearl ENT Clinic and Hospital, Thiruvanmiyur, Chennai. Fluent in English, Telugu, Tamil, and German. 10 years clinical experience. Phone: +91 9626482592.
